Transthyretin cardiac amyloidosis in aortic stenosis: Prevalence, diagnostic challenges, and clinical implications

• Main Authors: Giedre Balciunaite, Arnas Rimkus, Edvardas Zurauskas, Tomas Zaremba, Darius Palionis, Nomeda Valeviciene, Audrius Aidietis, Pranas Serpytis, Kestutis Rucinskas, Peter Sogaard, Sigita Glaveckaite, Aleksejus Zorinas, Vilius Janusauskas
• Format: Article
• Language: English
• Published: Elsevier 2020-03-01
• Series: Hellenic Journal of Cardiology
• Subjects: Aortic stenosis; Cardiac amyloidosis; Transthyretin
• Online Access: http://www.sciencedirect.com/science/article/pii/S1109966619302787

Transthyretin cardiac amyloidosis (ATTR-CA) is a challenging and underdiagnosed cause of heart failure. Advances in cardiac imaging have enabled noninvasive diagnosis of ATTR-CA, causing the recent upsurge in disease awareness and detection. ATTR-CA has been increasingly recognized in patients with degenerative aortic stenosis (AS). With the growing number of elderly patients undergoing aortic valve intervention, the identification of ATTR-CA in this group of patients is of high clinical importance. Timely and correct diagnosis is essential for amyloid-directed therapies, as well as deciding on the AS treatment strategy. This review provides a comprehensive overview of the recent studies investigating coexistence of these two entities. We present the data on the prevalence of ATTR-CA in AS and their prognostic associations. As the diagnosis of ATTR-CA may be challenging, special attention is paid to the diagnostic utility of different imaging modalities, namely, echocardiography, cardiovascular magnetic resonance, nuclear imaging, and distinctive imaging features, in patients with dual pathology. We also present a flowchart summarizing integrated imaging in patients with suspected ATTR-CA.