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J Am Coll Cardiol. 2019 Nov 26;74(21):2638-2651. doi: 10.1016/j.jacc.2019.09.056.

Aortic Stenosis and Cardiac Amyloidosis: JACC Review Topic of the Week.

Author information

1
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada; Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology Department, APHP Henri Mondor Hospital, Créteil, France; INSERM Unit U955, Team 8, Paris-Est Creteil University, Val-de-Marne, Créteil, France.
2
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada; Cardiology Department, Centre d'Accueil et de Soins Hospitaliers, Hôpital Max Fourestier, Nanterre, France.
3
CHU Limoges, Hôpital Dupuytren, Service Cardiologie, and INSERM 1094, Faculté de médecine de Limoges, Limoges, France; King Faisal Specialist Hospital & Research Center, Heart Center, Riyadh, Saudi Arabia.
4
CHU Limoges, Hôpital Dupuytren, Service Cardiologie, and INSERM 1094, Faculté de médecine de Limoges, Limoges, France.
5
Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology Department, APHP Henri Mondor Hospital, Créteil, France; INSERM Unit U955, Team 8, Paris-Est Creteil University, Val-de-Marne, Créteil, France.
6
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada.
7
Cardiology Department, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
8
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada. Electronic address: philippe.pibarot@med.ulaval.ca.

Abstract

The prevalence of calcific aortic stenosis (AS) and of cardiac amyloidosis (CA) increases with age, and their association is not uncommon in the elderly. The identification of CA is particularly challenging in patients with AS because these 2 conditions share several features. It is estimated that ≤15% of the AS population and ≤30% of the subset with low-flow, low-gradient pattern may have CA. In patients with AS, CA is associated with increased risk of heart failure, mortality, and treatment futility with aortic valve replacement. In case of suspicion of CA, it is thus crucial to confirm the diagnosis to guide therapeutic management of AS and eventually implement recently developed pharmacological treatment dedicated to transthyretin amyloidosis. Given the high surgical risk of patients with AS and concomitant CA, transcatheter aortic valve replacement may be preferred to surgery in these patients.

KEYWORDS:

Doppler echocardiography; aortic stenosis; cardiac amyloidosis; heart failure; surgical aortic valve replacement; tafamidis; transcatheter aortic valve replacement; transthyretin

PMID:
31753206
DOI:
10.1016/j.jacc.2019.09.056

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