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

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


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Amyloidosis / complications*
  • Amyloidosis / diagnostic imaging
  • Amyloidosis / epidemiology
  • Amyloidosis / therapy
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / pathology*
  • Aortic Valve Stenosis / complications*
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / therapy
  • Calcinosis / complications*
  • Calcinosis / diagnostic imaging
  • Calcinosis / therapy
  • Humans
  • Prevalence

Supplementary concepts

  • Aortic Valve, Calcification of