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. 2016 Dec 14;37(47):3525-3531.
doi: 10.1093/eurheartj/ehw033. Epub 2016 Feb 22.

Aortic stenosis and transthyretin cardiac amyloidosis: the chicken or the egg?

Arnault Galat  1   2   3   4   5 , Aziz Guellich  1   2   3   4   5 , Diane Bodez  1   2   3   4   5 , Michel Slama  6 , Marina Dijos  7 , David Messika Zeitoun  8 , Olivier Milleron  8 , David Attias  9 , Jean-Luc Dubois-Randé  1   2   3   4   5 , Dania Mohty  10 , Etienne Audureau  1   2   4   5   11   12 , Emmanuel Teiger  1   2   3   4   5 , Jean Rosso  1   2   13 , Jean-Luc Monin  1   2   3   4   5 , Thibaud Damy  14   2   3   4   5
Affiliations

Aortic stenosis and transthyretin cardiac amyloidosis: the chicken or the egg?

Arnault Galat et al. Eur Heart J. .

Abstract

Background: Aortic stenosis (AS) and transthyretin cardiac amyloidosis (TTR-CA) are both frequent in elderly. The combination of these two diseases has never been investigated.

Aims: To describe patients with concomitant AS and TTR-CA.

Methods: Six cardiologic French centres identified retrospectively cases of patients with severe or moderate AS associated with TTR-CA hospitalized during the last 6 years.

Results: Sixteen patients were included. Mean ± SD age was 79 ± 6 years, 81% were men. Sixty per cent were NYHA III-IV, 31% had carpal tunnel syndrome, and 56% had atrial fibrillation. Median (Q1;Q4) NT-proBNP was 4382 (2425;4730) pg/mL and 91% had elevated cardiac troponin level. Eighty-eight per cent had severe AS (n = 14/16), of whom 86% (n = 12) had low-gradient AS. Mean ± SD interventricular septum thickness was 18 ± 4 mm. Mean left ventricular ejection fraction and global LS were 50 ± 13% and -7 ± 4%, respectively. Diagnosis of TTR-CA was histologically proven in 38%, and was based on strong cardiac uptake of the tracer at biphosphonate scintigraphy in the rest. Eighty-one per cent had wild-type TTR-CA (n = 13), one had mutated Val122I and 19% did not had genetic test (n = 3). Valve replacement was surgical in 63% and via transcatheter in 13%. Median follow-up in survivors was 33 (16;65) months. Mortality was of 44% (n = 7) during the whole follow-up period.

Conclusions: Combination of AS and TTR-CA may occur in elderly patients particularly those with a low-flow low-gradient AS pattern and carries bad prognosis. Diagnosis of TTR-CA in AS is relevant to discuss specific treatment and management.

Keywords: Aortic stenosis; Cardiac amyloidosis; Low-flow low-gradient; Transthyretin.

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