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Severe Aortic Stenosis and ATTRwt Amyloidosis – Beware in the Aging: A Case Report and Review of the Literature

Authors Adam R, Munteanu A, Mititelu R, Onciul S, Deleanu D, Iliescu VA, Popescu BA, Jurcut R

Received 12 June 2020

Accepted for publication 5 August 2020

Published 2 October 2020 Volume 2020:15 Pages 1863—1872


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

Robert Adam,1,2 Alice Munteanu,3 Raluca Mititelu,4 Sebastian Onciul,2,5 Dan Deleanu,1 Vlad Anton Iliescu,2,6 Bogdan A Popescu,1,2 Ruxandra Jurcut1,2

1Department of Cardiology, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania; 2“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 3Department of Cardiology, Emergency University Central Military Hospital, Bucharest, Romania; 4Department of Nuclear Medicine, Emergency University Central Military Hospital, Bucharest, Romania; 5Department of Cardiology, Clinical Emergency Hospital, Bucharest, Romania; 6Department of Cardiovascular Surgery, “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

Correspondence: Ruxandra Jurcut Email

Abstract: Degenerative aortic valve (AV) disease is the most frequent valvular heart disease slowly progressing to severe aortic stenosis (AS) which usually requires aortic valve replacement. Another frequent condition, especially among elderly people, is cardiac amyloidosis (CA), particularly the wild-type transthyretin cardiac amyloidosis (ATTRwt). Since both of these diseases are considered a marker of ageing, there is a significant proportion of elderly patients who associate both severe AS and CA. Recent studies reported a high prevalence of both severe AS and CA (AS-CA) in elderly patients referred for TAVR of 13– 16%, carrying a worse prognosis. The present case illustrates the diagnostic algorithm and the management of ATTRwt CA in an elderly patient with severe paradoxical low-flow low-gradient AS, accompanied by a review of the current literature about the red flags which help identifying CA in patients with severe AS, as well as the prognosis and management of these disease association.

Keywords: aortic stenosis, cardiac amyloidosis, wild-type ATTR, transcatheter aortic valve replacement, conduction disorders

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