Author + information
- Received August 1, 2019
- Revision received September 13, 2019
- Accepted September 16, 2019
- Published online November 18, 2019.
- Julien Ternacle, MD, PhDa,b,c,
- Laura Krapf, MDa,d,
- Dania Mohty, MD, PhDe,f,
- Julien Magne, PhDe,
- Annabelle Nguyen, MDb,c,
- Arnault Galat, MDb,c,
- Romain Gallet, MD, PhDb,c,
- Emmanuel Teiger, MD, PhDb,c,
- Nancy Côté, PhDa,
- Marie-Annick Clavel, PhD, DVMa,
- François Tournoux, MDg,
- Philippe Pibarot, PhD, DVMa,∗ (, )@PPibarot and
- Thibaud Damy, MD, PhDb,c
- aInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
- bReferral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology Department, APHP Henri Mondor Hospital, Créteil, France
- cINSERM Unit U955, Team 8, Paris-Est Creteil University, Val-de-Marne, Créteil, France
- dCardiology Department, Centre d’Accueil et de Soins Hospitaliers, Hôpital Max Fourestier, Nanterre, France
- eCHU Limoges, Hôpital Dupuytren, Service Cardiologie, and INSERM 1094, Faculté de médecine de Limoges, Limoges, France
- fKing Faisal Specialist Hospital & Research Center, Heart Center, Riyadh, Saudi Arabia
- gCardiology Department, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada
- ↵∗Address for correspondence:
Dr. Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec G1V 4G5, Canada.
• CA may be present in ≤15% of patients with AS.
• Clinical and imaging “red flags” for CA should be systematically searched in patients with AS.
• Transcatheter rather than surgical AVR may be preferred in patients with CA.
• Recently developed pharmacological treatment for transthyretin CA should be instituted as soon as diagnosis is confirmed.
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.
- aortic stenosis
- cardiac amyloidosis
- Doppler echocardiography
- heart failure
- surgical aortic valve replacement
- transcatheter aortic valve replacement
Dr. Ternacle has received a fellowship grant from AREMCAR. Dr. Clavel has core laboratory contracts with Edwards Lifesciences, for which she receives no direct compensation; and has received a research grant from Medtronic. Dr. Tournoux has received consulting honorarium from Alnylam and Akcea. Dr. Pibarot holds the Canada Research Chair in Valvular Heart Diseases and a Foundation Scheme Grant (FDN-143225 from Canadian Institutes of Health Research); has received a grant from the Foundation of the Quebec Heart and Lung Institute; has echo core laboratory contracts with Edwards Lifesciences, for which he receives no direct compensation; and has a research contract with Medtronic. Dr. Damy has received consulting honorarium, research grants, and travel and congress funding from Pfizer, Alnylam, Ionis, Akcea, Sanofi, Prothena, and GlaxoSmithKline; and has received consultant honorarium from Neurimmune. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 1, 2019.
- Revision received September 13, 2019.
- Accepted September 16, 2019.
- 2019 American College of Cardiology Foundation
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