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

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.