Amyloid Cardiopathy and Aortic Stenosis.

Cardiac amyloidosis (amyloid cardiomyopathy, CA) is an increasingly diagnosed condition which is most frequently seen in older patients with heart failure and preserved ejection fraction as well as in those with biventricular hypertrophies and tight aortic stenosis (AS). Almost 15% of patients with tight AS can also have CA ATTR, an element with diagnostic, prognostic and therapeutic significance. The CA diagnostic, associated with AS or not, is laborious and it should be made on the basis of determining the severity of the associated AS, depending on the case. The presence of both ventricular hypertrophy (≥15 mm) and red flags indicates a high suspicion of CA. Extra tests, bone scintigraphy and an absence of light free chains in blood or urine have a high specificity and sensitivity for diagnostic. Genetic investigations identify the senile or hereditary ATTR type. Pharmacologic treatment of CA with heart failure has some peculiarities, including stopping or careful usage of beta-blockers, non-dihydropyridine calcium blockers, and angiotensin system inhibitors. Diuretic treatment, which is almost always necessary, must preserve euvolemia. Replacing the aortic valves through transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is recommended in tight AS associated with CA. The comparative results between the two methods of AVR favor TAVR, although perioperative complications are more frequent when the latter is used. Ongoing comparative studies of TAVR versus SAVR could define the options. Lately, pharmacological agents targeting CA ATTR can significantly change the management of ATTR amyloidosis.