ATTR Amyloidosis in Elderly Patients With Aortic Stenosis
ATTR Amyloidosis in Elderly Patients With Aortic Stenosis
Severe aortic stenosis is defined with a mean transvalvular pressure gradient (MTPG) > 40mmHg
 and a calculated aortic valve area of < 1cm2. However, a considerable proportion of patients
 do have a MTPG < 40mmHg due to a reduced stroke volume (stroke volume indexed to body surface
 area ≤ 35ml/m2) despite a normal left ventricular ejection fraction (LVEF > 50%). This entity
 is termed paradoxical low flow low gradient aortic stenosis (PLFLG AS) and is associated with
 a worse prognosis.

 ATTR amyloidosis is a disease of the elderly and might coexist in patients with severe aortic
 stenosis. Case reports and small observational studies suggest that senile ATTR amyloidosis
 could be frequent but underdiagnosed in patients with aortic stenosis. There is significant
 overlap between PLFLG AS and cardiac amyloidosis with regard to symptoms, increasing
 prevalence with age, concentric hypertrophy, impaired diastolic filling of the left ventricle
 (LV), as well as longitudinal LV dysfunction despite preserved ejection fraction - all
 features, which lead to a reduction in stroke volume, the underlying mechanism of the low
 flow condition as observed in PLFLG AS patients.
Inclusion Criteria:

 -  Symptomatic, severe aortic stenosis

 Exclusion Criteria:

 -  More than mild valvular disease of any other valve

 -  Other severe disease with a life expectancy < 1 year

 -  Participating in trial interfering with routine clinical practice or use of a non-CE
 marked device