Implications of screening for coexisting transthyretin amyloidosis and aortic stenosis

In recent years, transthyretin cardiac amyloidosis (ATTR-CA) has transformed from a historically under-recognised disease to a crucial concern in cardiology driven by increased awareness, advent of non-invasive confirmatory algorithms using nuclear scintigraphy and development of effective pharmacological treatments. Approximately 25% of people over 85 years of age have ATTR deposition in the myocardium at autopsy, while severe aortic stenosis (AS) affects >3% of individuals over 75 years. On the background of an ageing population, with both wildtype ATTR-CA and AS highly prevalent in older adults, the coexistence of ATTR-CA with AS (AS-ATTR) is particularly pertinent to cardiologists.

Prior studies have demonstrated that 8%–16% of patients with severe AS have coexistent ATTR (AS-ATTR)1–5 (table 1). Case ascertainment for ATTR-CA in a cohort with AS can be challenging as the two disease entities share common features, including older age, increased left...