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According to current guidelines, only clinical surveillance is recommended for patients with moderate aortic valve stenosis (AS), while aortic valve replacement may be considered in patients undergoing surgery for other indications. Recent studies have shown that moderate AS is associated with a high risk of adverse cardiovascular events, including death, especially in patients with left ventricular dysfunction. In this context, multimodality imaging can help to improve the accuracy of moderate AS diagnosis and to assess left ventricular remodeling response. This review discusses the natural history of this valve disease and the role of multimodality imaging in the diagnostic process, summarizes current evidence on the medical and non-medical management, and highlights ongoing trials on valve replacement. [ABSTRACT FROM AUTHOR]

Aims Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist but the diagnosis of CA in AS patients remains a diagnostic challenge. We aim to evaluate the echocardiographic parameters that may aid in the detection of the presence of CA in AS patients. Method and results We performed a systematic literature search of electronic databases for peer-reviewed articles from inception until 10 January 2022. Of the 1449 patients included, 160 patients had both AS–CA whereas the remaining 1289 patients had AS-only. The result of our meta-analyses showed that interventricular septal thickness [standardized mean difference (SMD): 0.74, 95% CI: 0.36–1.12, P  = 0.0001), relative wall thickness (SMD: 0.74, 95% CI: 0.17–1.30, P  < 0.0001), posterior wall thickness (SMD: 0.74, 95% CI 0.51 to 0.97, P  = 0.0011), LV mass index (SMD: 1.62, 95% CI: 0.63–2.62, P  = 0.0014), E/A ratio (SMD: 4.18, 95% CI: 1.91–6.46, P  = 0.0003), and LA dimension (SMD: 0.73, 95% CI: 0.43–1.02, P  < 0.0001)] were found to be significantly higher in patients with AS–CA as compared with AS-only patients. In contrast, myocardial contraction fraction (SMD: −2.88, 95% CI: −5.70 to −0.06, P  = 0.045), average mitral annular S′ (SMD: −1.14, 95% CI: −1.86 to −0.43, P  = 0.0017), tricuspid annular plane systolic excursion (SMD: −0.36, 95% CI: −0.62 to −0.09, P  = 0.0081), and tricuspid annular S′ (SMD: −0.77, 95% CI: −1.13 to −0.42, P  < 0.0001) were found to be significantly lower in AS–CA patients. Conclusion Parameters based on echocardiography showed great promise in detecting CA in patients with AS. Further studies should explore the optimal cut-offs for these echocardiographic variables for better diagnostic accuracy. [ABSTRACT FROM AUTHOR]

The association between aortic stenosis (AS) and cardiac amyloidosis (CA) is more frequent than expected. Albeit rare, CA, particularly the transthyretin (ATTR) form, is commonly found in elderly people. ATTR-CA is also the most prevalent form in patients with AS. These conditions share pathophysiological, clinical and imaging findings, making the diagnostic process very challenging. To date, a multiparametric evaluation is suggested in order to detect patients with both AS and CA and choose the best therapeutic option. Given the accuracy of modern non-invasive techniques (i.e., bone scintigraphy), early diagnosis of CA is possible. Flow-charts with the main CA findings which may help clinicians in the diagnostic process have been proposed. The prognostic impact of the combination of AS and CA is not fully known; however, new available specific treatments of ATTR-CA have changed the natural history of the disease and have some impact on the decision-making process for the management of AS. Hence the relevance of detecting these two conditions when simultaneously present. The specific features helping the detection of AS-CA association are discussed in this review, focusing on the shared pathophysiological characteristics and the common clinical and imaging hallmarks. [ABSTRACT FROM AUTHOR]