Aortic stenosis and cardiac amyloidosis cause similar functional and morphological changes in the heart, and discerning between the two conditions can be difficult. But in this European Heart Journal meta-analysis, researchers brought to light key differences in a large number of conventional echo criteria that can predict the presence of cardiac amyloidosis (CA) in aortic stenosis (AS) patients.
The authors reviewed observational data from 1,449 patients (160 AS-CA and 1,289 AS-only) and found that the following features were significantly higher in patients with AS-CA compared with AS-only patients:
- interventricular septal thickness (standardized mean difference: 0.74)
- relative wall thickness (SMD: 0.74)
- posterior wall thickness (SMD: 0.74
- LV mass index (SMD: 1.62)
- E/A ratio (SMD: 4.18)
- LA dimension (SMD: 0.73)
In contrast, these attributes were significantly lower in AS-CA patients:
- myocardial contraction fraction (SMD: −2.88)
- average mitral annular S′ (SMD: −1.14)
- tricuspid annular plane systolic excursion (SMD: −0.36)
- tricuspid annular S′ (SMD: −0.77)
As the study’s editorial put it, the authors have revealed a “fundamental principle.” Routine echocardiographic parameters may prove to be “the key” to spotting cardiac amyloidosis in the presence of aortic stenosis.