Beyond the valve: The long shadow of transthyretin amyloidosis in aortic stenosis

Aortic valve stenosis (AS) in older adults is increasingly managed as a procedural condition: define disease severity, replace the valve, and predict clinical recovery [1]. Yet, in a substantial proportion of patients, the myocardium tells a different story. Transthyretin amyloid cardiomyopathy (ATTR-CM) frequently coexists with AS, affecting hemodynamics, symptom burden and long-term outcomes [2]. Both conditions are strongly age-dependent, and their association is now recognized as more than coincidental. The critical question is no longer whether this dual pathology exists, but whether it is being systematically identified and managed with the same clarity and therapeutic intent routinely applied to the valve [3].