Cardiac amyloidosis mimicking severe aortic valve stenosis - a case report demonstrating diagnostic pitfalls and role of dobutamine stress echocardiography.
Aortic valve stenosis is a common finding diagnosed with high sensitivity in transthoracic echocardiography, but the examiner often finds himself confronted with uncertain results in patients with moderate pressure gradients and concomitant systolic heart failure. While patients with true-severe low-gradient aortic valve stenosis with either reduced or preserved left ventricular systolic function are primarily candidates for valve replacement, there is a relevant proportion of patients with pseudo-severe aortic valve stenosis anticipated not to benefit but actually rather deteriorate by interventional therapy or surgery.



In this article we present a case report of a male patient with pseudo-severe aortic valve stenosis due to cardiac amyloidosis highlighting the diagnostic schedule. The patient underwent stress echocardiography because of discrepant findings in transthoracic echocardiography and cardiac catheterization regarding the severity of aortic valve stenosis. After evaluation of the results, it became clear that he had a need for optimum heart failure medication and implantation of a cardiac resynchronization therapy defibrillator.



Due to the pitfalls in conventional as well as invasive diagnostics at rest, Stress echocardiography should be considered part of the standard optimum diagnostic spectrum in all unclear or borderline cases in order to confirm the correct diagnosis and constitute optimal therapy.
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.|Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.
Tim
T
Salinger
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.|Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.
Kai
K
Hu
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.|Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.
Dan
D
Liu
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.|Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.
Sebastian
S
Herrmann
Leibniz-Institut für Analytische Wissenschaften - ISAS, University Duisburg-Essen, Dortmund, Germany.
Kristina
K
Lorenz
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.|Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.
Georg
G
Ertl
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany. nordbeck_p@ukw.de.|Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany. nordbeck_p@ukw.de.|Medizinische Klinik und Poliklinik I - Kardiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany. nordbeck_p@ukw.de.
Peter
0000-0001-5156-3071
P
Nordbeck
D058665:Adrenergic beta-1 Receptor Agonists / Q000008:administration & dosage*; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging*; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004280:Dobutamine / Q000008:administration & dosage*; D025401:Echocardiography, Stress / Q000379:methods*; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D058665:Adrenergic beta-1 Receptor Agonists; D002316:Cardiotonic Agents; D004280:Dobutamine
Aortic valve stenosis (AS); Cardiac amyloidosis; Case report; Dobutamine stress echocardiography; Low-gradient AS; Pseudo-severe AS