A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice
Aesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1323023/full |
| _version_ | 1797299313784651776 |
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| author | H. Sabbour H. Sabbour K. Al-Humood Z. Al Taha I. Romany H. Haddadin D. Mohty |
| author_facet | H. Sabbour H. Sabbour K. Al-Humood Z. Al Taha I. Romany H. Haddadin D. Mohty |
| author_sort | H. Sabbour |
| collection | DOAJ |
| description | Aesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly being identified as having concomitant cardiac amyloidosis, which is an underrecognized cause of common cardiac conditions. The presence of cardiac amyloidosis negatively affects the outcome of patients with aortic stenosis, these patients undergo transcatheter aortic valve replacement (TAVR) with increasing frequency and have a significantly higher overall mortality rate than patients with aortic stenosis alone. Although left ventricular wall hypertrophy is expected in patients with aortic stenosis, it should not be assumed that this is caused only by aortic stenosis. A suspicion of cardiac amyloidosis should be raised in patients in whom the degree of hypertrophy is disproportionate to the degree of aortic stenosis severity. The remodeling, age, injury, systemic, and electrical (RAISE) score was developed to predict the presence of cardiac amyloidosis in patients with severe aortic stenosis. This article highlights the value of increased clinical suspicion, demonstrates the use of the multiparameter RAISE score in daily clinical practice, and illustrates the scoring system with case studies. In elderly patients being considered for TAVR, systematic testing for cardiac amyloidosis should be considered as part of the preoperative workup. |
| first_indexed | 2024-03-07T22:48:45Z |
| format | Article |
| id | doaj.art-addcca6f50c8464780b09fb6953ee6f4 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-07T22:48:45Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-addcca6f50c8464780b09fb6953ee6f42024-02-23T12:01:53ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-02-011110.3389/fcvm.2024.13230231323023A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practiceH. Sabbour0H. Sabbour1K. Al-Humood2Z. Al Taha3I. Romany4H. Haddadin5D. Mohty6Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab EmiratesWarren Alpert School of Medicine, Brown University, Providence, RI, United StatesAdvanced Heart Failure and Transplantation Unit, Chest Disease Hospital, Kuwait City, KuwaitSheikh Shakhbout Medical City, Abu Dhabi, United Arab EmiratesPfizer Gulf FZ LLC, Dubai, United Arab EmiratesPfizer Gulf FZ LLC, Dubai, United Arab EmiratesHeart Center, King Faisal Specialist Hospital, Riyadh, Saudi ArabiaAesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly being identified as having concomitant cardiac amyloidosis, which is an underrecognized cause of common cardiac conditions. The presence of cardiac amyloidosis negatively affects the outcome of patients with aortic stenosis, these patients undergo transcatheter aortic valve replacement (TAVR) with increasing frequency and have a significantly higher overall mortality rate than patients with aortic stenosis alone. Although left ventricular wall hypertrophy is expected in patients with aortic stenosis, it should not be assumed that this is caused only by aortic stenosis. A suspicion of cardiac amyloidosis should be raised in patients in whom the degree of hypertrophy is disproportionate to the degree of aortic stenosis severity. The remodeling, age, injury, systemic, and electrical (RAISE) score was developed to predict the presence of cardiac amyloidosis in patients with severe aortic stenosis. This article highlights the value of increased clinical suspicion, demonstrates the use of the multiparameter RAISE score in daily clinical practice, and illustrates the scoring system with case studies. In elderly patients being considered for TAVR, systematic testing for cardiac amyloidosis should be considered as part of the preoperative workup.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1323023/fullaortic stenosisdiagnosiscardiac amyloidosislow-flow/low-gradientRAISE scoretransthyretin |
| spellingShingle | H. Sabbour H. Sabbour K. Al-Humood Z. Al Taha I. Romany H. Haddadin D. Mohty A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice Frontiers in Cardiovascular Medicine aortic stenosis diagnosis cardiac amyloidosis low-flow/low-gradient RAISE score transthyretin |
| title | A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice |
| title_full | A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice |
| title_fullStr | A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice |
| title_full_unstemmed | A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice |
| title_short | A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice |
| title_sort | wolf in sheep s clothing aortic stenosis and cardiac amyloidosis raise ing awareness in clinical practice |
| topic | aortic stenosis diagnosis cardiac amyloidosis low-flow/low-gradient RAISE score transthyretin |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1323023/full |
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