In clinical practice, when we approach an elderly patient with AS, especially if is a low-flow low-gradient one, we have to raise a suspicion for ATTRwt-CA after performing a careful clinical evaluation (bilateral carpal tunnel syndrome, hypotension or normotensive if previous hypertensive ECG pseudoinfarct pattern or low/decreased QRS voltage to the degree of LV thickness or AV conduction disease, disproportionally elevated NT-proBNP to the degree of HF, persisting elevated troponin levels) (67). This evidence concerns the gene NPPB and hydrops fetalis.