Practical recommendations for the diagnosis and management of transthyretin cardiac amyloidosis.
Vasiliki BistolaJohn ParissisEmmanouil FoukarakisPipitsa N ValsamakiAris AnastasakisGeorgios KoutsisGeorgios EfthimiadisEfstathios KastritisPublished in: Heart failure reviews (2021)
Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by accumulation in the heart interstitium of amyloid fibrils formed by misfolded proteins. Most common CA types are light chain amyloidosis (AL) caused by monoclonal immunoglobulin light chains and transthyretin amyloidosis (ATTR) caused by either mutated or wild-type transthyretin aggregates. Previously considered a rare disease, CA is increasingly recognized among patients who may be misdiagnosed as undifferentiated heart failure with preserved ejection fraction (HFPEF), paradoxical low-flow/low-gradient aortic stenosis, or otherwise unexplained left ventricular hypertrophy. Progress in diagnosis has been due to the refinement of cardiac echocardiographic techniques (speckle tracking imaging) and magnetic resonance (T1 mapping) and mostly due to the advent of bone scintigraphy that has enabled noninvasive diagnosis of ATTR, limiting the need for endomyocardial biopsy. Importantly, proper management of CA starts from early recognition of suspected cases among high prevalence populations, followed by advanced diagnostic evaluation to confirm diagnosis and typing, preferentially in experienced amyloidosis centers. Differentiating ATTR from other types of amyloidosis, especially AL, is critical. Emerging targeted ATTR therapies offer the potential to improve outcomes of these patients previously treated only palliatively.
Keyphrases
- left ventricular
- wild type
- aortic stenosis
- ejection fraction
- multiple myeloma
- magnetic resonance
- heart failure
- aortic valve replacement
- cardiac resynchronization therapy
- mitral valve
- newly diagnosed
- transcatheter aortic valve implantation
- end stage renal disease
- transcatheter aortic valve replacement
- protein kinase
- hypertrophic cardiomyopathy
- chronic kidney disease
- risk factors
- acute myocardial infarction
- weight loss
- coronary artery disease
- pulmonary embolism
- ultrasound guided
- acute coronary syndrome
- computed tomography
- metabolic syndrome
- risk assessment
- bone regeneration
- glycemic control
- postmenopausal women
- soft tissue