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Arora S, Patil NS, Strassle PD, Qamar A, Vaduganathan M, Fatima A, Mogili K, Garipalli D, Grodin JL, Vavalle JP, Fonarow GC, Bhatt DL, Pandey A. Amyloidosis and 30-Day Outcomes Among Patients With Heart Failure: A Nationwide Readmissions Database Study. JACC CardioOncol 2020; 2:710-718. [PMID: 34396285 PMCID: PMC8352138 DOI: 10.1016/j.jaccao.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The burden of amyloidosis among hospitalized patients is increasing over time. However, amyloidosis remains an underdiagnosed cause of heart failure (HF) hospitalization among older adults. OBJECTIVES We investigated the prevalence and prognostic implications of amyloidosis among patients hospitalized with HF. METHODS All hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015, identified in the Nationwide Readmissions Database were categorized into those with and without a secondary diagnosis of amyloidosis. HF hospitalizations with amyloidosis were then matched in a 3:1 fashion to HF hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes were inpatient mortality and 30-day readmission. Multivariable logistic regression was used to estimate the association between HF with amyloidosis and clinical outcomes. RESULTS Of 1,593,360 HF hospitalizations that met inclusion criteria, 2,846 (0.18%) had HF with a secondary diagnosis of amyloidosis and were matched to 8,515 hospitalizations for HF without amyloidosis. Hospitalizations for HF with amyloidosis were associated with higher prevalence of kidney disease (56% vs. 45%), malignancy (20% vs. 4%), and higher inpatient mortality (6% vs. 3%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis was associated with higher odds of in-hospital mortality (odds ratio: 1.46; 95% confidence interval [CI]: 1.17 to 1.82), 30-day readmission (odds ratio: 1.17; 95% CI: 1.05 to 1.31), and longer mean length of stay (least-squares mean difference: 1.46; 95% CI: 1.12 to 1.80). CONCLUSIONS In patients hospitalized with decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.
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Affiliation(s)
- Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nikita S. Patil
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paula D. Strassle
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Arman Qamar
- Cardiovascular Institute, NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, Illinois, USA
| | - Muthiah Vaduganathan
- Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amber Fatima
- Department of Internal Medicine, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Kalyan Mogili
- Department of Internal Medicine, Carolinas Medical Center, Monroe, North Carolina, USA
| | - Deepak Garipalli
- Department of Internal Medicine, Carolinas Medical Center, Monroe, North Carolina, USA
| | - Justin L. Grodin
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas, USA
| | - John P. Vavalle
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gregg C. Fonarow
- Division of Cardiology, UCLA Medical Center, Los Angeles, California, USA
| | - Deepak L. Bhatt
- Division of Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas, USA
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Recipe for Success in Transthyretin Cardiomyopathy: Monoclonal Protein Rule Out, SPECT Imaging, and Genetic Testing. JACC Cardiovasc Imaging 2020; 14:1232-1234. [PMID: 33221210 DOI: 10.1016/j.jcmg.2020.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 01/12/2023]
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Staron A, Connors LH, Zheng L, Doros G, Sanchorawala V. Race/ethnicity in systemic AL amyloidosis: perspectives on disease and outcome disparities. Blood Cancer J 2020; 10:118. [PMID: 33173025 PMCID: PMC7655813 DOI: 10.1038/s41408-020-00385-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023] Open
Abstract
In marked contrast to multiple myeloma, racial/ethnic minorities are underrepresented in publications of systemic light-chain (AL) amyloidosis. The impact of race/ethnicity is therefore lacking in the narrative of this disease. To address this gap, we compared disease characteristics, treatments, and outcomes across racial/ethnic groups in a referred cohort of patients with AL amyloidosis from 1990 to 2020. Among 2416 patients, 14% were minorities. Non-Hispanic Blacks (NHBs) comprised 8% and had higher-risk sociodemographic factors. Hispanics comprised 4% and presented with disproportionately more BU stage IIIb cardiac involvement (27% vs. 4-17%). At onset, minority groups were younger in age by 4-6 years. There was indication of more aggressive disease phenotype among NHBs with higher prevalence of difference between involved and uninvolved free light chains >180 mg/L (39% vs. 22-33%, P = 0.044). Receipt of stem cell transplantation was 30% lower in Hispanics compared to non-Hispanic White (NHWs) on account of sociodemographic and physiologic factors. Although the age/sex-adjusted hazard for death among NHBs was 24% higher relative to NHWs (P = 0.020), race/ethnicity itself did not impact survival after controlling for disease severity and treatment variables. These findings highlight the complexities of racial/ethnic disparities in AL amyloidosis. Directed efforts by providers and advocacy groups are needed to expand access to testing and effective treatments within underprivileged communities.
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Affiliation(s)
- Andrew Staron
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, USA
- Section of Hematology and Oncology, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, USA
| | - Lawreen H Connors
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, USA
| | - Luke Zheng
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA
| | - Gheorghe Doros
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, USA.
- Section of Hematology and Oncology, Boston University School of Medicine and Boston Medical Center, 1 Boston Medical Center Place, Boston, MA, USA.
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Spencer-Bonilla G, Alexander KM, Witteles RM. Advances in the Diagnosis and Management of Transthyretin Amyloid Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alexander KM, Jha A, Liao R. Decoding the Nanoenvironment in Cardiac Amyloidosis Through Proteomics. JACC CardioOncol 2020; 2:644-646. [PMID: 34396275 PMCID: PMC8352303 DOI: 10.1016/j.jaccao.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cuomo RE. Shift in racial communities impacted by COVID-19 in California. J Epidemiol Community Health 2020; 75:jech-2020-215148. [PMID: 33067251 DOI: 10.1136/jech-2020-215148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Since the first case of COVID-19 was recorded in California, the geospatial distribution of disease cases has fluctuated over time. Given documented racial disparities in other parts of the country, longitudinal convergence of COVID-19 rates around race groups warrants assessment. METHODS County-level cases for COVID-19 were collected from the Johns Hopkins University, and racial distributions were collected from the American Community Survey. Pearson's correlation coefficients were computed for each day since COVID-19 was first reported in California, and the longitudinal distribution of each race-specific set of correlation coefficients was assessed for stationarity, linear trend and exponential trend. RESULTS Earlier in the outbreak, the distribution of COVID-19 was most highly correlated with Asian American communities; after approximately 100 days, the distribution of COVID-19 most closely resembled that of African American communities. For every day in this dataset, the county-level distribution of COVID-19 was negatively correlated with the distribution of White American communities in California. DISCUSSION The geospatial distribution of COVID-19 in California has increasingly resembled that of African American communities within the state. Further study should be conducted to characterise potentially disproportionate impacts of the COVID-19 pandemic across race groups.
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Affiliation(s)
- Raphael E Cuomo
- University of California San Diego, La Jolla, California, USA
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Bianchi G, Kumar S. Systemic Amyloidosis Due to Clonal Plasma Cell Diseases. Hematol Oncol Clin North Am 2020; 34:1009-1026. [PMID: 33099420 DOI: 10.1016/j.hoc.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Immunoglobulin light chain amyloidosis is the most common systemic amyloidosis. The pathogenetic mechanism is deposition of fibrils of misfolded immunoglobulin free light chains, more often lambda, typically produced by clonal plasma cells. Distinct Ig light chain variable region genotypes underlie most light chain amyloidosis and dictate tissue tropism. Light chain amyloidosis fibrils cause distortion of the histologic architecture and direct cytotoxicity, leading to rapidly progressive organ dysfunction and eventually patient demise. A high index of clinical suspicion with rapid tissue diagnosis and commencement of combinatorial, highly effective cytoreductive therapy is crucial to avoid irreversible organ damage and early mortality.
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Affiliation(s)
- Giada Bianchi
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Shaji Kumar
- Myeloma, Amyloidosis, Dysproteinemia Group, Mayo Clinic, First Street Southwest, Rochester, MN 55904, USA.
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Vuong J, Singh A, Falk RH, Merchant R, Dorbala S. Geographic variation in public interest about amyloidosis in the United States and English speaking countries. Amyloid 2020; 27:210-212. [PMID: 32053019 DOI: 10.1080/13506129.2020.1724941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Avinainder Singh
- Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Raina Merchant
- University of Pennsylvania Center for Digital Health, Philadelphia, PA, USA
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Radiology, Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Gertz MA. Immunoglobulin light chain amyloidosis: 2020 update on diagnosis, prognosis, and treatment. Am J Hematol 2020; 95:848-860. [PMID: 32267020 DOI: 10.1002/ajh.25819] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 01/10/2023]
Abstract
DISEASE OVERVIEW Immunoglobulin light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin light or heavy chain are deposited in tissues. Clinical features depend on organs involved but can include heart failure with preserved ejection fraction, nephrotic syndrome, hepatic dysfunction, peripheral/autonomic neuropathy, and "atypical smoldering multiple myeloma or monoclonal gammopathy undetermined significance (MGUS)." DIAGNOSIS Tissue biopsy stained with Congo red demonstrating amyloid deposits with apple-green birefringence is required for diagnosis. Invasive organ biopsy is not required in 85% of patients. Verification that amyloid is composed of immunoglobulin light chains is mandatory. The gold standard is laser capture mass spectroscopy. PROGNOSIS N-terminal pro-brain natriuretic peptide (NT-proBNP), serum troponin T, and difference between involved and uninvolved immunoglobulin free light chain (FLC) values are used to classify patients into four groups of similar size; median survivals are 94.1, 40.3, 14.0, and 5.8 months. THERAPY All patients with a systemic amyloid syndrome require therapy to prevent deposition of amyloid in other organs and prevent progressive organ failure. Stem cell transplant (SCT) is preferred, but only 20% of patients are eligible. Requirements for safe SCT include systolic blood pressure >90 mmHg, troponin T < 0.06 ng/mL and serum creatinine ≤1.7 mg/dL. Nontransplant candidates can be offered cyclophosphamide-bortezomib-dexamethasone or daratumumab-containing regimens as it appears to be highly active in AL amyloidosis. FUTURE CHALLENGES Delayed diagnosis remains a major obstacle to initiating effective therapy prior to the development of end-stage organ failure.
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Affiliation(s)
- Morie A. Gertz
- Division of HematologyMayo Clinic Rochester Minnesota USA
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Abe T, Chang EY, De Allie G, Ajose T, Nwokike C, Bakinde N. Rapid decline in ejection fraction and persistent elevation of troponin associated with cardiac amyloidosis. SAGE Open Med Case Rep 2020; 8:2050313X20923259. [PMID: 32547758 PMCID: PMC7249551 DOI: 10.1177/2050313x20923259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/05/2020] [Indexed: 01/15/2023] Open
Abstract
Cardiac amyloidosis is an increasingly recognized cause of heart failure. It remains underdiagnosed despite a significant morbidity and mortality rate. The mean survival in patients with cardiac amyloidosis is less than 1 year in untreated primary light-chain amyloidosis and less than 4 years in wild-type transthyretin amyloidosis. We report a unique case of a 78-year-old male with transthyretin cardiac amyloidosis, who presented with persistently elevated troponin and progressive heart failure unresponsive to conventional therapy. With this case, we would like to highlight the role of cardiac biomarkers in the early diagnosis of cardiac amyloidosis.
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Affiliation(s)
| | | | | | - Taiwo Ajose
- Morehouse School of Medicine, Atlanta, GA, USA
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Bone Scintigraphy Imaging for Transthyretin Cardiac Amyloidosis. JACC Cardiovasc Imaging 2020; 13:1322-1324. [DOI: 10.1016/j.jcmg.2019.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 01/15/2023]
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Porcari A, Falco L, Lio V, Merlo M, Fabris E, Bussani R, Sinagra G. Cardiac amyloidosis: do not forget to look for it. Eur Heart J Suppl 2020; 22:E142-E147. [PMID: 32523459 PMCID: PMC7270903 DOI: 10.1093/eurheartj/suaa080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Amyloidosis is a systemic disease due to buildup of protein material in the extracellular space, which can affect the heart, mainly in its light chain and transtyretin forms. Historically this condition has been considered very uncommon, and it was certainly under-diagnosed. Today is well known that in certain group of patients its prevalence is, indeed, very high (25% in patients over the age of 80 years; 32% in patients over 75 years with heart failure and preserved systolic function, and 5% in post-mortem series of hypertrophic cardiomyopathy). Some genetically determined form of transthyretin amyloidosis are quite common in certain populations, such as Caribbean origin African-Americans. The wide spectrum of signs, symptoms, and first-level tests often overlapping among various other conditions, represent a diagnostic challenge for the clinical cardiologist. The opportunity to reach the diagnosis with non-invasive testing (first and foremost scintiscan with bone markers), as well as encouraging results of newer classes of drugs, raised the interest in this condition, so far burdened by an ominous prognosis. Early diagnosis of amyloidosis should always be guided by clinical suspicion but should also be supported by a multidisciplinary approach, aimed at optimizing the prognosis of the condition. Despite the newer drugs now available, a late diagnosis affect negatively the prognosis, and the opportunity to implement disease-modifying therapies (e.g. liver transplant in ATTR, or bone marrow transplant in AL) able to cure or at least delay the progression of the disease.
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Affiliation(s)
- Aldostefano Porcari
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - Luca Falco
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - Veronica Lio
- Division of Clinical Cardiology, Azienda Ospedaliera Universitaria 'Maggiore della Carità', Novara, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - Rossana Bussani
- Pathology Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste (ASUITS), Trieste, Italy
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Abstract
Light chain amyloidosis is a deadly disease in which a monoclonal plasma cell dyscrasia produces misfolded immunoglobulin light chains (AL) that aggregate and form rigid amyloid fibrils. The amyloid deposits infiltrate one or more organs, leading to injury and severe dysfunction. The degree of cardiac involvement is a major driver of morbidity and mortality. Early diagnosis and treatment are crucial to prevent irreversible end-organ damage and improve overall survival. Treatment of AL cardiac amyloidosis involves eliminating the underlying plasma cell dyscrasia with chemotherapy and pursuing supportive heart failure management.
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Staron A, Connors LH, Ruberg FL, Mendelson LM, Sanchorawala V. A new era of amyloidosis: the trends at a major US referral centre. Amyloid 2019; 26:192-196. [PMID: 31306033 DOI: 10.1080/13506129.2019.1640672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To characterize the changing spectrum of amyloidosis classes, as well as patient demographics, at a major US referral centre. Patients and methods: A retrospective analysis was conducted of all referrals to the Amyloidosis Centre at Boston University and Boston Medical Centre over the last 3 decades. Results: A total of 3987 new patients with amyloidosis were evaluated between 1990 and 2018 with the average number of new cases per year increasing 2.5-fold during this period. Systemic immunoglobulin light-chain (AL) amyloidosis decreased in proportion with each decade from 77% to 69% to 50% of new cases. Meanwhile, ATTR amyloidosis increased from 12% to 16% to 29%, predominately due to more diagnosis of ATTRwt and ATTRV122I amyloidosis. Gender and race profile differences, while changing over the observed time period, persisted among amyloidosis patients. Conclusion: Amyloid diseases are more widely recognized and classes of amyloidosis, including ATTRwt and ATTRV122I, once considered rare are now increasingly diagnosed. These data likely reflect a national trend of increased amyloidosis awareness facilitated by accessible diagnostic approaches, emerging treatments, and coordinated educational initiatives. ClinicalTrials.gov identifier: NCT00898235.
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Affiliation(s)
- Andrew Staron
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center , Boston , MA , USA
| | - Lawreen H Connors
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center , Boston , MA , USA
| | - Frederick L Ruberg
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center , Boston , MA , USA
| | - Lisa M Mendelson
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center , Boston , MA , USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center , Boston , MA , USA
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Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol 2019; 26:2065-2123. [PMID: 31468376 DOI: 10.1007/s12350-019-01760-6] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, VA, USA
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Increasing Rate of Hospital Admissions in Patients With Amyloidosis (from the National Inpatient Sample). Am J Cardiol 2019; 124:1765-1769. [PMID: 31607373 DOI: 10.1016/j.amjcard.2019.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022]
Abstract
Cardiac amyloidosis is an increasingly recognized cause of heart failure with preserved or mildly reduced ejection fraction with emerging treatment options. We sought to analyze the temporal trends and impact of hospital admissions in patients with amyloidosis. The National Inpatient Sample was queried to identify patients from 2005 to 2014 who were hospitalized with a diagnosis of amyloidosis using ICD9 codes. Trends over time of prevalence, demographics, co-morbidities, and outcomes were described. Propensity-matching was used to assess the impact of amyloidosis on in-hospital outcomes, including mortality. A total of 156,914 admissions in patients with amyloidosis (age 69.86 +/- 12.33 years, 45.7% female, 68.5% Caucasian) were identified. Hospitalizations more than doubled with a peak of 21,740 per year and 62 per 100,000 admissions in 2014. Over time, patients admitted with amyloidosis were older and more likely to have co-morbid medical conditions. A diagnosis of heart failure was present in 34.7% of patients, increased over time (p = 0.001), and was associated with further morbidity and mortality. In a propensity-matched analysis, patients admitted with amyloidosis had a longer length of stay (7.5 vs 6.2 days), were less likely to be discharged home (43.6% vs 48.7%), and were more likely to die during the hospitalization (7.4% vs 4.9%, p <0.001 for all). In conclusion, inpatient hospitalizations in the United States in patients with amyloidosis have increased over time and are associated with high morbidity and mortality, particularly when there is concomitant heart failure.
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Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging. J Card Fail 2019; 25:e1-e39. [PMID: 31473268 DOI: 10.1016/j.cardfail.2019.08.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, Virginia
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Patil N, Arora S, Qamar A, Strassle PD, Alexander KM, Fatima A, Maurer MS, Grodin JL, Pandey A. Trends and causes of hospitalizations in patients with amyloidosis. Amyloid 2019; 26:177-178. [PMID: 31172802 DOI: 10.1080/13506129.2019.1618261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nikita Patil
- a Division of Cardiology, University of North Carolina School of Medicine , Chapel Hill , NC , USA
| | - Sameer Arora
- b Center of Research and Population Health , Apex , NC , USA
| | - Arman Qamar
- c Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Paula D Strassle
- d Department of Epidemiology, University of North Carolina , Chapel Hill , NC , USA
| | - Kevin M Alexander
- e Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford , CA , USA
| | - Amber Fatima
- f Division of Internal Medicine, Tufts University School of Medicine , Boston , MA , USA
| | - Mathew S Maurer
- g Columbia University Irving Medical Center , New York , NY , USA
| | - Justin L Grodin
- h Division of Cardiology, University of Texas Southwestern School of Medicine , Dallas , TX , USA
| | - Ambarish Pandey
- h Division of Cardiology, University of Texas Southwestern School of Medicine , Dallas , TX , USA
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69
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Lairez O. Les cardiomyopathies hypertrophiques. Rev Med Interne 2019; 40:380-388. [DOI: 10.1016/j.revmed.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 12/25/2022]
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71
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Correction to: Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation: A Single-Center Study of Over 7000 Cases. Circ Cardiovasc Imaging 2019; 12:e000025. [PMID: 30866649 DOI: 10.1161/hci.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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