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Cianci V, Cianci A, Sapienza D, Cracò A, Germanà A, Ieni A, Gualniera P, Asmundo A, Mondello C. Epidemiological Changes in Transthyretin Cardiac Amyloidosis: Evidence from In Vivo Data and Autoptic Series. J Clin Med 2024; 13:5140. [PMID: 39274353 PMCID: PMC11396392 DOI: 10.3390/jcm13175140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/16/2024] Open
Abstract
Cardiac amyloidosis is an infiltrative disease that causes progressive myocardial impairment secondary to amyloid fibril deposition in the extracellular space of the myocardium. Many amyloid precursors, including transthyretin protein, are known to determine cardiac damage by aggregating and precipitating in cardiac tissue. Transthyretin cardiac amyloidosis may be either caused by rare genetic mutations of the transthyretin gene in the hereditary variant, or may arise as a consequence of age-related mechanisms in the acquired form. Although it has been labeled as a rare disease, in recent years, transthyretin cardiac amyloidosis has stood out as an emerging cause of aortic stenosis, unexplained left ventricular hypertrophy and heart failure with preserved ejection fraction, particularly in the elderly. Indeed, the integration of data deriving from both in vivo imaging techniques (whose advancement in the last years has allowed to achieve an easier and more accessible non-invasive diagnosis) and forensic studies (showing a prevalence of amyloid deposition in cardiac tissue of elderly patients up to 29%) suggests that cardiac amyloidosis is a more common disease than traditionally considered. Thanks to all the improvements in non-invasive diagnostic techniques, along with the development of efficacious therapies offering improvements in survival rates, transthyretin cardiac amyloidosis has been transformed from an incurable and infrequent condition to a relatively more diffuse and treatable disease, which physicians should take into consideration in the differential diagnostic processes in daily clinical practice.
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Affiliation(s)
- Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Alessio Cianci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Annalisa Cracò
- Department of Biomedical Sciences and Morphological and Functional Imaging, Diagnostic and Interventional Radiology Unit, University Hospital Messina, 98168 Messina, Italy
| | - Antonino Germanà
- Zebrafish Neuromorphology Lab, Department of Veterinary Sciences, Via Palatucci snc, University of Messina, 98168 Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Section of Pathology, University of Messina, 98125 Messina, Italy
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Legal Medicine, University of Messina, Via Consolare Valeria, 1, 98125 Messina, Italy
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Bézard M, Kharoubi M, Galat A, Le Bras F, Poullot E, Molinier-Frenkel V, Fanen P, Funalot B, Moktefi A, Abulizi M, Deux JF, Lemonnier F, Guendouz S, Chalard C, Zaroui A, Itti E, Hittinger L, Teiger E, Oghina S, Damy T. Real-Life Evaluation of an Algorithm for the Diagnosis of Cardiac Amyloidosis. Mayo Clin Proc 2023; 98:48-59. [PMID: 36464537 DOI: 10.1016/j.mayocp.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/25/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To evaluate the real-life use of a modified Gillmore algorithm with a "one-stop-shop" approach, bone scintigraphy (BS), a monoclonal gammopathy test (GT), a salivary gland biopsy (SGB), and genetic testing performed at the same time for the diagnosis of cardiac amyloidosis at the French National Reference Centre for Cardiac Amyloidosis (Henri Mondor Hospital, Créteil, France). METHODS This retrospective cohort study included a total of 1222 patients with suspected amyloidosis who underwent BS and GT between June 2008 and May 2019. RESULTS Of 1222 patients, 349 had no cardiac uptake on BS and negative GT (BS-/GT-), 276 were BS-/GT positive (GT+), 420 patients were BS+/GT-, and 177 were BS+/GT+. Our one-stop-shop check-up enabled us to diagnose 892 (72.9%) patients; 330 (27.0%) patients required additional examinations, such as mass spectrometry and/or a cardiac biopsy. This subset notably included 112 patients with amyloid light chain amyloidosis. More than 64% of the patients with transthyretin amyloidosis or another type of amyloidosis were diagnosed during the one-stop shop visit. Sensitivity and specificity of BS for transthyretin amyloidosis diagnosis was 99% and 96%, respectively. For amyloid light chain diagnosis, sensitivity and specificity were 100% and 76%, respectively, for GT and 54% and 100%, respectively, for SGB. Of 910 transthyretin genetic tests, 205 (17%) detected mutations. CONCLUSION The results of our real-life cohort study confirmed the ability of a one-stop-shop approach with a modified Gillmore algorithm to diagnose cardiac amyloidosis and the interest of simultaneous testing for earlier diagnosis. The SGB has diagnostic value because it is easy, quick, and less invasive than a cardiac biopsy.
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Affiliation(s)
- Mélanie Bézard
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France.
| | - Mounira Kharoubi
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Arnault Galat
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Fabien Le Bras
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Lymphoid Malignancies, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Elsa Poullot
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Valérie Molinier-Frenkel
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Pascale Fanen
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Genetics Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Genetics Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Anissa Moktefi
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; Pathology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Mukedaisi Abulizi
- Nuclear Medicine Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Jean-François Deux
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Radiology Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - François Lemonnier
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Lymphoid Malignancies, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Soulef Guendouz
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Coraline Chalard
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Amira Zaroui
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Itti
- French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Nuclear Medicine Department, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; University Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France
| | - Luc Hittinger
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Teiger
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Silvia Oghina
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
| | - Thibaud Damy
- Cardiology Department, Henri Mondor University Hospital, Créteil, France; French National Reference Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, Créteil, France; GRC Amyloid Research Institute, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; DHU A-TVB, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France; Clinical Investigation Centre, Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Créteil, France
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Soper ER, Suckiel SA, Braganza GT, Kontorovich AR, Kenny EE, Abul-Husn NS. Genomic Screening Identifies Individuals at High Risk for Hereditary Transthyretin Amyloidosis. J Pers Med 2021; 11:49. [PMID: 33467513 PMCID: PMC7829706 DOI: 10.3390/jpm11010049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 12/21/2022] Open
Abstract
The TTR V142I variant associated with hereditary transthyretin amyloidosis (hATTR) is present in up to 4% of African American (AA) and 1% of Hispanic/Latinx (HL) individuals and increases risk for heart failure. Delayed and missed diagnoses could potentiate health disparities in these populations. We evaluated whether population-based genomic screening could effectively identify individuals at risk for hATTR and prompt initiation of risk management. We identified participants of the BioMe Biobank in New York City who received TTR V142I results through a pilot genomic screening program. We performed a retrospective medical record review to evaluate for the presence hATTR-related systemic features, uptake of recommended follow-up, and short-term outcomes. Thirty-two AA (N = 17) and HL (N = 15) individuals received a TTR V142I result (median age 57, 81% female). None had a previous diagnosis of hATTR. Eighteen (56%) had hATTR-related systemic features, including 4 (13%) with heart failure, 10 (31%) with carpal tunnel syndrome, and 10 (31%) with spinal stenosis. Eighteen (56%) pursued follow-up with a cardiologist within 8 months. One person received a diagnosis of hATTR. Thus, we found that the majority of V142I-positive individuals had hATTR-related systemic features at the time of result disclosure, including well-described red flags. Genomic screening can help identify hATTR risk and guide management early on, avoiding potential delays in diagnosis and treatment.
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Affiliation(s)
- Emily R. Soper
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.R.S.); (S.A.S.); (G.T.B.); (E.E.K.)
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sabrina A. Suckiel
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.R.S.); (S.A.S.); (G.T.B.); (E.E.K.)
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Giovanna T. Braganza
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.R.S.); (S.A.S.); (G.T.B.); (E.E.K.)
| | - Amy R. Kontorovich
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine, New York, NY 10029, USA;
| | - Eimear E. Kenny
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.R.S.); (S.A.S.); (G.T.B.); (E.E.K.)
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S. Abul-Husn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (E.R.S.); (S.A.S.); (G.T.B.); (E.E.K.)
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Adamczak DM, Oduah MT, Kiebalo T, Nartowicz S, Bęben M, Pochylski M, Ciepłucha A, Gwizdała A, Lesiak M, Straburzyńska-Migaj E. Heart Failure with Preserved Ejection Fraction-a Concise Review. Curr Cardiol Rep 2020; 22:82. [PMID: 32648130 PMCID: PMC7347676 DOI: 10.1007/s11886-020-01349-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of Review Heart failure with preserved ejection fraction (HFpEF) is a relatively new disease entity used in medical terminology; however, both the number of patients and its clinical significance are growing. HFpEF used to be seen as a mild condition; however, the symptoms and quality of life of the patients are comparable to those with reduced ejection fraction. The disease is much more complex than previously thought. In this article, information surrounding the etiology, diagnosis, prognosis, and possible therapeutic options of HFpEF are reviewed and summarized. Recent Findings It has recently been proposed that heart failure (HF) is rather a heterogeneous syndrome with a spectrum of overlapping and distinct characteristics. HFpEF itself can be distilled into different phenotypes based on the underlying biology. The etiological factors of HFpEF are unclear; however, systemic low-grade inflammation and microvascular damage as a consequence of comorbidities associated with endothelial dysfunction, oxidative stress, myocardial remodeling, and fibrosis are considered to play a crucial role in the pathogenesis of a disease. The H2FPEF score and the HFpEF nomogram are recently validated highly sensitive tools employed for risk assessment of subclinical heart failure. Summary Despite numerous studies, there is still no evidence-based pharmacotherapy for HFpEF and the mortality and morbidity associated with HFpEF remain high. A better understanding of the etiological factors, the impact of comorbidities, the phenotypes of the disease, and implementation of machine learning algorithms may play a key role in the development of future therapeutic strategies.
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Affiliation(s)
- Daria M Adamczak
- Ist Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848, Poznan, Poland.
| | - Mary-Tiffany Oduah
- Center for Medical Education in English, Poznan University of Medical Sciences, Poznan, Poland
| | - Thomas Kiebalo
- Center for Medical Education in English, Poznan University of Medical Sciences, Poznan, Poland
| | - Sonia Nartowicz
- Faculty of Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Bęben
- Faculty of Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Pochylski
- Faculty of Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Ciepłucha
- Ist Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848, Poznan, Poland
| | - Adrian Gwizdała
- Ist Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848, Poznan, Poland
| | - Maciej Lesiak
- Ist Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848, Poznan, Poland
| | - Ewa Straburzyńska-Migaj
- Ist Department of Cardiology, Poznan University of Medical Sciences, Dluga Street ½, 61-848, Poznan, Poland
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