1
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Quintella Sangiorgi Olivetti N, Sacilotto L, Wulkan F, D'Arezzo Pessente G, Lombardi Peres de Carvalho M, Moleta D, Tessariol Hachul D, Veronese P, Hardy C, Pisani C, Wu TC, Vieira MLC, de França LA, de Souza Freitas M, Rochitte CE, Bueno SC, Bastos Lovisi V, Krieger JE, Scanavacca M, da Costa Pereira A, da Costa Darrieux F. Clinical Features, Genetic Findings, and Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: Data From a Brazilian Cohort. Circ Arrhythm Electrophysiol 2023; 16:e011391. [PMID: 36720007 DOI: 10.1161/circep.122.011391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited disease, causes ventricular tachycardia, sudden cardiac death, and heart failure (HF). We investigated ARVC clinical features, genetic findings, natural history, and the occurrence of life-threatening arrhythmic events (LTAEs), HF death, or heart transplantation (HF-death/HTx) to identify risk factors. METHODS The clinical course of 111 consecutive patients with definite ARVC, predictors of LTAE, HF-death/HTx, and combined events were analyzed in the entire cohort and in a subgroup of 40 patients without sustained ventricular arrhythmia before diagnosis. RESULTS The 5-year cumulative probability of LTAE was 30% and HF-death/HTx was 10%. Predictors of HF-death/HTx were reduced right ventricle ejection fraction (HR: 0.93; P=0.010), HF symptoms (HR: 4.37; P=0.010), epsilon wave (HR: 4.99; P=0.015), and number of leads with low QRS voltage (HR: 1.28; P=0.001). Each additional lead with low QRS voltage increased the risk of HF-death/HTx by 28%. Predictors of LTAE were prior syncope (HR: 1.81; P=0.040), number of leads with T wave inversion (HR: 1.17; P=0.039), low QRS voltage (HR: 1.12; P=0.021), younger age (HR: 0.97; P=0.006), and prior ventricular arrhythmia/ventricular fibrillation (HR: 2.45; P=0.012). Each additional lead with low QRS voltage increased the risk of LTAE by 17%. In patients without ventricular arrhythmia before clinical diagnosis of ARVC, the number of leads with low QRS voltage (HR: 1.68; P=0.023) was independently associated with HF-death/HTx. CONCLUSIONS Our study demonstrated the characteristics of a specific cohort with a high prevalence of arrhythmic burden at presentation, male predominance, younger age and HF severe outcomes. Our main results suggest that the presence and extension of low QRS voltage can be a risk predictor for HF-death/HTx in ARVC patients, regardless of the arrhythmic risk. This study can contribute to the global ARVC risk stratification, adding new insights to the international current scientific knowledge.
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Affiliation(s)
- Natália Quintella Sangiorgi Olivetti
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.).,Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Luciana Sacilotto
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Fanny Wulkan
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Gabrielle D'Arezzo Pessente
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Danilo Moleta
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Denise Tessariol Hachul
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Pedro Veronese
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Carina Hardy
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Cristiano Pisani
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Tan Chen Wu
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Marcelo Luiz Campos Vieira
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Lucas Arraes de França
- Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Matheus de Souza Freitas
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Carlos Eduardo Rochitte
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Sávia Christina Bueno
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Vitor Bastos Lovisi
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Maurício Scanavacca
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Francisco da Costa Darrieux
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
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Zegkos T, Gossios T, Ntelios D, Parcharidou D, Karvounis H, Efthimiadis G. Wild-Type Transthyretin Amyloid Cardiomyopathy: The Gordian-Knot of Novel Therapeutic Regimens. Cardiol Rev 2023; 31:36-41. [PMID: 36469360 DOI: 10.1097/crd.0000000000000427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Wild-type TTR amyloidosis (wtATTR) represents a disease difficult to diagnose with poor prognosis. Increased clinical suspicion is key, allowing for timely diagnosis. Until recently, only off-label therapies were available but recent introduction of disease specific therapy has shown potential to alter the natural history of the disease. Tafamidis, the only currently approved drug for the therapy of wtATTR, provided significantly better survival and quality of life. However, not all subgroups of patients derived equal benefit. This, along with the increased cost of treatment raised question on whether treatment should be invariably administered through the wtATTR population. This review aims to summarize current evidence on the natural history and staging systems for wtATTR, as well as available treatment options. Special consideration is given to the selection process of patients who would be expected to gain maximum benefit from tafamidis treatment, based on an ethical and cost-effective point of view.
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Affiliation(s)
- Thomas Zegkos
- From the 1st Cardiology Department, Center of Cardiomyopathies and Inherited Cardiac Diseases, AHEPA University Hospital, Thessaloniki, Greece
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3
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Amyloid Cardiomyopathy in Older Adults. CURRENT GERIATRICS REPORTS 2022. [DOI: 10.1007/s13670-022-00374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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4
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Hasegawa K, Uzui H, Fukuoka Y, Miyanaga D, Shiomi Y, Tama N, Ikeda H, Ishida K, Miyazaki S, Sekijima Y, Naiki H, Tada H. Abdominal Fat Pad Fine-Needle Aspiration for Diagnosis of Cardiac Amyloidosis in Patients with Non-Ischemic Cardiomyopathy. Int Heart J 2022; 63:49-55. [DOI: 10.1536/ihj.21-430] [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: 11/18/2022]
Affiliation(s)
- Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Yoshitomo Fukuoka
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Dai Miyanaga
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University
| | - Hironobu Naiki
- Department of Molecular Pathology, Faculty of Medical Sciences, University of Fukui
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
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Minutoli F, Russo M, Di Bellaearly Phase Planar Imaging G, Laudicella R, Spataro A, Vento A, Comis A, Gentile L, Mazzeo A, Vita G, Baldari S. Diagnosis of cardiac amyloid transthyretin (ATTR) amyloidosis by early (soft tissue) phase [ 99mTc]Tc-DPD whole body scan: comparison with late (bone) phase imaging. Eur Radiol 2022; 32:3035-3044. [PMID: 35031838 DOI: 10.1007/s00330-021-08420-9] [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: 07/02/2021] [Revised: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Although expert consensus recommendations suggest 2-3 h as the time interval between bone-seeking radiotracers injection and acquisition, it has been reported that images obtained early after [99mTc]Tc-HMDP administration are sufficient to diagnose cardiac amyloidosis. We evaluated the diagnostic performance of [99mTc]Tc-DPD early phase whole body scan with respect to late phase imaging. METHODS We qualitatively and semiquantitatively reviewed [99mTc]Tc-DPD imaging of 53 patients referred for suspect cardiac amyloidosis. Findings of early and late phase images were compared with SPECT results (considered the standard-of-reference) determining sensitivity and specificity for visual analysis of each phase imaging and for each semiquantitative index. RESULTS SPECT imaging was negative for cardiac accumulation in 25 patients and positive in 28. Visual analysis of early phase whole body scan had an extremely significant capability to predict SPECT results; nevertheless, complete agreement was not reached. Visual analysis of late phase imaging showed slightly better results. Semiquantitative analysis of early phase images, namely heart to mediastinum ratio, performed better than semiquantitative analysis of late phase images. CONCLUSION Visual analysis of [99mTc]Tc-DPD early phase whole body scan is promising in diagnosing cardiac amyloidosis; further studies are needed to confirm our results in different clinical scenarios. KEY POINTS • Visual analysis of early phase planar imaging using [99mTc]Tc-DPD is accurate to diagnose cardiac amyloidosis and may be satisfactory at least in frail patients with high cardiac burden of amyloid fibrils.
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Affiliation(s)
- Fabio Minutoli
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Massimo Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy. .,Nuclear Medicine Unit, University Hospital "Policlinico G.Martino", via Consolare Valeria n.1, 98125, Messina, Italy.
| | - Alessandro Spataro
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Antonio Vento
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Alessio Comis
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
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Lioncino M, Monda E, Palmiero G, Caiazza M, Vetrano E, Rubino M, Esposito A, Salerno G, Dongiglio F, D'Onofrio B, Verrillo F, Cerciello G, Manganelli F, Pacileo G, Bossone E, Golino P, Calabrò P, Limongelli G. Cardiovascular Involvement in Transthyretin Cardiac Amyloidosis. Heart Fail Clin 2021; 18:73-87. [PMID: 34776085 DOI: 10.1016/j.hfc.2021.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is a systemic disorder resulting from the extracellular deposition of amyloid fibrils of misfolded transthyretin protein in the heart. ATTR-CA is a life-threatening disease, which can be caused by progressive deposition of wild type transthyretin (wtATTR) or by aggregation of an inherited mutated variant of transthyretin (mATTR). mATTR Is a rare condition transmitted in an autosomal dominant manner with incomplete penetrance, causing heterogenous phenotypes which can range from predominant neuropathic involvement, predominant cardiomyopathy, or mixed. Diagnosis of ATTR-CA is complex and requires integration of different imaging tools (echocardiography, bone scintigraphy, magnetic resonance) with genetics, clinical signs, laboratory tests, and histology. In recent years, new therapeutic agents have shown good efficacy and impact on survival and quality of life in this subset of patients, nevertheless patients affected by ATTR-CA may still carry an unfavorable prognosis, thus highlighting the need for new therapies. This review aims to assess cardiovascular involvement, diagnosis, and management of patients affected by ATTR-CA.
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Affiliation(s)
- Michele Lioncino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Emanuele Monda
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Erica Vetrano
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy; Internal Medicine Unit, Department of Translational Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marta Rubino
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Augusto Esposito
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Gemma Salerno
- Vanvitelli Cardiology Unit, Monaldi Hospital, Naples 80131, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Barbara D'Onofrio
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Cerciello
- Haematology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Via Pansini, 5, Naples 81025, Italy
| | - Giuseppe Pacileo
- Heart Failure and Cardiac Rehabilitation Unit, Department of Cardiology, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples 80131, Italy
| | - Paolo Golino
- Vanvitelli Cardiology Unit, Monaldi Hospital, Naples 80131, Italy; Department of Translational Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Calabrò
- Department of Translational Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Division of Cardiology, A.O.R.N. "Sant'Anna & San Sebastiano", Caserta I-81100, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, London WC1E 6DD, UK.
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Porcari A, Pagura L, Longo F, Sfriso E, Barbati G, Murena L, Longo E, Ramella V, Arnež ZM, Rapezzi C, Merlo M, Sinagra G. Prognostic significance of unexplained left ventricular hypertrophy in patients undergoing carpal tunnel surgery. ESC Heart Fail 2021; 9:751-760. [PMID: 34755478 PMCID: PMC8787962 DOI: 10.1002/ehf2.13606] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022] Open
Abstract
Aims Carpal tunnel (CT) syndrome is a recognized red‐flag of cardiac amyloidosis (CA) and increased cardiovascular (CV) morbidity. We designed this study to characterize the CV profile of patients with CT syndrome at the time of first surgery and to identify high‐risk presentations. Methods and results We retrospectively reviewed 643 patients who underwent CT surgery between 2007 and 2019. Of them, 130 patients (77 years, 45% male patients, left ventricular ejection fraction 62%) with available CV characterization within ±12 months from CT surgery were included. Abnormal loading conditions causing cardiac left ventricular hypertrophy (LVH) were investigated to distinguish explained LVH (Ex‐LVH) from unexplained LVH (Un‐LVH). LVH was found in 66 (51%) patients, 33% of them presented Un‐LVH. Compared with the others, Un‐LVH patients were older (77 and 75 vs. 70 years in Un‐LVH, Ex‐LVH, and non‐LVH, respectively; P = 0.002), had higher rates of electrocardiogram‐echo discrepancy (70%, 14.3%, and 1.6%, respectively; P < 0.001) and of echocardiographic findings of CA (24%, 7%, and 0%, P < 0.001). Among Un‐LVH patients, 9 (43%) experienced death and 7 (33%) developed heart failure (HF) at 3.8 and 2.4 years from CT surgery, respectively. Compared with the others, death and HF development rates were higher in Un‐LVH patients both at unadjusted (P = 0.01 and P = 0.02, respectively) and adjusted analysis for age, gender, and renal insufficiency (P = 0.00038 and P = 0.050, respectively). Conclusions At the time of CT surgery, Un‐LVH was found in more than 30% of patients with LVH, and 24% of them showed echocardiographic features suggesting an underdiagnosed CA. Un‐LVH was associated with higher all‐cause mortality and HF development.
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Affiliation(s)
- Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Linda Pagura
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Francesca Longo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Enrico Sfriso
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Giulia Barbati
- Department of Medical Sciences, Biostatistics UnitUniversity of TriesteTriesteItaly
| | - Luigi Murena
- Orthopaedics and Traumatology Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Emiliano Longo
- Orthopaedics and Traumatology Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Vittorio Ramella
- Plastic and Reconstructive Surgery Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Zoran Marij Arnež
- Plastic and Reconstructive Surgery Unit, Cattinara Hospital‐ Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteTriesteItaly
| | - Claudio Rapezzi
- Cardiothoracic DepartmentUniversity of FerraraFerraraItaly
- Maria Cecilia HospitalGVM Care & ResearchCotignola, RavennaItaly
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI)University of TriesteVia P. Valdoni 7Trieste34100Italy
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Sex-related differences in the clinical characteristics of wild-type transthyretin amyloidosis cardiomyopathy. J Cardiol 2021; 79:50-57. [PMID: 34756766 DOI: 10.1016/j.jjcc.2021.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND A significant male predominance has been reported in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). Hence, female cases of ATTRwt-CM are overlooked, and sex-related differences in ATTRwt-CM remain unclear. This study aimed to examine sex-related differences in clinical characteristics and diagnostic approaches in ATTRwt-CM. METHODS We retrospectively analyzed 199 consecutive patients who were diagnosed with ATTRwt-CM and evaluated sex-related differences in clinical characteristics, imaging parameters, biomarkers, and diagnostic approaches. RESULTS Twenty-nine patients (15%) were female. These female patients were significantly older at diagnosis (77.1 ± 6.5 years vs. 82.9 ± 4.8 years; p<0.001) and had a more advanced New York Health Association functional class (2.2 ± 0.7 vs. 2.6 ± 0.8; p = 0.006) than their male counterparts. The median B-type natriuretic peptide levels were significantly higher (236 pg/mL vs. 394 pg/mL; p = 0.017) in female patients. Echocardiography revealed that the mean interventricular septum diameter was thinner (15.7 ± 2.6 mm vs. 14.1 ± 2.5 mm; p = 0.004) and left ventricular ejection fraction (LVEF) was preserved (51.2 ± 10.2% vs. 57.2 ± 9.1%; p = 0.003) in female patients. The mean heart-to-contralateral ratio obtained using 99mTc-labeled pyrophosphate (99mTc-PYP) was significantly lower (1.89 ± 0.33 vs. 1.63 ± 0.20; p < 0.001), moderate to severe aortic stenosis was more frequently observed (5% vs. 45%; p < 0.001), and the frequency of histological diagnosis was significantly lower (77% vs. 59%; p = 0.036) in female patients. CONCLUSIONS Female patients with ATTRwt-CM were predominantly octogenarians and less hypertrophic and had preserved LVEF and weaker cardiac uptake of the 99mTc-PYP tracer compared with male patients. These characteristics contribute to the underdiagnosis of ATTRwt-CM in female patients.
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Minutoli F, Di Bella G, Mazzeo A, Laudicella R, Gentile L, Russo M, Vita G, Baldari S. Serial scanning with 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid ( 99mTc-DPD) for early detection of cardiac amyloid deposition and prediction of clinical worsening in subjects carrying a transthyretin gene mutation. J Nucl Cardiol 2021; 28:1949-1957. [PMID: 31741327 DOI: 10.1007/s12350-019-01950-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/07/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND To determine the capability of 99mTc-DPD scintigraphy to detect early cardiac involvement and predict clinical worsening in transthyretin (TTR) gene mutation patients. METHODS Eleven mutated subjects with normal interventricular septum (IVS) thickness, NT-proBNP level and no cardiac symptoms underwent three seriate 99mTc-DPD scans (visually and semiquantitatively analyzed), and was followed-up for 5-8-years. RESULTS Six patients showed no myocardial accumulation in all scans. Increased IVS thickness occurring in one patient 4 years after the last scan was the only abnormal finding in these patients; no cardiac symptoms developed during the follow-up. In three patients, cardiac radiotracer uptake was found at enrollment; other laboratory/instrumental abnormal findings occurred later and cardiac symptoms developed during the follow-up period. Two patients had a negative 99mTc-DPD scan at enrollment and showed cardiac uptake in the following scans. Increased mean left-ventricular (LV) wall thickness was found 3 years after positive scintigraphy; NT-proBNP increased later in one patient. These patients developed cardiac symptoms during the follow-up period. CONCLUSIONS 99mTc-DPD scan detects cardiac involvement in subjects with TTR gene mutation earlier than ECG, echocardiography and biochemical markers, occurring some years before the fulfillment of current diagnostic criteria for cardiac amyloidosis. A positive 99mTc-DPD scan predicts cardiac symptoms onset.
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Affiliation(s)
- F Minutoli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, University Hospital "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
| | - G Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
| | - A Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
| | - R Laudicella
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, University Hospital "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy.
| | - L Gentile
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
| | - M Russo
- Nemo Sud Clinical Centre, University Hospital "G. Martino", Messina, Italy
| | - G Vita
- Department of Clinical and Experimental Medicine, University of Messina, University Hospital "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
| | - S Baldari
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, University Hospital "G. Martino", Via Consolare Valeria 1, 98125, Messina, Italy
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10
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Capustin M, Frishman WH. Transthyretin Cardiac Amyloidosis and Novel Therapies to Treat This Not-so-rare Cause of Cardiomyopathy. Cardiol Rev 2021; 29:263-273. [PMID: 34397539 DOI: 10.1097/crd.0000000000000387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is typically a late-onset disease caused by the deposit of transthyretin amyloid fibrils throughout the heart. When this occurs, various cardiac sequelae can develop, including hypotension, conduction abnormalities, and valvular lesions. The cardiomyopathy caused by ATTR-CA (ATTR-CM) has proven difficult to treat. Until recently, symptomatic management was the only therapeutic option, and many therapies used to treat congestive heart failure were ineffective or even detrimental to patients with ATTR-CM. In addition, treatment was limited to heart and liver transplantation. As a result, prognosis was poor. Recently, a few drug therapies have come to light as potential treatment modalities for ATTR-CM, most notably tafamidis, sold under the brand names Vyndaqel and Vyndamax. After the phase III Transthyretin Amyloidosis Cardiomyopathy trial displayed the drug's efficacy, it was given breakthrough therapy designation and was approved by the Food and Drug Administration on May 6, 2019, for the treatment of ATTR-CA. This novel therapy, as well as various other therapies in the pipeline, such as inotersen and patisiran, provide hope where, until recently, there was little. Unfortunately, the exorbitant cost of these new therapies may present a barrier to long-term treatment for some patients. However, by further improving diagnostic algorithms and incorporating these new treatments into our existing therapeutic modalities, patients with ATTR-CA should be able to live far longer than previously expected. Finally, further research combining these novel treatment modalities must be done, as they may prove to be additive or even synergistic in their treatment of ATTR amyloidosis.
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Affiliation(s)
- Matthew Capustin
- From the Department of Medicine, Zucker School of Medicine/Northwell Northshore-Long Island Jewish Medical Center, Manhasset, NY
| | - William H Frishman
- Department of Medicine and Cardiology, New York Medicine and Westchester Medical Center, Valhalla, NY
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11
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Licordari R, Minutoli F, Recupero A, Campisi M, Donato R, Mazzeo A, Dattilo G, Baldari S, Vita G, Zito C, Di Bella G. Early Impairment of Right Ventricular Morphology and Function in Transthyretin-Related Cardiac Amyloidosis. J Cardiovasc Echogr 2021; 31:17-22. [PMID: 34221881 PMCID: PMC8230159 DOI: 10.4103/jcecho.jcecho_112_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Our study aimed to evaluate right ventricular (RV) morphology and strain (S) in the early stage of familial transthyretin (TTR) cardiac amyloidosis (CA). Methods and Results: Thirty-seven patients with transthyretin mutation underwent 99mTc-3,3-diphosphono-1,2 propanodicarboxylic acid (99mTc-DPD) scans and/or cardiac magnetic resonance (CMR) to identify TTR CA. Each patient underwent echocardiography to quantify RV dimensions, tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), longitudinal (L) strain of the RV free wall, left ventricular (LV) septal thickness (ST), ejection fraction, E/E', LV global (G) L, radial (R), and circumferential (C) S. 99mTc-DPD and CMR revealed the accumulation in 22 of 37 patients (CA group) and no accumulation in 15 patients (no-CA group). Left ventricular (LV) septal thickness (ST) was higher (P < 0.0001) while LV ejection fraction and E/E' were lower (P < 0.05) in the CA group than the no-CA group. LV-global longitudinal strain (LS) was lower (P < 0.0001) in the CA-group than the no CA-group, whereas LV-global circumferential strain and LV-global radial strain were similar. The CA group showed higher values of RV dimensions (P < 0.05) and sPAP (0.02) and a lower (P = 0.002) TAPSE. Globally, RV-LS was lower (P = 0.005) in the CA group than the no-CA group. Basal and mid segments of the RV free wall showed a lower LS in the CA group than the no-CA group (P < 0.01), while apical S was similar between groups. Conclusions: RV deformation, particularly in basal and mid segments, is early impaired in CA.
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Affiliation(s)
- Roberto Licordari
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Fabio Minutoli
- Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Antonino Recupero
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Mariapaola Campisi
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Rocco Donato
- Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Giuseppe Dattilo
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, AOU "Policlinico G. Martino," Messina, Italy
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12
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Yamada T, Takashio S, Arima Y, Nishi M, Morioka M, Hirakawa K, Hanatani S, Fujisue K, Yamanaga K, Kanazawa H, Sueta D, Araki S, Usuku H, Nakamura T, Suzuki S, Yamamoto E, Ueda M, Kaikita K, Tsujita K. Clinical characteristics and natural history of wild-type transthyretin amyloid cardiomyopathy in Japan. ESC Heart Fail 2020; 7:2829-2837. [PMID: 32672425 PMCID: PMC7524255 DOI: 10.1002/ehf2.12884] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/27/2023] Open
Abstract
Aims The focus on wild‐type transthyretin amyloid cardiomyopathy (ATTRwt‐CM) is increasing because of novel treatment options. There is currently no report on a large number of Japanese patients with ATTRwt‐CM. The study aimed to examine the characteristics and prognosis of ATTRwt‐CM in Japan. Methods and results Consecutive patients (78.5 ± 6.4 years old at diagnosis) with ATTRwt‐CM diagnosed at Kumamoto University Hospital between December 2002 and December 2019 were retrospectively reviewed. Data, including demographic characteristics, co‐morbidities, clinical manifestations at diagnosis, laboratory results, electrocardiographic and echocardiographic data, imaging and pathological findings, and treatment were obtained. Of 129 patients included in this study, 110 patients (85%) were male. The median period from initial symptom onset to diagnosis was 15.5 (2–75) months. Heart failure was the most common clinical manifestation leading to diagnosis (61%) and initial manifestations (49%). Of 106 patients, carpal tunnel syndrome was observed in 57 patients (54%), and the median period from initial symptom onset to diagnosis was 96 (48–120) months. Histopathological confirmation of transthyretin amyloid was achieved in 94 patients (73%), including 66 (51%) and 28 cases (22%) with endomyocardial and extracardiac biopsies. During the observation period (median 15.0 [inter‐quartile range, 5.4–33.2] months after diagnosis), 34 patients (26%) died. Of these, 27 patients (79%) had cardiovascular deaths (heart failure, 25; sudden death, two). The median survival duration was 58.9 months and the 5 years' survival rate was 48%. According to a multivariate Cox hazard analysis, age [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.05–1.23, P = 0.002] and low serum sodium levels (HR, 0.89; 95% CI, 0.79–0.996; P = 0.04) contributed to all‐cause mortality, and low serum sodium levels contributed to hospitalization for heart failure (HR, 0.86; 95% CI, 0.77–0.96; P = 0.005). Conclusions Clinical characteristics and prognosis of ATTRwt‐CM patients in Japan were examined. Carpal tunnel syndrome can be considered an indication for diagnosis of ATTRwt‐CM. Age and low serum sodium level were significant predictive factors of all survival outcomes. The clinical features of ATTRwt‐CM should be recognized to provide appropriate treatment.
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Affiliation(s)
- Toshihiro Yamada
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan.,International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan.,International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan
| | - Masato Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Mami Morioka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Kyoko Hirakawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Satoru Suzuki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chou-ku, Kumamoto, 860-8556, Japan
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13
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Yamada S, Yoshihisa A, Hijioka N, Kamioka M, Kaneshiro T, Yokokawa T, Misaka T, Ishida T, Takeishi Y. Autonomic dysfunction in cardiac amyloidosis assessed by heart rate variability and heart rate turbulence. Ann Noninvasive Electrocardiol 2020; 25:e12749. [PMID: 32083399 PMCID: PMC7358876 DOI: 10.1111/anec.12749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/03/2019] [Accepted: 01/08/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiac amyloidosis (CA) is characterized by left ventricular hypertrophy (LVH) and autonomic nervous imbalance due to amyloid infiltration. However, autonomic dysfunction is often seen in heart failure (HF) with LVH from other etiologies. We aimed to characterize autonomic dysfunction in CA from other etiologies of LVH. METHODS Fifty-five HF patients with LVH (35 males, mean age 65 ± 16 years) were enrolled. LVH was defined as left ventricular mass index measured by echocardiography >95 g/m2 in women and 115 g/m2 in men. The etiology was as follows: amyloid light chain (AL)-CA, n = 14; hypertrophic cardiomyopathy, n = 21; and aortic stenosis (AS), n = 20. With the patient in a clinically stable condition, heart rate variability (HRV) and heart rate turbulence (HRT), which reflect autonomic dysfunction, were measured using Holter monitoring and compared among the three groups. RESULTS Brain natriuretic peptide levels, LVH severity, left ventricular ejection fraction, and tissue Doppler index E/e' did not differ among the three groups. However, severe abnormalities of HRV and HRT were obtained in AL-CA. In the ROC analysis to identify AL-CA in HF with LVH, the best cutoff value for standard deviation of all R-R intervals, standard deviation of the 5-min mean R-R intervals, turbulence onset, and turbulence slope were 68.5 ms (AUC: 0.865), 58.5 ms (AUC: 0.834), 0.25% (AUC: 0.813), and 1.00 ms/RR (AUC 0.736), respectively. CONCLUSION Autonomic dysfunction is a hallmark of AL-CA, and its noninvasive assessment by Holter monitoring may be a useful tool for differential diagnosis of HF with LVH.
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Affiliation(s)
- Shinya Yamada
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Akiomi Yoshihisa
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
- Department of Advanced Cardiac TherapeuticsFukushima Medical UniversityFukushimaJapan
| | - Naoko Hijioka
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Masashi Kamioka
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Takashi Kaneshiro
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
- Department of Arrhythmia and Cardiac PacingFukushima Medical UniversityFukushimaJapan
| | - Tetsuro Yokokawa
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Tomofumi Misaka
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
- Department of Advanced Cardiac TherapeuticsFukushima Medical UniversityFukushimaJapan
| | - Takafumi Ishida
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
| | - Yasuchika Takeishi
- Department of Cardiovascular MedicineFukushima Medical UniversityFukushimaJapan
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14
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Kimishima Y, Yoshihisa A, Kiko T, Yokokawa T, Miyata-Tatsumi M, Misaka T, Oikawa M, Kobayashi A, Takeishi Y. Utility of B-Type Natriuretic Peptide for Detecting Cardiac Involvement in Immunoglobulin Amyloidosis. Int Heart J 2019; 60:1106-1112. [DOI: 10.1536/ihj.19-043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yusuke Kimishima
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University
| | - Takatoyo Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University
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15
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Maurer MS, Bokhari S, Damy T, Dorbala S, Drachman BM, Fontana M, Grogan M, Kristen AV, Lousada I, Nativi-Nicolau J, Cristina Quarta C, Rapezzi C, Ruberg FL, Witteles R, Merlini G. Expert Consensus Recommendations for the Suspicion and Diagnosis of Transthyretin Cardiac Amyloidosis. Circ Heart Fail 2019; 12:e006075. [PMID: 31480867 DOI: 10.1161/circheartfailure.119.006075] [Citation(s) in RCA: 283] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiomyopathy is a manifestation of transthyretin amyloidosis (ATTR), which is an underrecognized systemic disease whereby the transthyretin protein misfolds to form fibrils that deposit in various tissues and organs. ATTR amyloidosis is debilitating and associated with poor life expectancy, especially in those with cardiac dysfunction, but a variety of treatment options have recently become available. Considered a rare disease, ATTR amyloidosis may be more prevalent than thought, particularly in older persons. Diagnosis is often delayed because of a lack of disease awareness and the heterogeneity of symptoms at presentation. Given the recent availability of effective treatments, early recognition and diagnosis are especially critical because treatment is likely more effective earlier in the disease course. The Amyloidosis Research Consortium recently convened a group of experts in ATTR amyloidosis who, through an iterative process, agreed on best practices for suspicion, diagnosis, and characterization of disease. This review describes these consensus recommendations for ATTR associated with cardiomyopathy as a resource to aid cardiologists and others in the recognition and diagnosis of ATTR associated with cardiomyopathy. Included in this review is an overview of red flag signs and symptoms and a recommended diagnostic approach, including testing for monoclonal protein, scintigraphy, or biopsy and, if ATTR associated with cardiomyopathy is identified, TTR genotyping.
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Affiliation(s)
- Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York (M.S.M., S.B.)
| | - Sabahat Bokhari
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York (M.S.M., S.B.)
| | - Thibaud Damy
- Department of Cardiology, Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU A-TVB, APHP CHU Henri Mondor and Université Paris Est Créteil, France (T.D.)
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA (S.D.)
| | - Brian M Drachman
- Department of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (B.M.D.)
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, United Kingdom (M.F., C.C.Q.)
| | - Martha Grogan
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.G.)
| | - Arnt V Kristen
- Department of Cardiology, Amyloidosis Center, University of Heidelberg, Germany (A.V.K.)
| | | | - Jose Nativi-Nicolau
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City (J.N.-N.)
| | - Candida Cristina Quarta
- National Amyloidosis Centre, Division of Medicine, University College London, United Kingdom (M.F., C.C.Q.).,Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.C.Q., C.R.)
| | - Claudio Rapezzi
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.C.Q., C.R.)
| | - Frederick L Ruberg
- Cardiovascular Center, Boston University School of Medicine, Boston Medical Center, MA (F.L.R.)
| | - Ronald Witteles
- Stanford Amyloid Center, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (R.W.)
| | - Giampaolo Merlini
- Amyloidosis Center Foundation IRCCS Policlinico San Matteo, Italy (G.M.).,Department of Molecular Medicine, University of Pavia, Italy (G.M.)
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16
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Marume K, Takashio S, Nishi M, Hirakawa K, Yamamoto M, Hanatani S, Oda S, Utsunomiya D, Shiraishi S, Ueda M, Yamashita T, Sakamoto K, Yamamoto E, Kaikita K, Izumiya Y, Yamashita Y, Ando Y, Tsujita K. Combination of Commonly Examined Parameters Is a Useful Predictor of Positive 99 mTc-Labeled Pyrophosphate Scintigraphy Findings in Elderly Patients With Suspected Transthyretin Cardiac Amyloidosis. Circ J 2019; 83:1698-1708. [PMID: 31189791 DOI: 10.1253/circj.cj-19-0255] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A recent study revealed a high prevalence of transthyretin (TTR) cardiac amyloidosis (CA) in elderly patients. 99 mTc-labeled pyrophosphate (99 mTc-PYP) scintigraphy is a remarkably sensitive and specific modality for TTR-CA, but is only available in specialist centres; thus, it is important to raise the pretest probability. The aim of this study was to evaluate the characteristics of patients with 99 mTc-PYP positivity and make recommendations about patient selection for 99 mTc-PYP scintigraphy.Methods and Results:We examined 181 consecutive patients aged ≥70 years who underwent 99 mTc-PYP scintigraphy at Kumamoto University Hospital between January 2012 and December 2018. Logistic regression analyses showed that high-sensitivity cardiac troponin T (hs-cTnT) ≥0.0308 ng/mL, left ventricular posterior wall thickness ≥13.6 mm, and wide QRS (QRS ≥120 ms) were strongly associated with 99 mTc-PYP positivity. We developed a new index for predicting 99 mTc-PYP positivity by adding 1 point for each of the 3 factors. The 99 mTc-PYP positive rate increased by a factor of 4.57 for each 1-point increase (P<0.001). Zero points corresponded to a negative predictive value of 87% and 3 points corresponded to a positive predictive value of 96% for 99 mTc-PYP positivity. CONCLUSIONS The combination of biochemical (hs-cTnT), physiological (wide QRS), and structural (left ventricular posterior wall thickness) findings can raise the pretest probability for 99 mTc-PYP scintigraphy. It can assist clinicians in determining management strategies for elderly patients with suspected CA.
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Affiliation(s)
- Kyohei Marume
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Masato Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Kyoko Hirakawa
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Masahiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Science, Kumamoto University
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Graduate School of Medical Science, Kumamoto University
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Graduate School of Medical Science, Kumamoto University
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Science, Kumamoto University
| | - Taro Yamashita
- Department of Neurology, Graduate School of Medical Science, Kumamoto University
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Science, Kumamoto University
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Science, Kumamoto University
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
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17
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Abstract
PURPOSE OF REVIEW The aim is to provide a description of the most important echocardiographic features in systemic amyloidosis. RECENT FINDINGS Amyloidosis is a heterogeneous group of multisystem disorders, characterized by an extracellular deposition of amyloid fibrils. Several imaging tests are available for the diagnosis; however, echocardiography is the cornerstone of the non-invasive imaging modality for cardiac amyloidosis. So far, little is known about the diagnosis of cardiac amyloidosis through imaging modalities. We summarized the most important echocardiographic findings in cardiac amyloidosis. Hence, we offered a systematic report of the diagnostic performance of cardiac amyloidosis using echocardiography.
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Li J, Gu C, Li D, Chen L, Lu Z, Zhu L, Huang H. Effects of serum N-terminal pro B-type natriuretic peptide and D-dimer levels on patients with acute ischemic stroke. Pak J Med Sci 2018; 34:994-998. [PMID: 30190768 PMCID: PMC6115578 DOI: 10.12669/pjms.344.15432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: To detect the serum levels of D-dimer and N-terminal pro B-type natriuretic peptide (NT-pro BNP) in patients with Acute Ischemic Stroke (AIS), and to explore the risk factors of AIS. Methods: A total of 246 AIS patients treated in our hospital from January 2015 to January 2017 were selected. Meanwhile, 240 healthy subjects were selected as a control group. The D-dimer and NT-pro BNP levels of the two groups were compared. Correlations of such levels with age, gender, blood lipid, Intima-Media Thickness (IMT), fibrinogen and degree of neurological deficits were analyzed. Results: The AIS group had significantly higher levels of Triglyceride (TG), Low-Density Lipoprotein (LDL), D-dimer, NT-pro BNP and fibrinogen as well as IMT than those of the control group, but the High-Density Lipoprotein (HDL) level of the AIS group was significantly lower (P<0.05). The patients with different genders and ages had significantly different D-dimer and NT-pro BNP levels (P<0.05). The D-dimer and NT-pro BNP levels were correlated with gender and age. Such levels of females were significantly higher than those of males (P<0.05). The D-dimer and NT-pro BNP levels of the ≥60 years old group significantly exceeded those of the <60 years old group (P<0.05). The levels of D-dimer and NT-pro BNP were negatively correlated with that of HDL (P<0.05), but positively correlated with TG, LDL and fibrinogen levels, IMT, and National Institutes of Health Stroke Scale score (P<0.05). Multivariate Logistic regression analysis showed that the OR values of D-dimer and NT-pro BNP were 3.65 and 6.96 respectively. Conclusion: Serum D-dimer and NT-pro BNP levels usually increased in AIS patients, and the levels were significantly correlated with AIS onset.
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Affiliation(s)
- Jia Li
- Jia Li, Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Chengzhi Gu
- Chengzhi Gu, Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Dan Li
- Dan Li, Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Lan Chen
- Lan Chen, Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Zhenhui Lu
- Zhenhui Lu, Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Lianhai Zhu
- Lianhai Zhu, Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Huaiyu Huang
- Huaiyu Huang, Department of Neurology, Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis. Eur J Nucl Med Mol Imaging 2018; 45:1945-1955. [PMID: 29687207 DOI: 10.1007/s00259-018-4013-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR. METHODS A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) "amyloid" OR "amyloidosis" AND (b) "TTR" OR "ATTR" OR "transthyretin" AND (c) "scintigraphy" OR "scan" OR "SPECT" OR "SPET" OR "bone" OR "skeletal" OR "skeleton" OR "PYP" OR "DPD" OR "HMDP" OR "MDP" OR "HDP". Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated. RESULTS The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89-95%), specificity 95.4% (95% CI 77-99%), LR+ 7.02 (95% CI 3.42-14.4), LR- 0.09 (95% CI 0.06-0.14), and DOR 81.6 (95% CI 44-153). Mild heterogeneity was found among the selected studies. CONCLUSION Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.
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Klaassen SH, Tromp J, Nienhuis HL, van der Meer P, van den Berg MP, Blokzijl H, van Veldhuisen DJ, Hazenberg BP. Frequency of and Prognostic Significance of Cardiac Involvement at Presentation in Hereditary Transthyretin-Derived Amyloidosis and the Value of N-Terminal Pro-B-Type Natriuretic Peptide. Am J Cardiol 2018; 121:107-112. [PMID: 29153245 DOI: 10.1016/j.amjcard.2017.09.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study is to assess the prevalence of cardiac involvement in hereditary transthyretin-derived (ATTRm) amyloidosis at the time of diagnosis and to determine the diagnostic and clinical value of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The University Medical Center Groningen is the national center of expertise for amyloidosis. All consecutive patients between 1994 and 2016 with ATTRm amyloidosis were followed prospectively. Baseline was set at the time of the first positive biopsy. All patients underwent a standard cardiac and neurologic work-up. Cardiac involvement was defined by otherwise unexplained left and/or right ventricular wall hypertrophy on cardiac ultrasound and/or advanced conduction disturbances. Seventy-seven patients had ATTRm amyloidosis and were included in the study. The TTR V30M mutation was present in 30 patients (39%). In both the V30M and the non-V30M groups, the neurologic presentation dominated (77% vs 51%), whereas cardiac presentation was infrequent (7% vs 15%). Clinical work-up showed that cardiac involvement was present at baseline in 51% of all patients irrespective of genotype and was associated with increased overall mortality (hazard ratio 5.95, 95% confidence interval 2.12 to 16.7), independent from clinical confounders. At a cutoff level of 125 ng/L, NT-proBNP had a sensitivity of 92% for establishing cardiac involvement. In conclusion, irrespective of the frequent noncardiac presentation of ATTRm amyloidosis, cardiac involvement is already present at diagnosis in half of the patients and is associated with increased mortality. NT-proBNP is a useful marker to determine cardiac involvement in this disease.
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Non-invasive cardiac imaging in patients with systemic amyloidosis: a practical approach with emphasis on clinical contribution of bone-seeking radiotracers. Clin Transl Imaging 2017. [DOI: 10.1007/s40336-017-0255-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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22
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Cariou E, Bennani Smires Y, Victor G, Robin G, Ribes D, Pascal P, Petermann A, Fournier P, Faguer S, Roncalli J, Rousseau H, Chauveau D, Carrié D, Berry I, Galinier M, Lairez O. Diagnostic score for the detection of cardiac amyloidosis in patients with left ventricular hypertrophy and impact on prognosis. Amyloid 2017; 24:101-109. [PMID: 28553897 DOI: 10.1080/13506129.2017.1333956] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Among diagnosis associated with left ventricular hypertrophy (LVH), cardiac amyloidosis (CA) is a progressive disease with poor prognosis. Early noninvasive identification is of growing clinical importance. The objective of our study was to integrate clinical, biologic, electrocardiographic and echocardiographic parameters to build a diagnostic score in patients with LVH. METHODS AND RESULTS One hundred and fourteen patients with LVH underwent a cardiac magnetic resonance (CMR) and a 99mTc-hydroxymethylene-diphosphonate scintigraphy (99mTc-HMDP) allowing to discriminate three groups of diagnoses: CA (n = 50 including 31, 18 and 1 ATTR, AL and AA amyloidosis), hypertrophic cardiomyopathy (n = 19) and unspecific cardiomyopathy (n = 45). Seven continuous variables associated with CA (systolic arterial pressure <130 mmHg; PR duration >200 ms; Sokolow index <12 mV; diastolic left ventricular posterior thickness >13 mm; E/Ea ratio >10; global longitudinal strain > -12% and sum of basal longitudinal strain > -47%) were selected and dichotomized according to the best cutoff value to build the diagnostic score, which was validated in an independent cohort of 34 patients with LVH from aortic stenosis. The area under the ROC curve for the diagnosis of CA using the score was 0.933 (95%CI 0.889-0.978). The best cut off value for the score was 3 leading to a sensitivity of 90% and specificity of 81%. Area under the ROC curve for the score was 0.932 in the validation cohort. A diagnostic score >3 was associated with a poorest prognosis. CONCLUSION An integrated evaluation of 6 diagnostic factors including arterial blood pressure, ECG and echocardiographic parameters to build a diagnostic score is a simple and easily method to discriminate the 3 main CA in patients with LVH.
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Affiliation(s)
- Eve Cariou
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France
| | | | - Gérard Victor
- c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France
| | - Guillaume Robin
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France
| | - David Ribes
- d Department of Nephrology and Referral Center for Rare Diseases , University Hospital of Rangueil , Toulouse , France
| | - Pierre Pascal
- b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France
| | - Antoine Petermann
- b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,e Department of Radiology , University Hospital of Rangueil , Toulouse , France
| | - Pauline Fournier
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France
| | - Stanislas Faguer
- d Department of Nephrology and Referral Center for Rare Diseases , University Hospital of Rangueil , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Jérôme Roncalli
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Hervé Rousseau
- e Department of Radiology , University Hospital of Rangueil , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
| | - Dominique Chauveau
- d Department of Nephrology and Referral Center for Rare Diseases , University Hospital of Rangueil , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Didier Carrié
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Isabelle Berry
- b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
| | - Michel Galinier
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
| | - Olivier Lairez
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
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Mereles D, Aurich M, Greiner S, Riffel J, Buss SJ, Kristen AV, Katus HA. Diagnosis of cardiac involvement in systemic amyloidosis by state-of-the-art echocardiography: where are we now? Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1179573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Aurich
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Greiner
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian J. Buss
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Arnt V. Kristen
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
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Abstract
Cardiac amyloidosis is a condition characterised by rapidly progressive heart failure and poor prognosis. The two main subtypes, immunoglobulin light chains (AL) and transthyretin (ATTR), have been investigated extensively in recent years. Cardiac imaging has advanced with the widespread use of cardiac MRI with late gadolinium enhancement imaging and newer techniques including T1 mapping to quantify amyloid burden. Nuclear imaging has developed as a highly accurate method to confirm cardiac amyloid deposits non-invasively with very high sensitivity in ATTR amyloidosis. Despite advances in imaging, cardiac biopsy remains the gold standard diagnostic test to confirm and type amyloidosis. Hereditary ATTR amyloidosis of V122I type has been the focus of important studies in the past year, due to the high prevalence of the amyloidogenic allele in patients of African descent. Recent research concluded a significant number of Afro-Caribbean heart failure patients are likely to have undiagnosed cardiac amyloidosis. Misdiagnosis may lead to inappropriate treatment with potentially harmful 'standard' heart failure medications with no evidence base in amyloidosis. Treatment options have, until recently, been limited but cardiac amyloidosis is the focus of novel therapeutic regimes. New insights into the pathophysiological mechanisms resulting in disease have suggested exciting targets for drug therapy.
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Affiliation(s)
- Jason N Dungu
- Essex Cardiothoracic Centre, Basildon University Hospital, Basildon, United Kingdom
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