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AL_Akhali ES, Alshoabi SA, Hamid AM, Alsultan KD, Omer AM, Alhammadi MA. Cardiac amyloidosis: A diagnostic challenge. Radiol Case Rep 2024; 19:4730-4735. [PMID: 39228955 PMCID: PMC11366889 DOI: 10.1016/j.radcr.2024.07.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 09/05/2024] Open
Abstract
Cardiac amyloidosis is indeed a condition characterized by the deposition of amyloid proteins in the myocardium, leading to thickening and stiffening of the heart muscle. These abnormal protein deposits can interfere with the heart's normal functioning and may pose diagnostic challenges due to its varied clinical presentation and resemblance to other heart condition. Here, we present a case of 55-year-old female patient of uncontrolled hypertensions for 15 years. About 15 years ago, she presented with chest pain and was diagnosed with cardiomyopathy (CM) characterized by low left ventricle (LV) function of unknown cause. Despite being on antihypertensive treatment, the patient continued to experience chest heaviness with persistent elevate blood pressure. An echocardiogram revealed increased LV septal wall thickness, valvular thickening, and biatrial dilation. Subsequently, cardiac magnetic resonance imaging (CMR) was performed, which revealed left atrium enlargement and asymmetrical myocardial wall thickening, particularly at the septum. White blood axial image revealed thickened inter atrial septum, while late gadolinium enhancement (LGE) magnetic resonance (LGE MR) images showed patchy LGE at the base relative to the apex of the myocardium, highlighting the base-to-apex gradient, subendocardial pattern enhancement at apical lateral wall, and transmural pattern enhancement of the mid anteroseptal and inferoseptal wall. Additionally, a short axis time to invert T1 scout image of left ventricle displayed an abnormal nulling pattern initially in the myocardium, followed by the blood pool, and finally the spleen. These findings collectively led to the diagnosis of cardiac amyloidosis.
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Affiliation(s)
| | - Sultan A. Alshoabi
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | | | - Kamal D. Alsultan
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Awatif M. Omer
- Department of Diagnostic Radiology, College of Applied Medical Sciences, Taibah University, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Mohammed A. Alhammadi
- Diagnostic Radiology Department, King Faisal Specialist Hospital and Research Center, Al-Madinah Al-Munawwarah, Kingdom of Saudi Arabia
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2
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Kadoya Y, Omaygenc MO, Chow B, Small GR. Reproducibility of myocardial extracellular volume quantification using dual-energy computed tomography in patients with cardiac amyloidosis. J Cardiovasc Comput Tomogr 2024:S1934-5925(24)00445-3. [PMID: 39368897 DOI: 10.1016/j.jcct.2024.09.011] [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] [Received: 06/28/2024] [Accepted: 09/26/2024] [Indexed: 10/07/2024]
Abstract
BACKGROUND Quantifying myocardial extracellular volume (ECV) using computed tomography (CT) has been shown to be useful in the evaluation of cardiac amyloidosis. However, the reproducibility of CT measurements for myocardial ECV, is not well-established in patients with proven cardiac amyloidosis. METHODS This prospective single-center study enrolled cardiac amyloidosis patients to undergo dual-energy CT for myocardial fibrosis assessment. Delayed imaging at 7 and 8 min post-contrast and independent evaluations by two blinded cardiologists were performed for ECV quantification using 16-segment (ECVglobal) and septal sampling (ECVseptal). Inter- and intraobserver variability and test-retest reliability were measured using Spearman's rank correlation, Bland-Altman analysis, and intraclass correlation coefficients (ICC). RESULTS Among the 24 participants (median age = 78, 67 % male), CT ECVglobal and ECVseptal showed median values of 53.6 % and 49.1 % at 7 min, and 53.3 % and 50.1 % at 8 min, respectively. Inter- and intraobserver variability and test-retest reliability for CT ECVglobal (ICC = 0.798, 0.912, and 0.894, respectively) and ECVseptal (ICC = 0.791, 0.898, and 0.852, respectively) indicated good reproducibility, with no evidence of systemic bias between observers or scans. CONCLUSIONS Dual-energy CT-derived ECV measurements demonstrated good reproducibility in patients with proven cardiac amyloidosis, suggesting potential utility as a repeatable imaging biomarker for this disease.
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Affiliation(s)
- Yoshito Kadoya
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Mehmet Onur Omaygenc
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Benjamin Chow
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada
| | - Gary R Small
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, K1Y 4W7, Canada.
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Dobner S, Bernhard B, Ninck L, Wieser M, Bakula A, Wahl A, Köchli V, Spano G, Boscolo Berto M, Elchinova E, Safarkhanlo Y, Stortecky S, Schütze J, Shiri I, Hunziker L, Gräni C. Impact of tafamidis on myocardial function and CMR tissue characteristics in transthyretin amyloid cardiomyopathy. ESC Heart Fail 2024; 11:2759-2768. [PMID: 38736040 PMCID: PMC11424336 DOI: 10.1002/ehf2.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/28/2024] [Accepted: 04/01/2024] [Indexed: 05/14/2024] Open
Abstract
AIMS Tafamidis improves clinical outcomes in transthyretin amyloid cardiomyopathy (ATTR-CM), yet how tafamidis affects cardiac structure and function remains poorly described. This study prospectively analysed the effect of tafamidis on 12-month longitudinal changes in cardiac structure and function by cardiac magnetic resonance (CMR) compared with the natural course of disease in an untreated historic control cohort. METHODS AND RESULTS ATTR-CM patients underwent CMR at tafamidis initiation and at 12 months. Untreated patients with serial CMRs served as reference to compare biventricular function, global longitudinal strain (GLS), LV mass and extracellular volume fraction (ECV). Thirty-six tafamidis-treated (n = 35; 97.1% male) and 15 untreated patients (n = 14; 93.3% male) with a mean age of 78.3 ± 6.5 and 76.9 ± 6.5, respectively, and comparable baseline characteristics were included. Tafamidis was associated with preserving biventricular function (LVEF (%): 50.5 ± 12 to 50.7 ± 11.5, P = 0.87; RVEF (%): 48.2 ± 10.4 to 48.2 ± 9.4, P = 0.99) and LV-GLS (-9.6 ± 3.2 to -9.9 ± 2.4%; P = 0.595) at 12 months, while a significantly reduced RV-function (50.8 ± 7.3 to 44.2 ± 11.6%, P = 0.028; P (change over time between groups) = 0.032) and numerically worsening LVGLS (-10.9 ± 3.3 to -9.1 ± 2.9%, P = 0.097; P (change over time between groups) = 0.048) was observed without treatment. LV mass significantly declined with tafamidis (184.7 ± 47.7 to 176.5 ± 44.3 g; P = 0.011), yet remained unchanged in untreated patients (163.8 ± 47.5 to 171.2 ± 39.7 g P = 0.356, P (change over time between groups) = 0.027). Irrespective of tafamidis, ECV and native T1-mapping did not change significantly from baseline to 12-month follow-up (P > 0.05). CONCLUSIONS Compared with untreated ATTR-CM patients, initiation of tafamidis preserved CMR-measured biventricular function and reduced LV mass at 12 months. ECV and native T1-mapping did not change significantly comparable to baseline in both groups.
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Affiliation(s)
- Stephan Dobner
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Lorenz Ninck
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Monika Wieser
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Adam Bakula
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Andreas Wahl
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Valentin Köchli
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Martina Boscolo Berto
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Elena Elchinova
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Yasaman Safarkhanlo
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Jonathan Schütze
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
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4
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Rettl R, Calabretta R, Duca F, Kronberger C, Binder C, Willixhofer R, Poledniczek M, Hofer F, Doná C, Beitzke D, Loewe C, Nitsche C, Hengstenberg C, Badr Eslam R, Kastner J, Bergler-Klein J, Hacker M, Kammerlander AA. DPD Quantification Correlates With Extracellular Volume and Disease Severity in Wild-Type Transthyretin Cardiac Amyloidosis. JACC. ADVANCES 2024; 3:101261. [PMID: 39309666 PMCID: PMC11416666 DOI: 10.1016/j.jacadv.2024.101261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/01/2024] [Accepted: 08/12/2024] [Indexed: 09/25/2024]
Abstract
Background The pathophysiological hallmark of wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is the deposition of amyloid within the myocardium. Objectives This study aimed to investigate associations between quantitative cardiac 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) uptake and myocardial amyloid burden, cardiac function, cardiac biomarkers, and clinical status in ATTRwt-CM. Methods Forty ATTRwt-CM patients underwent quantitative DPD single photon emission computed tomography/computed tomography to determine the standardized uptake value (SUV) retention index, cardiac magnetic resonance imaging to determine extracellular volume (ECV) and cardiac function (RV-LS), and assessment of cardiac biomarkers (N-terminal prohormone of brain natriuretic peptide [NT-proBNP], troponin T) and clinical status (6-minute walk distance [6MWD], National Amyloidosis Centre [NAC] stage). ATTRwt-CM patients were divided into 2 cohorts based on median SUV retention index (low uptake: <5.19 mg/dL, n = 20; high uptake: ≥5.19 mg/dL, n = 20). Linear regression models were used to assess associations of the SUV retention index with variables of interest and the Mann-Whitney U or chi-squared test to compare variables between groups. Results ATTRwt-CM patients (n = 40) were elderly (78.0 years) and predominantly male (75.0%). Univariable linear regression analyses revealed associations of the SUV retention index with ECV (r = 0.669, β = 0.139, P < 0.001), native T1 time (r = 0.432, β = 0.020, P = 0.005), RV-LS (r = 0.445, β = 0.204, P = 0.004), NT-proBNP (log10) (r = 0.458, β = 2.842, P = 0.003), troponin T (r = 0.422, β = 0.048, P = 0.007), 6MWD (r = 0.385, β = -0.007, P = 0.017), and NAC stage (r = 0.490, β = 1.785, P = 0.001). Cohort comparison demonstrated differences in ECV (P = 0.001), native T1 time (P = 0.013), RV-LS (P = 0.003), NT-proBNP (P < 0.001), troponin T (P = 0.046), 6MWD (P = 0.002), and NAC stage (I: P < 0.001, II: P = 0.030, III: P = 0.021). Conclusions In ATTRwt-CM, quantitative cardiac DPD uptake correlates with myocardial amyloid load, longitudinal cardiac function, cardiac biomarkers, exercise capacity, and disease stage, providing a valuable tool to quantify and monitor cardiac disease burden.
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Affiliation(s)
- René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Raffaella Calabretta
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Kronberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Robin Willixhofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael Poledniczek
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Felix Hofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Carolina Doná
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Jutta Bergler-Klein
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas A. Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Krittanawong C, Britt WM, Rizwan A, Siddiqui R, Khawaja M, Khan R, Joolharzadeh P, Newman N, Rivera MR, Tang WHW. Clinical Update in Heart Failure with Preserved Ejection Fraction. Curr Heart Fail Rep 2024; 21:461-484. [PMID: 39225910 DOI: 10.1007/s11897-024-00679-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW To review the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trends in cardiometabolic interventions. RECENT FINDINGS Heart failure with preserved ejection fraction makes up approximately half of overall heart failure and is associated with significant morbidity, mortality, and overall burden on the healthcare system. It is a complex, heterogenous syndrome and clinical trials, to this point, have not revealed quite as many effective treatment options when compared to heart failure with reduced ejection fraction. Nevertheless, there is an expanding amount of data insight into the pathogenesis of this disease and the potential for newer therapies and management strategies. Heart failure with preserved ejection fraction pathology has been found to be linked to abnormal energetics, myocyte hypertrophy, cell signaling, inflammation, ischemia, and fibrosis. These mechanisms also intricately overlap with the significant comorbidities often associated with heart failure with preserved ejection fraction including, but not limited to, atrial fibrillation, chronic kidney disease, hypertension, obesity and coronary artery disease. Treatment of this disease, therefore, should focus on the management and strict regulation of these comorbidities by pharmacologic and nonpharmacologic means. In this review, a clinical update is provided reviewing the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trend in cardiometabolic interventions.
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Affiliation(s)
| | - William Michael Britt
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Affan Rizwan
- Baylor College of Medicine, Houston, TX, 77030, USA
| | - Rehma Siddiqui
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Muzamil Khawaja
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Rabisa Khan
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Pouya Joolharzadeh
- John T Milliken Department of Medicine, Division of Cardiovascular Disease, Barnes-Jewish Hospital, St Louis, United States
| | - Noah Newman
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Mario Rodriguez Rivera
- Advanced Heart Failure and Transplant, Barnes-Jewish Hospital Washington University in St Louis School of Medicine, St.Louis, MO, USA
| | - W H Wilson Tang
- Kaufman Center for Heart Failure Treatment and Recovery, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
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Kravchenko D, Isaak A, Zimmer S, Öztürk C, Mesropyan N, Bischoff LM, Voigt M, Ginzburg D, Attenberger U, Pieper CC, Kuetting D, Luetkens JA. Parametric mapping using cardiovascular magnetic resonance for the differentiation of light chain amyloidosis and transthyretin-related amyloidosis. Eur Heart J Cardiovasc Imaging 2024; 25:1451-1461. [PMID: 38912832 DOI: 10.1093/ehjci/jeae154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/25/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024] Open
Abstract
AIMS To evaluate different cardiovascular magnetic resonance (CMR) parameters for the differentiation of light chain amyloidosis (AL) and transthyretin-related amyloidosis (ATTR). METHODS AND RESULTS In total, 75 patients, 53 with cardiac amyloidosis {20 patients with AL [66 ± 12 years, 14 males (70%)] and 33 patients with ATTR [78 ± 5 years, 28 males (88%)]} were retrospectively analysed regarding CMR parameters such as T1 and T2 mapping, extracellular volume (ECV), late gadolinium enhancement (LGE) distribution patterns, and myocardial strain, and compared to a control cohort with other causes of left ventricular hypertrophy {LVH; 22 patients [53 ± 16 years, 17 males (85%)]}. One-way ANOVA and receiver operating characteristic analysis were used for statistical analysis. ECV was the single best parameter to differentiate between cardiac amyloidosis and controls [area under the curve (AUC): 0.97, 95% confidence intervals (CI): 0.89-0.99, P < 0.0001, cut-off: >30%]. T2 mapping was the best single parameter to differentiate between AL and ATTR amyloidosis (AL: 63 ± 4 ms, ATTR: 58 ± 2 ms, P < 0.001, AUC: 0.86, 95% CI: 0.74-0.94, cut-off: >61 ms). Subendocardial LGE was predominantly observed in AL patients (10/20 [50%] vs. 5/33 [15%]; P = 0.002). Transmural LGE was predominantly observed in ATTR patients (23/33 [70%] vs. 2/20 [10%]; P < 0.001). The diagnostic performance of T2 mapping to differentiate between AL and ATTR amyloidosis was further increased with the inclusion of LGE patterns [AUC: 0.96, 95% CI: (0.86-0.99); P = 0.05]. CONCLUSION ECV differentiates cardiac amyloidosis from other causes of LVH. T2 mapping combined with LGE differentiates AL from ATTR amyloidosis with high accuracy on a patient level.
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Affiliation(s)
- Dmitrij Kravchenko
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II-Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Can Öztürk
- Department of Internal Medicine II-Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Narine Mesropyan
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Leon M Bischoff
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marilia Voigt
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Ginzburg
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Attenberger
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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González-Moreno J, Galán Dávila L, Gonzalez-Lopez E, Conceiçao I. [Recommendations update for the diagnosis and treatment of transthyretin variant amyloidosis (ATTRv)]. Med Clin (Barc) 2024; 163:e69-e77. [PMID: 38897900 DOI: 10.1016/j.medcli.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Juan González-Moreno
- Servicio de Medicina Interna, Hospital Son Llàtzer. Instituto de Investigación Sanitaria Illes Balears (idISBA), Palma de Mallorca, España.
| | - Lucía Galán Dávila
- Servicio de Neurología, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Esther Gonzalez-Lopez
- Unidad de Cardiopatías Familiares e Insuficiencia Cardíaca, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, CIBERCV, Majadahonda, Madrid, España
| | - Isabel Conceiçao
- Serviço de Neurologia, Departamento de Neurociências, Hospital de Santa Maria (CHULN). Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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8
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Bashir Z, Musharraf M, Azam R, Bukhari S. Imaging modalities in cardiac amyloidosis. Curr Probl Cardiol 2024; 49:102858. [PMID: 39299367 DOI: 10.1016/j.cpcardiol.2024.102858] [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: 09/11/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by the deposition of amyloid fibrils in the myocardium, presenting primarily as transthyretin cardiac amyloidosis (ATTR) and immunoglobulin light chain cardiac amyloidosis (AL). ATTR is further classified into wild-type (ATTRwt) and hereditary (ATTRv) based on transthyretin gene mutation. The disease is increasingly recognized as a significant cause of heart failure. Advances in diagnostic modalities, including electrocardiography, echocardiography, cardiac magnetic resonance imaging, and technetium pyrophosphate scintigraphy, have revolutionized the non-invasive diagnosis of CA. While ATTR can often be diagnosed with scintigraphy, AL typically requires histological confirmation. This review explores these diagnostic tools, emphasizing their role in early detection and quantification of disease burden, which are crucial for timely treatment and prognostication. This comprehensive overview aims to aid clinicians in efficiently diagnosing CA, ultimately improving patient outcomes.
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Affiliation(s)
- Zubair Bashir
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Syed Bukhari
- Department of Cardiovascular Medicine, Johns Hopkins University, Baltimore, MD, USA.
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9
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Small GR. Myocardial extracellular volume by CT: Assessing the state of the union. J Cardiovasc Comput Tomogr 2024; 18:465-466. [PMID: 39098511 DOI: 10.1016/j.jcct.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Gary R Small
- Division of Cardiology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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10
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Regan JA, Fontana M, Selvaraj S. Genotype- vs Phenotype-Guided Approaches to Improve ATTR Detection. JAMA Cardiol 2024:2822887. [PMID: 39196584 DOI: 10.1001/jamacardio.2024.2654] [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: 08/29/2024]
Affiliation(s)
- Jessica A Regan
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Senthil Selvaraj
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
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11
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Lauwers C, Rosseel T, Droogné W, Van Aelst LNL, Van Cleemput J. A case report of transthyretin amyloidosis following cardiac transplantation: thick ventricles that look alike. Eur Heart J Case Rep 2024; 8:ytae242. [PMID: 39139853 PMCID: PMC11319867 DOI: 10.1093/ehjcr/ytae242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/24/2024] [Accepted: 05/07/2024] [Indexed: 08/15/2024]
Abstract
Background Transthyretin (ATTR) amyloidosis is more prevalent than initially thought. As much as 13% of patients hospitalized with heart failure with preserved ejection fraction may have ATTR-cardiomyopathy (CM). Conversely, heart transplant patients may manifest left ventricular hypertrophy or diastolic dysfunction, especially late after transplantation. Case summary We present a case of a 82-year-old male heart transplant patient, 31 years following orthotopic heart transplantation. While he was satisfied with his exercise capacity as an octogenarian, several years before, he required pacemaker implantation due to third-degree atrioventricular block, had bilateral carpal tunnel syndrome treated with carpal tunnel release surgery, and experienced idiopathic sudden deafness. Based on increasing left ventricular wall thickness during routine follow-up, a diagnosis of ATTR amyloidosis was suspected. Ultimately, the diagnosis was confirmed non-invasively with a specific scintigraphic exam, while an additional physicochemical stain on an endomyocardial biopsy taken several years before provided pathological proof. We initiated tafamidis, yet stopped this treatment after 1 month because of gastrointestinal intolerance. Ultimately, our patient died 2 years later due to heart failure. Discussion Our case shows the long delay between the onset of ATTR deposition, the presence of clinical signs, and the final diagnosis. Echocardiographic findings suggestive for ATTR-CM include left ventricular hypertrophy and diastolic dysfunction, which are both common in heart transplant patients. Yet, ATTR-CM should be considered in the differential diagnosis, especially late after transplantation, in this closely monitored population.
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Affiliation(s)
- Charlotte Lauwers
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Thomas Rosseel
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Walter Droogné
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lucas N L Van Aelst
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Sciences, campus Gasthuisberg, O&N1, Herestraat 49 box 911, 3000 Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Cardiovascular Sciences, campus Gasthuisberg, O&N1, Herestraat 49 box 911, 3000 Leuven, Belgium
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12
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Dungu JN, Hardy-Wallace A, Dimarco AD, Savage HO. Hypertrophic Cardiomyopathy. Curr Heart Fail Rep 2024; 21:428-438. [PMID: 38488965 DOI: 10.1007/s11897-024-00654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE OF REVIEW Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac condition with potential for severe complications including sudden cardiac death. Early diagnosis allows appropriate risk stratification and prompt intervention to minimise the potential for adverse outcomes. The implications of poorly coordinated screening are significant, either missing relatives at high-risk or burdening low-risk individuals with a diagnosis associated with reduced life expectancy. We aim to guide clinicians through the diagnostic pathway through to novel treatment options. Several conditions mimic the condition, and we discuss the phenocopies and how to differentiate from HCM. RECENT FINDINGS We summarise the latest developments informing clinical decision making in the modern era of myosin inhibitors and future gene editing therapies. Early identification will enable prompt referral to specialist centres. A diagnostic flowchart is included, to guide the general cardiology and heart failure clinician in important decision making regarding the care of the HCM patient and importantly their relatives at risk. We have highlighted the importance of screening because genotype-positive/phenotype-negative patients are likely to have the most to gain from novel therapies.
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Affiliation(s)
- Jason N Dungu
- Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex SS16 5NL, UK.
- Anglia Ruskin University, Chelmsford, UK.
| | - Amy Hardy-Wallace
- Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex SS16 5NL, UK
| | - Anthony D Dimarco
- Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex SS16 5NL, UK
| | - Henry O Savage
- Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex SS16 5NL, UK
- Anglia Ruskin University, Chelmsford, UK
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13
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Barison A, Gueli IA, Pizzino F, Grigoratos C, Todiere G. Cardiovascular Magnetic Resonance in the Management of Cardiac Amyloidosis: Current and Future Clinical Applications. Heart Fail Clin 2024; 20:295-305. [PMID: 38844300 DOI: 10.1016/j.hfc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Cardiac magnetic resonance represents the gold standard imaging technique to assess cardiac volumes, wall thickness, mass, and systolic function but also to provide noninvasive myocardial tissue characterization across almost all cardiac diseases. In patients with cardiac amyloidosis, increased wall thickness of all heart chambers, a mildly reduced ejection fraction and occasionally pleural and pericardial effusion are the characteristic morphologic anomalies. The typical pattern after contrast injection is represented by diffuse areas of late gadolinium enhancement, which can be focal and patchy in very early stages, circumferential, and subendocardial in intermediate stages or even diffuse transmural in more advanced stages.
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Affiliation(s)
- Andrea Barison
- Department of Cardiology and Cardiovascular Medicine, Fondazione "Gabriele Monasterio" CNR - Regione Toscana, Via Moruzzi, 1, Pisa 56124, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa 56127, Italy.
| | - Ignazio Alessio Gueli
- Department of Cardiology and Cardiovascular Medicine, Fondazione "Gabriele Monasterio" CNR - Regione Toscana, Via Moruzzi, 1, Pisa 56124, Italy; Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, Pisa 56127, Italy
| | - Fausto Pizzino
- Ospedale del Cuore, Fondazione "Gabriele Monasterio" CNR - Regione Toscana, Via Aurelia Sud, Massa 54100, Italy
| | - Chrysanthos Grigoratos
- Department of Cardiology and Cardiovascular Medicine, Fondazione "Gabriele Monasterio" CNR - Regione Toscana, Via Moruzzi, 1, Pisa 56124, Italy
| | - Giancarlo Todiere
- Department of Cardiology and Cardiovascular Medicine, Fondazione "Gabriele Monasterio" CNR - Regione Toscana, Via Moruzzi, 1, Pisa 56124, Italy
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14
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Ramanauskaitė D, Balčiūnaitė G, Palionis D, Besusparis J, Žurauskas E, Janušauskas V, Zorinas A, Valevičienė N, Sogaard P, Glaveckaitė S. The Relative Apical Sparing Strain Pattern in Severe Aortic Valve Stenosis: A Marker of Adverse Cardiac Remodeling. J Pers Med 2024; 14:707. [PMID: 39063961 PMCID: PMC11277935 DOI: 10.3390/jpm14070707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The presence of a relative apical sparing (RAS) echocardiographic strain pattern raises a suspicion of underlying cardiac amyloidosis (CA). However, it is also increasingly observed in patients with aortic stenosis (AS). We aimed to evaluate the prevalence, dynamics, and clinical characteristics of the RAS strain pattern in severe AS patients who had been referred for surgical aortic valve replacement (SAVR). METHODS A total of 77 patients with severe AS and without CA were included with a mean age of 70 (62-73) years, 58% female, a mean aortic valve area index of 0.45 ± 0.1 cm2/m2, and a mean gradient of 54.9 (45-70) mmHg. RESULTS An RAS strain pattern was detected in 14 (18%) patients. RAS-positive patients had a significantly higher LV mass index (125 ± 28 g/m2 vs. 91 ± 32, p = 0.001), a lower LV ejection fraction (62 ± 12 vs. 68 ± 13, p = 0.040), and lower global longitudinal strain (-14.9 ± 3 vs. -18.7 ± 5%, p = 0.002). RAS strain pattern-positive patients also had higher B-type natriuretic peptide (409 (161-961) vs. 119 (66-245) pg/L, p = 0.032) and high-sensitivity troponin I (15 (13-29) vs. 9 (5-18) pg/L, p = 0.026) levels. Detection of an RAS strain pattern was strongly associated with increased LV mass index (OR 1.03, 95% CI 1.01-1.06, p < 0.001). The RAS strain pattern had resolved in all patients by 3 months after SAVR. CONCLUSIONS Our findings suggest that the RAS strain pattern can be present in patients with severe AS without evidence of CA. The presence of an RAS strain pattern is associated with adverse LV remodeling, and it resolves after SAVR.
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Affiliation(s)
- Dovilė Ramanauskaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariškių Str. 2, LT-08410 Vilnius, Lithuania
| | - Giedrė Balčiūnaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariškių Str. 2, LT-08410 Vilnius, Lithuania
| | - Darius Palionis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariškių Str. 2, LT-08410 Vilnius, Lithuania
| | - Justinas Besusparis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, P. Baublio Str. 5, LT-08406 Vilnius, Lithuania
| | - Edvardas Žurauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, P. Baublio Str. 5, LT-08406 Vilnius, Lithuania
| | - Vilius Janušauskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariškių Str. 2, LT-08410 Vilnius, Lithuania
| | - Aleksejus Zorinas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariškių Str. 2, LT-08410 Vilnius, Lithuania
| | - Nomeda Valevičienė
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariškių Str. 2, LT-08410 Vilnius, Lithuania
| | - Peter Sogaard
- Departament of Cardiology, Faculty of Medicine, Department of Clinical Medicine, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Sigita Glaveckaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Santariškių Str. 2, LT-08410 Vilnius, Lithuania
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15
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Benz DC, Dorbala S. Multimodality imaging of cardiac amyloidosis. Heart 2024; 110:873-882. [PMID: 37586824 PMCID: PMC10869633 DOI: 10.1136/heartjnl-2022-321115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Dominik C Benz
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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16
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Grazzini G, Pradella S, Bani R, Fornaciari C, Cappelli F, Perfetto F, Cozzi D, Giovannelli S, Sica G, Miele V. The Role of T2 Mapping in Cardiac Amyloidosis. Diagnostics (Basel) 2024; 14:1048. [PMID: 38786346 PMCID: PMC11120592 DOI: 10.3390/diagnostics14101048] [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: 03/27/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy divided into two types: light-chain (LA) and transthyretin (ATTR) CA. Cardiac magnetic resonance (CMR) has emerged as an important diagnostic tool in CA. While late gadolinium enhancement (LGE), T1 mapping and extracellular volume (ECV) have a consolidate role in the assessment of CA, T2 mapping has been less often evaluated. We aimed to test the value of T2 mapping in the evaluation of CA. This study recruited 70 patients with CA (51 ATTR, 19 AL). All the subjects underwent 1.5 T CMR with T1 and T2 mapping and cine and LGE imaging. Their QALE scores were evaluated. The myocardial T2 values were significantly (p < 0.001) increased in both types of CA compared to the controls. In the AL-CA group, increased T2 values were associated with a higher QALE score. The myocardial native T1 values and ECV were significantly (p < 0.001) higher in the CA patients than in the healthy subjects. Left ventricular (LV) mass, QALE score and ECV were higher in ATTR amyloidosis compared with AL amyloidosis, while the LV ejection fraction was lower (p < 0.001). These results support the concept of the presence of myocardial edema in CA. Therefore, a CMR evaluation including not only myocardial T1 imaging but also myocardial T2 imaging allows for more comprehensive tissue characterization in CA.
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Affiliation(s)
- Giulia Grazzini
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Rossella Bani
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Chiara Fornaciari
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesco Cappelli
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Largo Piero Palagi 1, 50134 Florence, Italy
| | - Federico Perfetto
- Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Largo Piero Palagi 1, 50134 Florence, Italy
| | - Diletta Cozzi
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Simona Giovannelli
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
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17
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Beauvais D, Labeyrie C, Cauquil C, Francou B, Eliahou L, Not A, Echaniz-Laguna A, Adam C, Slama MS, Benmalek A, Leonardi L, Rouzet F, Adams D, Algalarrondo V, Beaudonnet G. Detailed clinical, physiological and pathological phenotyping can impact access to disease-modifying treatments in ATTR carriers. J Neurol Neurosurg Psychiatry 2024; 95:489-499. [PMID: 37875336 PMCID: PMC11103288 DOI: 10.1136/jnnp-2023-332180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis is a life-threatening autosomal dominant systemic disease due to pathogenic TTR variants (ATTRv), mostly affecting the peripheral nerves and heart. The disease is characterised by a combination of symptoms, organ involvement and histological amyloid deposition. The available disease-modifying ATTRv treatments (DMTs) are more effective if initiated early. Pathological nerve conduction studies (NCS) results are the cornerstone of large-fibre polyneuropathy diagnosis, but this anomaly occurs late in the disease. We investigated the utility of a multimodal neurological and cardiac evaluation for detecting early disease onset in ATTRv carriers. METHODS We retrospectively analysed a cohort of ATTRv carriers with normal NCS results regardless of symptoms. Multimodal denervation and infiltration evaluations included a clinical questionnaire (Lauria and New York Heart Association (NYHA)) and examination, intra-epidermal nerve fibre density assessment, autonomic assessment based on heart rate variability, Sudoscan, meta-iodo-benzyl-guanidine scintigraphy, cardiac biomarkers, echocardiography, MRI and searches for amyloidosis on skin biopsy and bone scintigraphy. RESULTS We included 130 ATTRv carriers (40.8% men, age: 43.6±13.5 years), with 18 amyloidogenic TTR gene mutations, the majority of which was the late-onset Val30Met variant (42.3%). Amyloidosis was detected in 16.9% of mutation carriers, including 9 (6.9%) with overt disease (Lauria>2 or NYHA>1) and 13 asymptomatic carriers (10%) with organ involvement (small-fibre neuropathy or cardiomyopathy). Most of these patients received DMT. Abnormal test results of unknown significance were obtained for 105 carriers (80.8%). Investigations were normal in only three carriers (2.3%). CONCLUSIONS Multimodal neurological and cardiac investigation of TTRv carriers is crucial for the early detection of ATTRv amyloidosis and initiation of DMT.
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Affiliation(s)
- Diane Beauvais
- AP-HP, Service de neurologie, CHU Bicêtre, Centre de référence national des neuropathies amyloïdes familiales et autres neuropathies périphériques rares, CERAMIC, FILNEMUS Network, Le Kremlin-Bicêtre, France
- Department of Neurology (Nerve-Muscle Unit), AOC National Reference Center for Neuromuscular Disorders, University Hospital of Bordeaux (CHU Pellegrin), Bordeaux, France
| | - Céline Labeyrie
- AP-HP, Service de neurologie, CHU Bicêtre, Centre de référence national des neuropathies amyloïdes familiales et autres neuropathies périphériques rares, CERAMIC, FILNEMUS Network, Le Kremlin-Bicêtre, France
| | - Cécile Cauquil
- AP-HP, Service de neurologie, CHU Bicêtre, Centre de référence national des neuropathies amyloïdes familiales et autres neuropathies périphériques rares, CERAMIC, FILNEMUS Network, Le Kremlin-Bicêtre, France
| | - Bruno Francou
- AP-HP, Laboratoire de Génétique Moléculaire, Pharmacogénétique et Hormonologie, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Adeline Not
- AP-HP, Service de neurologie, CHU Bicêtre, Centre de référence national des neuropathies amyloïdes familiales et autres neuropathies périphériques rares, CERAMIC, FILNEMUS Network, Le Kremlin-Bicêtre, France
| | - Andoni Echaniz-Laguna
- AP-HP, Service de neurologie, CHU Bicêtre, Centre de référence national des neuropathies amyloïdes familiales et autres neuropathies périphériques rares, CERAMIC, FILNEMUS Network, Le Kremlin-Bicêtre, France
- Université de Paris-Saclay, INSERM U1195, Le Kremlin-Bicêtre, France
| | - Clovis Adam
- AP-HP, Service d'Anatomopathologie Clinique, CHU Bicêtre, Le Kremlin-Bicêtre, France
| | - Michel S Slama
- AP-HP, Département de Cardiologie, CHU Bichat, Paris, France
| | - Anouar Benmalek
- Faculté de Pharmacie, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Luca Leonardi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - François Rouzet
- AP-HP, Service de Médecine nucléaire, CHU Bichat, Paris, France
| | - David Adams
- AP-HP, Service de neurologie, CHU Bicêtre, Centre de référence national des neuropathies amyloïdes familiales et autres neuropathies périphériques rares, CERAMIC, FILNEMUS Network, Le Kremlin-Bicêtre, France
- Université de Paris-Saclay, INSERM U1195, Le Kremlin-Bicêtre, France
| | - Vincent Algalarrondo
- AP-HP, Département de Cardiologie, CHU Bichat, Paris, France
- Université Paris Cité, Paris, France
| | - Guillemette Beaudonnet
- AP-HP, Service de neurologie, CHU Bicêtre, Centre de référence national des neuropathies amyloïdes familiales et autres neuropathies périphériques rares, CERAMIC, FILNEMUS Network, Le Kremlin-Bicêtre, France
- AP-HP, Unité de Neurophysiologie Clinique et Epileptologie (UNCE), CHU Bicêtre, Le Kremlin-Bicêtre, France
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18
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Porcari A, Sinagra G, Gillmore JD, Fontana M, Hawkins PN. Breakthrough advances enhancing care in ATTR amyloid cardiomyopathy. Eur J Intern Med 2024; 123:29-36. [PMID: 38184468 DOI: 10.1016/j.ejim.2024.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) has been traditionally considered a rare and inexorably fatal condition. ATTR-CM now is an increasingly recognized cause of heart failure (HF) and mortality worldwide with effective pharmacological treatments. Advances in non-invasive diagnosis, coupled with the development of effective treatments, have transformed the diagnosis of ATTR-CM, which is now possible without recourse to endomyocardial biopsy in ≈70 % of cases. Many patients are now diagnosed at an earlier stage. Echocardiography and cardiac magnetic resonance have enabled identification of patients with possible ATTR-CM and more accurate prognostic stratification. Although radionuclide scintigraphy with 'bone' tracers has an established diagnostic value, the diagnostic performance of the bone tracers validated for non-invasive confirmation of ATTR-CM may not be equal. Characterising the wider clinical phenotype of patients with ATTR-CM has enabled identification of features with potential for earlier diagnosis such as carpal tunnel syndrome. Therapies able to slow or halt ATTR-CM progression and increase survival are now available and there is also evidence that patients may benefit from specific conventional HF medications. Cutting-edge research in the field of antibody-mediated removal of ATTR deposits compellingly suggest that ATTR-CM is a truly reversible disorder, bringing hope for patients even with advanced disease. A wide horizon of possibilities is unfolding and awaits discovery.
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Affiliation(s)
- Aldostefano Porcari
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK; Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste 34149, Italy; European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy.
| | - Gianfranco Sinagra
- Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste 34149, Italy; European Reference Network for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Italy
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK
| | - Philip N Hawkins
- National Amyloidosis Centre, Division of Medicine, Royal Free Campus, University College London, Rowland Hill Street, London NW3 2PF, UK
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19
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Martini N, Sinigiani G, De Michieli L, Mussinelli R, Perazzolo Marra M, Iliceto S, Zorzi A, Perlini S, Corrado D, Cipriani A. Electrocardiographic features and rhythm disorders in cardiac amyloidosis. Trends Cardiovasc Med 2024; 34:257-264. [PMID: 36841466 DOI: 10.1016/j.tcm.2023.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/27/2023]
Abstract
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by extracellular deposition of amyloid fibrils, mainly derived from transthyretin, either wild-type or hereditary variants, or immunoglobulin light chains misfolding. It is characterized by an increased left ventricular (LV) mass and diastolic dysfunction, which can lead to heart failure with preserved ejection fraction and/or conduction disturbances. The diagnosis is based on invasive pathology demonstration of amyloid deposits, or non-invasive criteria using advanced cardiovascular imaging techniques. Nevertheless, 12-lead electrocardiogram (ECG) remains of crucial importance in the assessment of patients with CA, since they can manifest peculiar features such as low QRS voltages, in discordance with the LV hypertrophy, but also pseudo-infarction patterns, sinus node dysfunction, atrioventricular blocks, premature supraventricular and ventricular beats, which support the presence of a myocardial disease. Great awareness of these common ECG characteristics of CA is needed to increase diagnostic performance and improve patient's outcome. In the present review, we discuss the current role of the ECG in the diagnosis and management of CA, focusing on the most common ECG abnormalities and rhythm disorders.
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Affiliation(s)
- Nicolò Martini
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
| | - Giulio Sinigiani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
| | - Laura De Michieli
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Martina Perazzolo Marra
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
| | - Sabino Iliceto
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
| | - Alessandro Zorzi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
| | - Stefano Perlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy; Emergency Medicine, Vascular and Metabolic Disease Unit, Department of Internal Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy
| | - Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Via Giustiniani, 2, Padua 35128, Italy.
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20
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Forleo C, Carella MC, Basile P, Mandunzio D, Greco G, Napoli G, Carulli E, Dicorato MM, Dentamaro I, Santobuono VE, Memeo R, Latorre MD, Baggiano A, Mushtaq S, Ciccone MM, Pontone G, Guaricci AI. The Role of Magnetic Resonance Imaging in Cardiomyopathies in the Light of New Guidelines: A Focus on Tissue Mapping. J Clin Med 2024; 13:2621. [PMID: 38731153 PMCID: PMC11084160 DOI: 10.3390/jcm13092621] [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: 03/15/2024] [Revised: 04/27/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Cardiomyopathies (CMPs) are a group of myocardial disorders that are characterized by structural and functional abnormalities of the heart muscle. These abnormalities occur in the absence of coronary artery disease (CAD), hypertension, valvular disease, and congenital heart disease. CMPs are an increasingly important topic in the field of cardiovascular diseases due to the complexity of their diagnosis and management. In 2023, the ESC guidelines on cardiomyopathies were first published, marking significant progress in the field. The growth of techniques such as cardiac magnetic resonance imaging (CMR) and genetics has been fueled by the development of multimodal imaging approaches. For the diagnosis of CMPs, a multimodal imaging approach, including CMR, is recommended. CMR has become the standard for non-invasive analysis of cardiac morphology and myocardial function. This document provides an overview of the role of CMR in CMPs, with a focus on tissue mapping. CMR enables the characterization of myocardial tissues and the assessment of cardiac functions. CMR sequences and techniques, such as late gadolinium enhancement (LGE) and parametric mapping, provide detailed information on tissue composition, fibrosis, edema, and myocardial perfusion. These techniques offer valuable insights for early diagnosis, prognostic evaluation, and therapeutic guidance of CMPs. The use of quantitative CMR markers enables personalized treatment plans, improving overall patient outcomes. This review aims to serve as a guide for the use of these new tools in clinical practice.
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Affiliation(s)
- Cinzia Forleo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Donato Mandunzio
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Giulia Greco
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluigi Napoli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Eugenio Carulli
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Marco Maria Dicorato
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Ilaria Dentamaro
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Vincenzo Ezio Santobuono
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Riccardo Memeo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Michele Davide Latorre
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (A.B.); (S.M.); (G.P.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20138 Milan, Italy
| | - Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, 70124 Bari, Italy; (C.F.); (M.C.C.); (P.B.); (D.M.); (G.G.); (G.N.); (E.C.); (M.M.D.); (I.D.); (V.E.S.); (R.M.); (M.D.L.); (M.M.C.)
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Kamel MA, Abbas MT, Kanaan CN, Awad KA, Baba Ali N, Scalia IG, Farina JM, Pereyra M, Mahmoud AK, Steidley DE, Rosenthal JL, Ayoub C, Arsanjani R. How Artificial Intelligence Can Enhance the Diagnosis of Cardiac Amyloidosis: A Review of Recent Advances and Challenges. J Cardiovasc Dev Dis 2024; 11:118. [PMID: 38667736 PMCID: PMC11050851 DOI: 10.3390/jcdd11040118] [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: 02/29/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Cardiac amyloidosis (CA) is an underdiagnosed form of infiltrative cardiomyopathy caused by abnormal amyloid fibrils deposited extracellularly in the myocardium and cardiac structures. There can be high variability in its clinical manifestations, and diagnosing CA requires expertise and often thorough evaluation; as such, the diagnosis of CA can be challenging and is often delayed. The application of artificial intelligence (AI) to different diagnostic modalities is rapidly expanding and transforming cardiovascular medicine. Advanced AI methods such as deep-learning convolutional neural networks (CNNs) may enhance the diagnostic process for CA by identifying patients at higher risk and potentially expediting the diagnosis of CA. In this review, we summarize the current state of AI applications to different diagnostic modalities used for the evaluation of CA, including their diagnostic and prognostic potential, and current challenges and limitations.
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Affiliation(s)
- Moaz A. Kamel
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | | | - Kamal A. Awad
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Nima Baba Ali
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Isabel G. Scalia
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Juan M. Farina
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Ahmed K. Mahmoud
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - D. Eric Steidley
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Julie L. Rosenthal
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
- Division of Cardiovascular Imaging, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
- Division of Cardiovascular Imaging, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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22
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Maggialetti N, Torrente A, Lorusso G, Villanova I, Ficco M, Gravina M, Ferrari C, Giordano L, Granata V, Rubini D, Lucarelli NM, Stabile Ianora AA, Scardapane A. Role of Cardiovascular Magnetic Resonance in Cardiac Amyloidosis: A Narrative Review. J Pers Med 2024; 14:407. [PMID: 38673034 PMCID: PMC11051560 DOI: 10.3390/jpm14040407] [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: 03/17/2024] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Amyloidosis is a rare infiltrative condition resulting from the extracellular accumulation of amyloid fibrils at the cardiac level. It can be an acquired condition or due to genetic mutations. With the progression of imaging technologies, a non-invasive diagnosis was proposed. In this study, we discuss the role of CMR in cardiac amyloidosis, focusing on the two most common subtypes (AL and ATTR), waiting for evidence-based guidelines to be published.
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Affiliation(s)
- Nicola Maggialetti
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Andrea Torrente
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giovanni Lorusso
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Ilaria Villanova
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Michele Ficco
- U.O.C. Radiologia, P.O. San Paolo, ASL Bari, 70123 Bari, Italy
| | - Matteo Gravina
- Radiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Cristina Ferrari
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Luca Giordano
- U.O.C. Radiodiagnostica, Ospedaliera Vito Fazzi, 73100 Lecce, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Dino Rubini
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - Nicola Maria Lucarelli
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Amato Antonio Stabile Ianora
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Arnaldo Scardapane
- Sperimental Medicine Department, University of Salento, 73100 Lecce, Italy
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23
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Alfieri M, Guerra F, Lofiego C, Fogante M, Ciliberti G, Vagnarelli F, Barbarossa A, Principi S, Stronati G, Volpato G, Compagnucci P, Valeri Y, Tofoni P, Brugiatelli L, Capodaglio I, Esposto Pirani P, Argalia G, Schicchi N, Messano L, Centanni M, Giovagnoni A, Perna GP, Dello Russo A, Casella M. A Novel Approach to Cardiac Magnetic Resonance Scar Characterization in Patients Affected by Cardiac Amyloidosis: A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:613. [PMID: 38674259 PMCID: PMC11051713 DOI: 10.3390/medicina60040613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Cardiac magnetic resonance (CMR) imaging has become an essential instrument in the study of cardiomyopathies; it has recently been integrated into the diagnostic workflow for cardiac amyloidosis (CA) with remarkable results. An additional emerging role is the stratification of the arrhythmogenic risk by scar analysis and the possibility of merging these data with electro-anatomical maps. This is made possible by using a software (ADAS 3D, Galgo Medical, Barcelona, Spain) able to provide 3D heart models by detecting fibrosis along the whole thickness of the myocardial walls. Little is known regarding the applications of this software in the wide spectrum of cardiomyopathies and the potential benefits have yet to be discovered. In this study, we tried to apply the ADAS 3D in the context of CA. Materials and Methods: This study was a retrospectively analysis of consecutive CMR imaging of patients affected by CA that were treated in our center (Marche University Hospital). Wherever possible, the data were processed with the ADAS 3D software and analyzed for a correlation between the morphometric parameters and follow-up events. The outcome was a composite of all-cause mortality, unplanned cardiovascular hospitalizations, sustained ventricular arrhythmias (VAs), permanent reduction in left ventricular ejection fraction, and pacemaker implantation. The secondary outcomes were the need for a pacemaker implantation and sustained VAs. Results: A total of 14 patients were deemed eligible for the software analysis: 8 patients with wild type transthyretin CA, 5 with light chain CA, and 1 with transthyretin hereditary CA. The vast majority of imaging features was not related to the composite outcome, but atrial wall thickening displayed a significant association with both the primary (p = 0.003) and the secondary outcome of pacemaker implantation (p = 0.003). The software was able to differentiate between core zones and border zones of scars, with the latter being the most extensively represented in all patients. Interestingly, in a huge percentage of CMR images, the software identified the highest degree of core zone fibrosis among the epicardial layers and, in those patients, we found a higher incidence of the primary outcome, without reaching statistical significance (p = 0.18). Channels were found in the scar zones in a substantial percentage of patients without a clear correlation with follow-up events. Conclusions: CMR imaging plays a pivotal role in cardiovascular diagnostics. Our analysis shows the feasibility and applicability of such instrument for all types of CA. We could not only differentiate between different layers of scars, but we were also able to identify the presence of fibrosis channels among the different scar zones. None of the data derived from the ADAS 3D software seemed to be related to cardiac events in the follow-up, but this might be imputable to the restricted number of patients enrolled in the study.
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Affiliation(s)
- Michele Alfieri
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Carla Lofiego
- Division of Cardiology, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Marco Fogante
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy; (M.F.)
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Fabio Vagnarelli
- Division of Cardiology, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Alessandro Barbarossa
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Samuele Principi
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Giulia Stronati
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Paolo Tofoni
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Leonardo Brugiatelli
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Irene Capodaglio
- Division of Cardiology, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Paolo Esposto Pirani
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy; (M.F.)
| | - Giulio Argalia
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy; (M.F.)
| | - Nicolò Schicchi
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy; (M.F.)
| | - Loredana Messano
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Maurizio Centanni
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
| | - Andrea Giovagnoni
- Cardiovascular Radiological Diagnostics, Department of Radiological Sciences, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy; (M.F.)
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
| | - Gian Piero Perna
- Division of Cardiology, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Azienda Ospedaliero-Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy (G.C.); (P.C.); (Y.V.); (P.T.); (L.B.)
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
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24
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Bart NK, Fatkin D, Gunton J, Hare JL, Korczyk D, Kwok F, Lam K, Russell D, Sidiqi H, Sutton T, Gibbs SDJ, Mollee P, Thomas L. 2024 Australia-New Zealand Expert Consensus Statement on Cardiac Amyloidosis. Heart Lung Circ 2024; 33:420-442. [PMID: 38570258 DOI: 10.1016/j.hlc.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 04/05/2024]
Abstract
Over the past 5 years, early diagnosis of and new treatments for cardiac amyloidosis (CA) have emerged that hold promise for early intervention. These include non-invasive diagnostic tests and disease modifying therapies. Recently, CA has been one of the first types of cardiomyopathy to be treated with gene editing techniques. Although these therapies are not yet widely available to patients in Australia and New Zealand, this may change in the near future. Given the rapid pace with which this field is evolving, it is important to view these advances within the Australian and New Zealand context. This Consensus Statement aims to update the Australian and New Zealand general physician and cardiologist with regards to the diagnosis, investigations, and management of CA.
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Affiliation(s)
- Nicole K Bart
- Department of Cardiology, St Vincent's Hospital, Sydney; School of Clinical Medicine, Faculty of Health and Medicine, The University of New South Wales, Sydney, and The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia. http://www.twitter.com/drnikkibart
| | - Diane Fatkin
- Department of Cardiology, St Vincent's Hospital, Sydney; School of Clinical Medicine, Faculty of Health and Medicine, The University of New South Wales, Sydney, and The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - James Gunton
- Department of Cardiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - James L Hare
- Department of Cardiology, Alfred Health, Melbourne, and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Dariusz Korczyk
- Department of Cardiology, The Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Fiona Kwok
- Department of Haematology, Westmead Hospital, Sydney, NSW, Australia
| | - Kaitlyn Lam
- Department of Cardiology, Western Australia Advanced Heart Failure and Cardiac Transplant Service, Perth, WA, Australia
| | - David Russell
- Department of Cardiology, Royal Hobart Hospital, Hobart, Tas, Australia
| | - Hasib Sidiqi
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
| | - Tim Sutton
- Te Whatu Ora Counties Manukau, Auckland; and Department of Cardiology, Auckland, Aotearoa, New Zealand
| | - Simon D J Gibbs
- Department of Haematology, Eastern Health; Epworth Freemasons; and Monash University, Melbourne, Vic, Australia
| | - Peter Mollee
- Queensland Amyloidosis Centre, The Princess Alexandra Hospital, Brisbane; and, School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney; Westmead Clinical School, University of Sydney, Sydney; and, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
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25
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He X, Wang M, Sun J, Yu Z, Hu X, Liu Y, Lin X. Characterization of Transthyretin Mutation G47V Associated with Hereditary Cardiac Amyloidosis. Cardiology 2024; 149:383-395. [PMID: 38437799 PMCID: PMC11309070 DOI: 10.1159/000538081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Amyloidosis caused by TTR mutations (ATTRv) is a rare inherited and autosomal dominant disease. More than 150 mutants of TTR have been reported, whereas some of them remain to be investigated. METHODS A 52-year-old male presented with heart failure and clinically diagnosed ATTR cardiac amyloidosis (ATTR-CA) was recruited. Whole-exome sequencing (WES) was performed. Biochemical and biophysical experiments characterized protein stability using urea-mediated tryptophan fluorescence. Drug response was analyzed by fibril formation assay. Finally, tetramer TTR concentration in patient's serum sample was measured by ultra-performance liquid chromatography (UPLC). RESULTS For the proband, WES revealed a mutation (c.200G>T; p.Gly67Val and referred to as G47V) in TTR gene. Biochemical and biophysical kinetics study showed that the thermodynamic stability of G47V-TTR (Cm = 2.4 m) was significantly lower than that of WT-TTR (Cm = 3.4 m) and comparable to that of L55P-TTR (Cm = 2.3 m), an early age-of-onset mutation. G47V:WT-TTR heterozygous tetramer kinetic stability (t1/2 = 1.4 h) was further compromised compared to that of the homozygous G47V-TTR (t1/2 = 3.1 h). Among three small molecule stabilizers, AG10 exhibited the best inhibition of the fibrillation of G47V-TTR homozygous protein. Using a UPLC assay, nearly 40% of TTR in this patient was calculated to be non-tetrameric. CONCLUSION In this work, we reported a patient presented early onset of clinically typical ATTR-CA due to G47V-TTR mutation. Our work for the first time not only characterized the biochemical properties of G47V-TTR mutation, but also provided hints for the pathogenicity of this mutation.
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Affiliation(s)
- Xiaopeng He
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengdie Wang
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Science, Dalian, China
- Department of Chemistry, University of Chinese Academy of Sciences, Beijing, China
| | - Jialu Sun
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Science, Dalian, China
| | - Zhengyang Yu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Liu
- CAS Key Laboratory of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Science, Dalian, China
| | - Xiaoping Lin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Ungericht M, Groaz V, Messner M, Schuetz T, Brunelli L, Zaruba MM, Lener D, Stocker E, Bauer A, Kroiss AS, Mayr A, Röcken C, Poelzl G. Correlation of 99mTc-DPD bone scintigraphy with histological amyloid load in patients with ATTR cardiac amyloidosis. Amyloid 2024; 31:22-31. [PMID: 37530216 DOI: 10.1080/13506129.2023.2239986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The significance of measuring 99mTc-labelled-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) in transthyretin (ATTR) cardiac amyloidosis has not been adequately studied. This single-centre observational study evaluated the correlation between 99mTc-DPD scintigraphy and histological amyloid load in endomyocardial biopsy (EMB). METHODS Twenty-eight patients with biopsy-proven ATTR amyloidosis and concomitantly available 99mTc-DPD scintigraphy were included. Visual Perugini scoring, and (semi-)quantitative analysis of cardiac 99mTc-DPD uptake by planar whole-body imaging and single photon emission computed tomography (SPECT/CT) using regions of interest (ROI) were performed. From this, heart-to-whole-body ratio (H/WB) and heart-to-contralateral-chest ratio (H/CL) were calculated. The histological amyloid load was quantified using two different staining methods. RESULTS Increased cardiac tracer uptake was documented in all patients (planar: ROImean 129 ± 37 cps; SPECT/CT: ROImean 369 ± 142 cps). Histological amyloid load (19 ± 13%) significantly correlated with Perugini score (r = 0.69, p < .001) as well as with cardiac 99mTc-DPD uptake (planar: r = 0.64, p < .001; H/WB: r = 0.50, p = .014; SPECT/CT: r = 0.53, p = .008; H/CL: r = 0.43, p = .037) (results are shown for correlations with Congo Red-staining). CONCLUSION In ATTR, cardiac 99mTc-DPD uptake significantly correlated with histological amyloid load in EMB. Further studies are needed to implement thresholds in cardiac 99mTc-DPD uptake measurements for risk stratification and guidance of therapy.
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Affiliation(s)
- Maria Ungericht
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Valeria Groaz
- Department of Emergency Medicine, Klinik Arlesheim, Arlesheim, Switzerland
| | - Moritz Messner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Schuetz
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luca Brunelli
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marc-Michael Zaruba
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Lener
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Stocker
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Agnes Mayr
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - Gerhard Poelzl
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
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Yamaguchi S, Oda S, Kidoh M, Hayashi H, Takashio S, Usuku H, Nagayama Y, Nakaura T, Tsujita K, Hirai T, Aoki T. Cardiac MRI T1 and T2 Mapping as a Quantitative Imaging Biomarker in Transthyretin Amyloid Cardiomyopathy. Acad Radiol 2024; 31:514-522. [PMID: 37775448 DOI: 10.1016/j.acra.2023.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to assess the utility of cardiac magnetic resonance imaging (MRI) T1 and T2 mapping as quantitative imaging biomarkers in transthyretin amyloid cardiomyopathy (ATTR-CM). MATERIALS AND METHODS This study retrospectively evaluated 74 patients with confirmed wild-type ATTR-CM who underwent cardiac MRI, 99mTc-labeled pyrophosphate (99mTc-PYP) scintigraphy, and echocardiography. We assessed the quantitative disease parameters, for example, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) by echocardiography, native T1, extracellular volume fraction (ECV), and native T2 value by cardiac MRI, heart-to-contralateral ratio (H/CL) by 99mTc-PYP, and high-sensitive cardiac troponin T. Myocardial native T2 of ≥50 ms was defined as myocardial edema. Correlations between the disease's quantitative parameters were evaluated, and the ECV was compared to other parameters in ATTR-CM with/without myocardial edema. RESULTS ECV in all patients with ATTR-CM revealed a strong correlation with native T1 (r = 0.62), a moderate correlation with hs-TnT (r = 0.59), LVEF (r = -0.48), GLS (r = 0.58), and H/CL (r = 0.48). Correlations between ECV and other quantitative parameters decreased in ATTR-CM with myocardial edema except for H/CL. Meanwhile, the correlations increased in ATTR-CM without myocardial edema. CONCLUSION The presence of myocardial edema affected the interpretation of ECV assessment, although ECV can be a comprehensive imaging biomarker for ATTR-CM. ECV showed a significant correlation with various quantitative disease parameters and can be a reliable disease monitoring marker in patients with ATTR-CM when myocardial edema was excluded.
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Affiliation(s)
- Shinpei Yamaguchi
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan (S.Y., T.A.); Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.).
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Hidetaka Hayashi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan (S.T., H.U., K.T.)
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan (S.T., H.U., K.T.)
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan (S.T., H.U., K.T.)
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University,1-1-1 Honjo, Chuo-ku, Kumamoto, Japan (S.Y., S.O., M.K., H.H., Y.N., T.N., T.H.)
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan (S.Y., T.A.)
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Alwan L, Benz DC, Cuddy SAM, Dobner S, Shiri I, Caobelli F, Bernhard B, Stämpfli SF, Eberli F, Reyes M, Kwong RY, Falk RH, Dorbala S, Gräni C. Current and Evolving Multimodality Cardiac Imaging in Managing Transthyretin Amyloid Cardiomyopathy. JACC Cardiovasc Imaging 2024; 17:195-211. [PMID: 38099914 DOI: 10.1016/j.jcmg.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/06/2023] [Accepted: 10/18/2023] [Indexed: 01/29/2024]
Abstract
Amyloid transthyretin (ATTR) amyloidosis is a protein-misfolding disease characterized by fibril accumulation in the extracellular space that can result in local tissue disruption and organ dysfunction. Cardiac involvement drives morbidity and mortality, and the heart is the major organ affected by ATTR amyloidosis. Multimodality cardiac imaging (ie, echocardiography, scintigraphy, and cardiac magnetic resonance) allows accurate diagnosis of ATTR cardiomyopathy (ATTR-CM), and this is of particular importance because ATTR-targeting therapies have become available and probably exert their greatest benefit at earlier disease stages. Apart from establishing the diagnosis, multimodality cardiac imaging may help to better understand pathogenesis, predict prognosis, and monitor treatment response. The aim of this review is to give an update on contemporary and evolving cardiac imaging methods and their role in diagnosing and managing ATTR-CM. Further, an outlook is presented on how artificial intelligence in cardiac imaging may improve future clinical decision making and patient management in the setting of ATTR-CM.
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Affiliation(s)
- Louhai Alwan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik C Benz
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Cardiac Imaging, Department of Cardiology and Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Sarah A M Cuddy
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Federico Caobelli
- University Clinic of Nuclear Medicine, Inselspital, Bern University Hospital, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Simon F Stämpfli
- Department of Cardiology, Heart Centre Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Franz Eberli
- Department of Cardiology, Triemli Hospital (Triemlispital), Zurich, Switzerland
| | - Mauricio Reyes
- Insel Data Science Center, Inselspital, Bern University Hospital, Bern, Switzerland; Artificial Intelligence in Medical Imaging, ARTORG Center for Biomedical Research, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rodney H Falk
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; CV Imaging Program, Cardiovascular Division, Department of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Ney S, Gertz RJ, Pennig L, Nies RJ, Holtick U, Völker LA, Wunderlich G, Seuthe K, Hohmann C, Metze C, Nähle CP, von Stein J, Brüwer M, ten Freyhaus H, Pfister R. Multiparametric Monitoring of Disease Progression in Contemporary Patients with Wild-Type Transthyretin Amyloid Cardiomyopathy Initiating Tafamidis Treatment. J Clin Med 2024; 13:284. [PMID: 38202291 PMCID: PMC10779991 DOI: 10.3390/jcm13010284] [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: 11/24/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Recently, a disease modifying therapy has become available for transthyretin amyloid cardiomyopathy (ATTR-CM). A validated monitoring concept of treatment is lacking, but a current expert consensus recommends three clinical domains (clinical, biomarker and ECG/imaging) assessed by several measurable features to define disease progression. METHODS We retrospectively analyzed data of wild-type ATTR-CM patients initiating tafamidis therapy assessed within our local routine protocol at baseline and 6-months follow-up with respect to the frequency of values beyond the proposed thresholds defining disease progression. Additionally, associations of cardiac magnetic resonance (CMR) tomography with clinical domains were examined within a subgroup. RESULTS Sixty-two ATTR-CM patients were included (88.7% male, mean age 79 years). In total, 16.1% of patients had progress in the clinical and functional domain, 33.9% in the biomarker domain and 43.5% in the imaging/electrocardiography (ECG) domain, with the latter driven by deterioration of the diastolic dysfunction grade and global longitudinal strain. In total, 35.5% of patients showed progress in none, 35.5% in one, 29.0% in two and no patient in three domains, the latter indicating overall disease progression. A subgroup analysis of twenty-two patients with available baseline and follow-up CMR data revealed an increase in CMR-based extracellular volume by more than 5% in 18.2% of patients, with no significant correlation with progress in one of the clinical domains. CONCLUSIONS We provide first frequency estimates of the markers of disease progression according to a recent expert consensus statement, which might help refine the multiparametric monitoring concept in patients with ATTR-CM.
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Affiliation(s)
- Svenja Ney
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Roman Johannes Gertz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.G.); (L.P.); (C.P.N.)
| | - Lenhard Pennig
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.G.); (L.P.); (C.P.N.)
| | - Richard J. Nies
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Udo Holtick
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Linus A. Völker
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Cologne Cluster of Excellence on Cellular Stress Responses in Ageing-Associated Diseases, 50923 Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology and Center for Rare Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Katharina Seuthe
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Christopher Hohmann
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Clemens Metze
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Claas Philip Nähle
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.G.); (L.P.); (C.P.N.)
- Radiologische Allianz Hamburg, 20357 Hamburg, Germany
| | - Jennifer von Stein
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Monique Brüwer
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Henrik ten Freyhaus
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
| | - Roman Pfister
- Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (R.J.N.); (K.S.); (C.H.); (C.M.); (J.v.S.); (M.B.); (H.t.F.); (R.P.)
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Jain H, Reddy MMRK, Dey RC, Jain J, Shakhatreh Z, Manandhar S, Neupane P, Waleed MS, Yadav R, Sah BK, Mahawa R. Exploring Transthyretin Amyloid Cardiomyopathy: A Comprehensive Review of the Disease and Upcoming Treatments. Curr Probl Cardiol 2024; 49:102057. [PMID: 37640179 DOI: 10.1016/j.cpcardiol.2023.102057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023]
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a mutation-based genetic disorder due to the accumulation of unstable transthyretin protein and presents with symptoms of congestive heart failure (CHF) and numerous extracardiac symptoms like carpal tunnel syndrome and neuropathy. Two subtypes of ATTR-CM are hereditary and wild-type, both of which have different risk factors, gender prevalence and major clinical symptoms. Timely usage of imaging modalities like echocardiography, cardiac magnetic imaging resonance, and cardiac scintigraphy has made it possible to suspect ATTR-CM in patients presenting with CHF. Management of ATTR-CM includes appropriate treatment for heart failure for symptomatic relief, prevention of arrhythmias and heart transplantation for nonresponders. With the recent approval of tafamidis in the successful management of ATTR-CM, numerous potential therapeutic points have been identified to stop or delay the progression of ATTR-CM. This article aims to provide a comprehensive review of ATTR-CM and insights into its novel therapeutics and upcoming treatments.
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Affiliation(s)
- Hritvik Jain
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India.
| | | | - Rohit Chandra Dey
- Department of Internal Medicine, Altai State Medical University, Barnaul, Russia
| | - Jyoti Jain
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Zaid Shakhatreh
- Department of Internal Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sarbagya Manandhar
- Department of Internal Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Purushottam Neupane
- Department of Internal Medicine, Punjab Medical College, Faisalabad, Pakistan
| | | | - Rukesh Yadav
- Department of Internal Medicine, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Maharajgunj, Nepal
| | - Biki Kumar Sah
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rukam Mahawa
- Department of Internal Medicine, Government Medical College, Amritsar, India
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Starr N, Ioannou A, Martinez-Naharro A. Monitoring cardiac amyloidosis with multimodality imaging. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:79-87. [PMID: 37696332 DOI: 10.1016/j.rec.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/30/2023] [Indexed: 09/13/2023]
Abstract
Cardiac amyloidosis (CA) refers to an infiltrative process involving amyloid fibril deposition in the myocardium causing restrictive cardiomyopathy. While various types can affect the heart, the predominant forms are immunoglobulin light-chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis. This review article explores the expanding field of imaging techniques used to diagnose AL-CA and ATTR-CA, highlighting their usefulness in prognostication and disease surveillance. Echocardiography is often the initial imaging modality to suspect CA and, since the incorporation of nonbiopsy criteria using bone scintigraphy, diagnosing ATTR-CA has become more attainable following exclusion of plasma cell dyscrasia. Cardiac magnetic resonance is progressively emerging as a vital tool for imaging CA, and is used in diagnosis, prognostication, and disease surveillance. The use of cardiac magnetic resonance in AL-CA is discussed, as it has been shown to accurately evaluate organ response to chemotherapy. As novel drug treatments emerge in the realm of ATTR-CA, the use of cardiovascular imaging surveillance to monitor disease progression is discussed, as it is gaining prominence as a critical consideration. The ongoing phase III trials investigating treatments for patients with ATTR-CA, will undoubtedly enhance our understanding of cardiac imaging surveillance.
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Affiliation(s)
- Neasa Starr
- National Amyloidosis Centre, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Adam Ioannou
- National Amyloidosis Centre, Royal Free Hospital NHS Foundation Trust, London, United Kingdom
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, Royal Free Hospital NHS Foundation Trust, London, United Kingdom.
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Slart RHJA, Chen W, Tubben A, Tingen HSA, Davies DR, Grogan M, Wechalekar AD, Kittleson MM, Thomson LEJ, Slomka PJ, Wechalekar K, Chareonthaitawee P. Emerging Role of Scintigraphy Using Bone-Seeking Tracers for Diagnosis of Cardiac Amyloidosis: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329347. [PMID: 37315017 DOI: 10.2214/ajr.23.29347] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Amyloidoses are a complex group of clinical diseases that result from progressive organ dysfunction due to extracellular protein misfolding and deposition. The two most common types of cardiac amyloidosis are transthyretin amyloidosis (ATTR) and light-chain (AL) amyloidosis. Diagnosis of ATTR cardiomyopathy (ATTR-CM) is challenging owing to its phenotypic similarity to other more common cardiac conditions, the perceived rarity of the disease, and unfamiliarity with its diagnostic algorithms; endomyocardial biopsy was historically required for diagnosis. However, myocardial scintigraphy using bone-seeking tracers has shown high accuracy for detection of ATTR-CM and has become a key noninvasive diagnostic test for the condition, receiving support from professional society guidelines and transforming prior diagnostic paradigms. This AJR Expert Panel Narrative Review describes the role of myocardial scintigraphy using bone-seeking tracers in the diagnosis of ATTR-CM. The article summarizes available tracers, acquisition techniques, interpretation and reporting considerations, diagnostic pitfalls, and gaps in the current literature. The critical need for monoclonal testing of patients with positive scintigraphy results to differentiate ATTR-CM from AL cardiac amyloidosis is highlighted. Recent updates in guideline recommendations that emphasize the importance of a qualitative visual assessment are also discussed.
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Affiliation(s)
- Riemer H J A Slart
- Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Alwin Tubben
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrea S A Tingen
- Department of Nuclear Medicine & Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands
| | - Daniel R Davies
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Martha Grogan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London (Royal Free Campus), London, United Kingdom
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Piotr J Slomka
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA
- Department of Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA
| | - Kshama Wechalekar
- Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, Part of the Guy's and St Thomas' Foundation Trust Hospitals, London, United Kingdom
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Duca F, Rettl R, Kronberger C, Binder C, Mann C, Dusik F, Schrutka L, Dalos D, Öztürk B, Dachs TM, Cherouny B, Camuz Ligios L, Agis H, Kain R, Koschutnik M, Donà C, Badr-Eslam R, Kastner J, Beitzke D, Loewe C, Nitsche C, Hengstenberg C, Kammerlander AA, Bonderman D. Myocardial structural and functional changes in cardiac amyloidosis: insights from a prospective observational patient registry. Eur Heart J Cardiovasc Imaging 2023; 25:95-104. [PMID: 37549339 PMCID: PMC10735280 DOI: 10.1093/ehjci/jead188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS The pathophysiological hallmark of cardiac amyloidosis (CA) is the deposition of amyloid within the myocardium. Consequently, extracellular volume (ECV) of affected patients increases. However, studies on ECV progression over time are lacking. We aimed to investigate the progression of ECV and its prognostic impact in CA patients. METHODS AND RESULTS Serial cardiac magnetic resonance (CMR) examinations, including ECV quantification, were performed in consecutive CA patients. Between 2012 and 2021, 103 CA patients underwent baseline and follow-up CMR, including ECV quantification. Median ECVs at baseline of the total (n = 103), transthyretin [(ATTR) n = 80], and [light chain (AL) n = 23] CA cohorts were 48.0%, 49.0%, and 42.6%, respectively. During a median period of 12 months, ECV increased significantly in all cohorts [change (Δ) +3.5% interquartile range (IQR): -1.9 to +6.9, P < 0.001; Δ +3.5%, IQR: -2.0 to +6.7, P < 0.001; and Δ +3.5%, IQR: -1.6 to +9.1, P = 0.026]. Separate analyses for treatment-naïve (n = 21) and treated (n = 59) ATTR patients revealed that the median change of ECV from baseline to follow-up was significantly higher among untreated patients (+5.7% vs. +2.3%, P = 0.004). Survival analyses demonstrated that median change of ECV was a predictor of outcome [total: hazard ratio (HR): 1.095, 95% confidence interval (CI): 1.047-1.0145, P < 0.001; ATTR: HR: 1.073, 95% CI: 1.015-1.134, P = 0.013; and AL: HR: 1.131, 95% CI: 1.041-1.228, P = 0.003]. CONCLUSION The present study supports the use of serial ECV quantification in CA patients, as change of ECV was a predictor of outcome and could provide information in the evaluation of amyloid-specific treatments.
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Affiliation(s)
- Franz Duca
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - René Rettl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christina Kronberger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christina Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christopher Mann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Fabian Dusik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lore Schrutka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Begüm Öztürk
- Division of Cardiology, Favoriten Clinic, Kundratstraße 3, 1100 Vienna, Austria
| | - Theresa Marie Dachs
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Bernhard Cherouny
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Luciana Camuz Ligios
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Hermine Agis
- Department of Internal Medicine I, Division of Hematology, Medical University of Vienna, Vienna, Austria
| | - Renate Kain
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Matthias Koschutnik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Carolina Donà
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Roza Badr-Eslam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Kastner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dietrich Beitzke
- Department of Bioimaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Bioimaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Nitsche
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andreas Anselm Kammerlander
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
- Division of Cardiology, Favoriten Clinic, Kundratstraße 3, 1100 Vienna, Austria
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Saro R, Pavan D, Porcari A, Sinagra G, Mojoli M. Lights and Shadows of Clinical Applications of Cardiac Scintigraphy with Bone Tracers in Suspected Amyloidosis. J Clin Med 2023; 12:7605. [PMID: 38137674 PMCID: PMC10743682 DOI: 10.3390/jcm12247605] [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: 10/13/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Radionuclide bone scintigraphy is the cornerstone of an imaging-based algorithm for accurate non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). In patients with heart failure and suggestive echocardiographic and/or cardiac magnetic resonance imaging findings, the positive predictive value of Perugini grade 2 or 3 myocardial uptake on a radionuclide bone scan approaches 100% for the diagnosis of ATTR-CA as long as there is no biochemical evidence of a clonal dyscrasia. The technetium-labelled tracers that are currently validated for non-invasive diagnosis of ATTR-CA include pyrophosphate (99mTc-PYP); hydroxymethylene diphosphonate (99mTc-HMDP); and 3,3-diphosphono-1,2-propanodicarboxylate (99mTc-DPD). Although nuclear scintigraphy has transformed the contemporary diagnostic approach to ATTR-CA, a number of grey areas remains, including the mechanism for binding tracers to the infiltrated heart, differences in the kinetics and distribution of these radiotracers, differences in protocols of image acquisition worldwide, the clinical significance of extra-cardiac uptake, and the use of this technique for prognostic stratification, monitoring disease progression and assessing the response to disease-modifying treatments. This review will deal with the most relevant unmet needs and clinical questions concerning scintigraphy with bone tracers in ATTR-CA, providing expert opinions on possible future developments in the clinical application of these radiotracers in order to offer practical information for the interpretation of nuclear images by physicians involved in the care of patients with this ATTR-CA.
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Affiliation(s)
- Riccardo Saro
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy; (R.S.); (A.P.); (G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Giuliano Isontina University Health Authority, 34149 Trieste, Italy
| | - Daniela Pavan
- Ospedale Santa Maria degli Angeli, Azienda Ospedaliera Friuli Occidentale (ASFO), 33170 Pordenone, Italy;
| | - Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy; (R.S.); (A.P.); (G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Giuliano Isontina University Health Authority, 34149 Trieste, Italy
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Via P. Valdoni 7, 34100 Trieste, Italy; (R.S.); (A.P.); (G.S.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Giuliano Isontina University Health Authority, 34149 Trieste, Italy
| | - Marco Mojoli
- Ospedale Santa Maria degli Angeli, Azienda Ospedaliera Friuli Occidentale (ASFO), 33170 Pordenone, Italy;
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Moya A, Oeste CL, Beles M, Verstreken S, Dierckx R, Heggermont W, Bartunek J, Bogaerts E, Masuy I, Hens D, Bertolone D, Vanderheyden M. Detection of transthyretin amyloid cardiomyopathy by automated data extraction from electronic health records. ESC Heart Fail 2023; 10:3483-3492. [PMID: 37726928 PMCID: PMC10682883 DOI: 10.1002/ehf2.14517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/21/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS Transthyretin amyloid cardiomyopathy (ATTR-CM), a progressive and fatal cardiomyopathy, is frequently misdiagnosed or entails diagnostic delays, hindering patients from timely treatment. This study aimed to generate a systematic framework based on data from electronic health records (EHRs) to assess patients with ATTR-CM in a real-world population of heart failure (HF) patients. Predictive factors or combinations of predictive factors related to ATTR-CM in a European population were also assessed. METHODS AND RESULTS Retrospective unstructured and semi-structured data from EHRs of patients from OLV Hospital Aalst, Belgium (2012-20), were processed using natural language processing (NLP) to generate an Observational Medical Outcomes Partnership Common Data Model database. NLP model performance was assessed on a random subset of EHRs by comparing algorithm outputs to a physician-generated standard (using precision, recall, and their harmonic mean, or F1-score). Of the 3127 HF patients, 103 potentially had ATTR-CM (age 78 ± 9 years; male 55%; ejection fraction of 48% ± 16). The mean diagnostic delay between HF and ATTR-CM diagnosis was 1.8 years. Besides HF and cardiomyopathy-related phenotypes, the strongest cardiac predictor was atrial fibrillation (AF; 72% in ATTR-CM vs. 60% in non-ATTR-CM, P = 0.02), whereas the strongest non-cardiac predictor was carpal tunnel syndrome (21% in ATTR-CM vs. 3% in non-ATTR-CM, P < 0.001). The strongest combination predictor was AF, joint disorders, and HF with preserved ejection fraction (29% in ATTR-CM vs. 18% in non-ATTR-CM: odds ratio = 2.03, 95% confidence interval = 1.28-3.22). CONCLUSIONS Not only well-known variables associated with ATTR-CM but also unique combinations of cardiac and non-cardiac phenotypes are able to predict ATTR-CM in a real-world HF population, aiding in early identification of ATTR-CM patients.
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Affiliation(s)
- Ana Moya
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
- CardioPath PhD Program, Department of Advanced Biomedical Sciences, Cardiovascular Pathophysiology and TherapeuticsUniversity of Naples Federico IINaplesItaly
| | | | - Monika Beles
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Sofie Verstreken
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Riet Dierckx
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Ward Heggermont
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | - Eline Bogaerts
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
| | | | | | - Dario Bertolone
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
- CardioPath PhD Program, Department of Advanced Biomedical Sciences, Cardiovascular Pathophysiology and TherapeuticsUniversity of Naples Federico IINaplesItaly
| | - Marc Vanderheyden
- Cardiovascular Center, OLV Hospital AalstMoorselbaan n. 164Aalst9300Belgium
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Slivnick JA, Singulane C, Sun D, Eshun D, Narang A, Mazzone S, Addetia K, Patel AR, Zareba KM, Smart S, Kwon JW, Husain A, Cody B, Scheetz S, Asch FM, Goyal A, Sarswat N, Mor-Avi V, Lang RM. Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis. J Am Soc Echocardiogr 2023; 36:1290-1301. [PMID: 37574149 DOI: 10.1016/j.echo.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND In patients with cardiac amyloidosis (CA), left ventricular ejection fraction (LVEF) is frequently preserved, despite commonly reduced global longitudinal strain (GLS). We hypothesized that nonlongitudinal contraction may initially serve as a mitigating mechanism to maintain cardiac output and studied the relationship between global circumferential (GCS) and radial (GRS) strain with LVEF and extracellular volume (ECV), a marker of amyloid burden. METHODS Patients with CA who underwent cardiac magnetic resonance (CMR; n = 140, 70.7 ± 11.5 years, 66% male) or echocardiography (n = 67, 71 ± 13 years, 66% male) and normal controls (CMR, n = 20; echocardiography, n = 45) were retrospectively identified, and GCS, GLS, and GRS were quantified using feature-tracking CMR or speckle-tracking echocardiography and compared between CA patients with preserved and reduced LVEF (CAHFpEF, CAHFrEF) and controls. The prevalence of impaired strain (magnitudes <2.5th percentile of the controls) was compared between CAHFpEF and CAHFrEF and between ECV quartiles. RESULTS While echocardiography-derived GLS was impaired in both CAHFpEF (-13.4% ± 3.1%, P < .003) and CAHFrEF (-9.1% ± 3.2%, P < .003), compared with controls (-20.8% ± 2.4%), GCS was more impaired in CAHFrEF compared with both controls (-15.6% ± 5.0% vs -32.3% ± 3.3%, P < .003) and CAHFpEF (-30.4% ± 5.7%, P < .003) and did not differ between CAHFpEF and controls (P = .24). The prevalence of abnormal CMR-derived GCS (P < .0001) and GRS (P < .0001) but not GLS (P = .054) varied significantly across ECV quartiles. CONCLUSIONS Among CA patients with preserved LVEF, preserved GCS and GRS, despite near-universally impaired GLS, may be explained by an initial predominantly subendocardial involvement, where mostly longitudinal fibers are located. If confirmed in future studies, these findings may facilitate identification of patients with early stages of CA, when treatments may be most effective.
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Affiliation(s)
- Jeremy A Slivnick
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Cristiane Singulane
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Deyu Sun
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Derek Eshun
- Division of Cardiology, Northwestern Medicine, Chicago, Illinois
| | - Akhil Narang
- Division of Cardiology, Northwestern Medicine, Chicago, Illinois
| | - Steven Mazzone
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Karima Addetia
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Amit R Patel
- Division of Cardiology, University of Virginia, Charlottesville, Virginia
| | - Karolina M Zareba
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Suzanne Smart
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jung Woo Kwon
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Aliya Husain
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Brittany Cody
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Seth Scheetz
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Federico M Asch
- Division of Cardiology, Medstar Health, Washington, District of Columbia
| | - Akash Goyal
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nitasha Sarswat
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Victor Mor-Avi
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois
| | - Roberto M Lang
- Division of Cardiology, University of Chicago Medical Center, Chicago, Illinois.
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Jaiswal V, Agrawal V, Khulbe Y, Hanif M, Huang H, Hameed M, Shrestha AB, Perone F, Parikh C, Gomez SI, Paudel K, Zacks J, Grubb KJ, De Rosa S, Gimelli A. Cardiac amyloidosis and aortic stenosis: a state-of-the-art review. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead106. [PMID: 37941729 PMCID: PMC10630099 DOI: 10.1093/ehjopen/oead106] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 11/10/2023]
Abstract
Cardiac amyloidosis is caused by the extracellular deposition of amyloid fibrils in the heart, involving not only the myocardium but also any cardiovascular structure. Indeed, this progressive infiltrative disease also involves the cardiac valves and, specifically, shows a high prevalence with aortic stenosis. Misfolded protein infiltration in the aortic valve leads to tissue damage resulting in the onset or worsening of valve stenosis. Transthyretin cardiac amyloidosis and aortic stenosis coexist in patients > 65 years in about 4-16% of cases, especially in those undergoing transcatheter aortic valve replacement. Diagnostic workup for cardiac amyloidosis in patients with aortic stenosis is based on a multi-parametric approach considering clinical assessment, electrocardiogram, haematologic tests, basic and advanced echocardiography, cardiac magnetic resonance, and technetium labelled cardiac scintigraphy like technetium-99 m (99mTc)-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, and 99mTc-hydroxymethylene diphosphonate. However, a biopsy is the traditional gold standard for diagnosis. The prognosis of patients with coexisting cardiac amyloidosis and aortic stenosis is still under evaluation. The combination of these two pathologies worsens the prognosis. Regarding treatment, mortality is reduced in patients with cardiac amyloidosis and severe aortic stenosis after undergoing transcatheter aortic valve replacement. Further studies are needed to confirm these findings and to understand whether the diagnosis of cardiac amyloidosis could affect therapeutic strategies. The aim of this review is to critically expose the current state-of-art regarding the association of cardiac amyloidosis with aortic stenosis, from pathophysiology to treatment.
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Affiliation(s)
- Vikash Jaiswal
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Vibhor Agrawal
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Yashita Khulbe
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Muhammad Hanif
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maha Hameed
- Department of Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Abhigan Babu Shrestha
- Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic ‘Villa delle Magnolie’,81020 Castel Morrone, Caserta, Italy
| | | | - Sabas Ivan Gomez
- Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA
| | - Kusum Paudel
- Department of Medicine, Kathmandu University School of Medical Science, Dhulikhel, Kathmandu 45209, Nepal
| | - Jerome Zacks
- Department of Cardiology, The Icahn Medical School at Mount Sinai, NewYork 10128, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Salvatore De Rosa
- Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana/CNR Gabriele Monasterio, Pisa 56124, Italy
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Gharbin J, Winful A, Alebna P, Grewal N, Brgdar A, Rhodd S, Taha M, Fatima U, Mehrotra P, Onwuanyi A. Trends in incidence and clinical outcome of non-ST elevation myocardial infarction in patients with amyloidosis in the United States, 2010-2020. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100336. [PMID: 38511180 PMCID: PMC10945973 DOI: 10.1016/j.ahjo.2023.100336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 03/22/2024]
Abstract
Study objective To assess temporal changes in clinical profile and in-hospital outcome of patients with amyloidosis presenting with non-ST elevation myocardial infarction, NSTEMI. Design/setting We conducted a retrospective observational study using the National Inpatient Sample (NIS) database from January 1, 2010, to December 31, 2020. Main outcomes Primary outcome of interest was trend in adjusted in-hospital mortality in patients with amyloidosis presenting with NSTEMI from 2010 to 2020. Our secondary outcomes were trend in rate of coronary revascularization, and trend in duration of hospitalization. Results We identified 272,896 hospitalizations for amyloidosis. There was a temporal increase in incidence of NSTEMI among patients aged 18-44 years from 15.5 % to 28.0 %, a reverse trend was observed in 45-64 years: 22.1 % to 17.7 %, p = 0.043. There was no statistically significant difference in rate of coronary revascularization from 2010 to 2020; 16.3 % to 14.2 %, p = 0.86. We observed an increased odds of all-cause in-hospital mortality in patients with NSTEMI compared to those without NSTEMI (aOR = 2.2, 95 % CI: 1.9-2.6, p < 0.001) but there was a decrease trend in mortality from 21.5 % to 11.3 %, p = 0.013 for trend. Hospitalization duration was also observed to decreased from 14.1 days to 10.9 days during the study period (p = 0.055 for trend). Conclusion In patients with amyloidosis presenting with NSTEMI, there was increased incidence of NSTEMI among young adults, a steady trend in coronary revascularization, and a decreasing trend of adjusted all-cause in-hospital mortality and length of hospitalization from 2010 to 2020 in the United States.
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Affiliation(s)
- John Gharbin
- Department of Internal Medicine, Howard University, Washington, DC, USA
| | - Adwoa Winful
- Medical University of South Carolina Health, Orangeburg, SC, USA
| | - Pamela Alebna
- Division of Cardiology, Virginia Commonwealth University, Virginia, USA
| | - Niyati Grewal
- Department of Internal Medicine, Howard University, Washington, DC, USA
| | - Ahmed Brgdar
- Division of Cardiology, Howard University, Washington, DC, USA
| | - Suchelis Rhodd
- Division of Cardiology, Howard University, Washington, DC, USA
| | - Mohammed Taha
- Division of Cardiology, Virginia Commonwealth University, Virginia, USA
| | - Urooj Fatima
- Division of Cardiology, Howard University, Washington, DC, USA
| | | | - Anekwe Onwuanyi
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA
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Zhang X, Zhao R, Deng W, Li Y, An S, Qian Y, Liu B, Yu Y, Li X. Left Atrial and Ventricular Strain Differentiates Cardiac Amyloidosis and Hypertensive Heart Disease: A Cardiac MR Feature Tracking Study. Acad Radiol 2023; 30:2521-2532. [PMID: 36925334 DOI: 10.1016/j.acra.2023.02.003] [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: 12/06/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 03/17/2023]
Abstract
RATIONALE AND OBJECTIVES Strain measured by feature tracking technique represents the degree of deformation and reflects the systolic and diastolic function of the heart. Our purpose was to evaluate the differential diagnostic value and correlations of left atrial (LA) strain (LAS) and left ventricular (LV) strain (LVS) in cardiac amyloidosis (CA) and hypertensive heart disease (HHD) patients. MATERIALS AND METHODS We recruited 25 CA patients, 30 sex- and age-matched HHD patients and 20 healthy subjects totally. LAS and LVS were analyzed by CVI42 post-processing software. The efficiency of LAS and LVS in differentiating CA from HHD was compared by receiver operating characteristic curves analysis. Pearson or Spearman's analysis were used to assess the correlation between LAS and LV parameters. RESULTS Both HHD and CA patients had impaired LVS, the gradient of increasing absolute values of longitudinal strain (LS) and radial strain (RS) from the basal to the apical myocardium was most pronounced in the CA group, its relative apical sparing of LS (RASLS) ratio reached 0.91 ± 0.02, significantly higher than other two groups (HHD: 0.72 ± 0.02; controls: 0.56 ± 0.01, all p <0.001). Additionally, except for the booster strain in the HHD group was preserved, all other LAS were reduced in patients' groups. The RASLS had the best differential diagnostic efficacy with an area under the curve (AUC) of 0.930 (p <0.001); The AUCs of LAS all greater than 0.850, above global LS (GLS) (AUC = 0.770, p = 0.001). LAS was notably correlated with LV ejection fraction (LVEF) and GLS, with reservoir strain having the greatest correlation with GLS (r = -0.828, p <0.001). CONCLUSION The RASLS has high efficiency in guiding the differential diagnosis of CA and HHD with similar degree and presentation of LVH. Moreover, LAS values can also provide some useful information and they are closely linked with LV function, CMR feature tracking may provide assistance in the evaluation of LA-LV coupling.
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Affiliation(s)
- Xinna Zhang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Wei Deng
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Yuguo Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Shutian An
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Yinfeng Qian
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Bin Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230032, Anhui Province, China; Research Center of Clinical Medical Imaging, Anhui Province Clinical Image Quality Control Center, No. 218 Jixi Road, Hefei 230032, Anhui Province, China.
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Brito D, Albrecht FC, de Arenaza DP, Bart N, Better N, Carvajal-Juarez I, Conceição I, Damy T, Dorbala S, Fidalgo JC, Garcia-Pavia P, Ge J, Gillmore JD, Grzybowski J, Obici L, Piñero D, Rapezzi C, Ueda M, Pinto FJ. World Heart Federation Consensus on Transthyretin Amyloidosis Cardiomyopathy (ATTR-CM). Glob Heart 2023; 18:59. [PMID: 37901600 PMCID: PMC10607607 DOI: 10.5334/gh.1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 10/31/2023] Open
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive and fatal condition that requires early diagnosis, management, and specific treatment. The availability of new disease-modifying therapies has made successful treatment a reality. Transthyretin amyloid cardiomyopathy can be either age-related (wild-type form) or caused by mutations in the TTR gene (genetic, hereditary forms). It is a systemic disease, and while the genetic forms may exhibit a variety of symptoms, a predominant cardiac phenotype is often present. This document aims to provide an overview of ATTR-CM amyloidosis focusing on cardiac involvement, which is the most critical factor for prognosis. It will discuss the available tools for early diagnosis and patient management, given that specific treatments are more effective in the early stages of the disease, and will highlight the importance of a multidisciplinary approach and of specialized amyloidosis centres. To accomplish these goals, the World Heart Federation assembled a panel of 18 expert clinicians specialized in TTR amyloidosis from 13 countries, along with a representative from the Amyloidosis Alliance, a patient advocacy group. This document is based on a review of published literature, expert opinions, registries data, patients' perspectives, treatment options, and ongoing developments, as well as the progress made possible via the existence of centres of excellence. From the patients' perspective, increasing disease awareness is crucial to achieving an early and accurate diagnosis. Patients also seek to receive care at specialized amyloidosis centres and be fully informed about their treatment and prognosis.
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Affiliation(s)
- Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Fabiano Castro Albrecht
- Dante Pazzanese Institute of Cardiology – Cardiac Amyloidosis Center Dante Pazzanese Institute, São Paulo, Brazil
| | | | - Nicole Bart
- St Vincent’s Hospital, Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, Australia
| | - Nathan Better
- Cabrini Health, Malvern, Royal Melbourne Hospital, Parkville, Monash University and University of Melbourne, Victoria, Australia
| | | | - Isabel Conceição
- Department of Neurosciences and Mental Health, CHULN – Hospital de Santa Maria, Portugal
- Centro de Estudos Egas Moniz Faculdade de Medicina da Universidade de Lisboa Portugal, Portugal
| | - Thibaud Damy
- Department of Cardiology, DHU A-TVB, CHU Henri Mondor, AP-HP, INSERM U955 and UPEC, Créteil, France
- Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Reseau amylose, Créteil, France. Filière CARDIOGEN
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- CV imaging program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Julian D. Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, United Kingdom
| | - Jacek Grzybowski
- Department of Cardiomyopathy, National Institute of Cardiology, Warsaw, Poland
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Rapezzi
- Cardiovascular Institute, University of Ferrara, Ferrara, Italy
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Fausto J. Pinto
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Moody WE, Turvey-Haigh L, Knight D, Coats CJ, Cooper RM, Schofield R, Robinson S, Harkness A, Oxborough DL, Gillmore JD, Whelan C, Augustine DX, Fontana M, Steeds RP. British Society of Echocardiography guideline for the transthoracic echocardiographic assessment of cardiac amyloidosis. Echo Res Pract 2023; 10:13. [PMID: 37653443 PMCID: PMC10468878 DOI: 10.1186/s44156-023-00028-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023] Open
Abstract
These guidelines form an update of the BSE guideline protocol for the assessment of restrictive cardiomyopathy (Knight et al. in Echo Res Prac, 2013). Since the original recommendations were conceived in 2013, there has been an exponential rise in the diagnosis of cardiac amyloidosis fuelled by increased clinician awareness, improvements in cardiovascular imaging as well as the availability of new and effective disease modifying therapies. The initial diagnosis of cardiac amyloidosis can be challenging and is often not clear-cut on the basis of echocardiography, which for most patients presenting with heart failure symptoms remains the first-line imaging test. The role of a specialist echocardiographer will be to raise the suspicion of cardiac amyloidosis when appropriate, but the formal diagnosis of amyloid sub-type invariably requires further downstream testing. This document seeks to provide a focused review of the literature on echocardiography in cardiac amyloidosis highlighting its important role in the diagnosis, prognosis and screening of at risk individuals, before concluding with a suggested minimum data set, for use as an aide memoire when reporting.
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Affiliation(s)
- William E Moody
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
- Institute of Cardiovascular Science, College of Medical and Dental Science, University of Birmingham, Birmingham, UK.
| | - Lauren Turvey-Haigh
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Daniel Knight
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | | | - Robert M Cooper
- Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool John Moores University, Liverpool, UK
| | | | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - David L Oxborough
- Sports and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Carol Whelan
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Daniel X Augustine
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
- Department For Health, University of Bath, Bath, UK
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Richard P Steeds
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- Institute of Cardiovascular Science, College of Medical and Dental Science, University of Birmingham, Birmingham, UK
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Gröschel J, Trauzeddel RF, Müller M, von Knobelsdorff-Brenkenhoff F, Viezzer D, Hadler T, Blaszczyk E, Daud E, Schulz-Menger J. Multi-site comparison of parametric T1 and T2 mapping: healthy travelling volunteers in the Berlin research network for cardiovascular magnetic resonance (BER-CMR). J Cardiovasc Magn Reson 2023; 25:47. [PMID: 37574535 PMCID: PMC10424349 DOI: 10.1186/s12968-023-00954-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Parametric mapping sequences in cardiovascular magnetic resonance (CMR) allow for non-invasive myocardial tissue characterization. However quantitative myocardial mapping is still limited by the need for local reference values. Confounders, such as field strength, vendors and sequences, make intersite comparisons challenging. This exploratory study aims to assess whether multi-site studies that control confounding factors provide first insights whether parametric mapping values are within pre-defined tolerance ranges across scanners and sites. METHODS A cohort of 20 healthy travelling volunteers was prospectively scanned at three sites with a 3 T scanner from the same vendor using the same scanning protocol and acquisition scheme. A Modified Look-Locker inversion recovery sequence (MOLLI) for T1 and a fast low-angle shot sequence (FLASH) for T2 were used. At one site a scan-rescan was performed to assess the intra-scanner reproducibility. All acquired T1- and T2-mappings were analyzed in a core laboratory using the same post-processing approach and software. RESULTS After exclusion of one volunteer due to an accidentally diagnosed cardiac disease, T1- and T2-maps of 19 volunteers showed no significant differences between the 3 T sites (mean ± SD [95% confidence interval] for global T1 in ms: site I: 1207 ± 32 [1192-1222]; site II: 1207 ± 40 [1184-1225]; site III: 1219 ± 26 [1207-1232]; p = 0.067; for global T2 in ms: site I: 40 ± 2 [39-41]; site II: 40 ± 1 [39-41]; site III 39 ± 2 [39-41]; p = 0.543). CONCLUSION Parametric mapping results displayed initial hints at a sufficient similarity between sites when confounders, such as field strength, vendor diversity, acquisition schemes and post-processing analysis are harmonized. This finding needs to be confirmed in a powered clinical trial. Trial registration ISRCTN14627679 (retrospectively registered).
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Affiliation(s)
- Jan Gröschel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Ralf-Felix Trauzeddel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin Und Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Maximilian Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- KIZ, Kardiologie im Zentrum, Eisenmannstr. 4, 80331, Munich, Deutschland
| | - Darian Viezzer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Thomas Hadler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Edyta Blaszczyk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Elias Daud
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- The Cardiology Department, Galilee Medical Center, Azrieli Faculty of Medicine Bar-Ilan University, Nahariya, Safed, Israel
| | - Jeanette Schulz-Menger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, ECRC Experimental and Clinical Research Center, Lindenberger Weg 80, 13125, Berlin, Germany.
- Working Group On Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.
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Garcia-Pavia P, Aus dem Siepen F, Donal E, Lairez O, van der Meer P, Kristen AV, Mercuri MF, Michalon A, Frost RJA, Grimm J, Nitsch RM, Hock C, Kahr PC, Damy T. Phase 1 Trial of Antibody NI006 for Depletion of Cardiac Transthyretin Amyloid. N Engl J Med 2023; 389:239-250. [PMID: 37212440 DOI: 10.1056/nejmoa2303765] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Transthyretin amyloid (ATTR) cardiomyopathy is a progressive and fatal disease caused by misfolded transthyretin. Despite advances in slowing disease progression, there is no available treatment that depletes ATTR from the heart for the amelioration of cardiac dysfunction. NI006 is a recombinant human anti-ATTR antibody that was developed for the removal of ATTR by phagocytic immune cells. METHODS In this phase 1, double-blind trial, we randomly assigned (in a 2:1 ratio) 40 patients with wild-type or variant ATTR cardiomyopathy and chronic heart failure to receive intravenous infusions of either NI006 or placebo every 4 weeks for 4 months. Patients were sequentially enrolled in six cohorts that received ascending doses (ranging from 0.3 to 60 mg per kilogram of body weight). After four infusions, patients were enrolled in an open-label extension phase in which they received eight infusions of NI006 with stepwise increases in the dose. The safety and pharmacokinetic profiles of NI006 were assessed, and cardiac imaging studies were performed. RESULTS The use of NI006 was associated with no apparent drug-related serious adverse events. The pharmacokinetic profile of NI006 was consistent with that of an IgG antibody, and no antidrug antibodies were detected. At doses of at least 10 mg per kilogram, cardiac tracer uptake on scintigraphy and extracellular volume on cardiac magnetic resonance imaging, both of which are imaging-based surrogate markers of cardiac amyloid load, appeared to be reduced over a period of 12 months. The median N-terminal pro-B-type natriuretic peptide and troponin T levels also seemed to be reduced. CONCLUSIONS In this phase 1 trial of the recombinant human antibody NI006 for the treatment of patients with ATTR cardiomyopathy and heart failure, the use of NI006 was associated with no apparent drug-related serious adverse events. (Funded by Neurimmune; NI006-101 ClinicalTrials.gov number, NCT04360434.).
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Affiliation(s)
- Pablo Garcia-Pavia
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Fabian Aus dem Siepen
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Erwan Donal
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Olivier Lairez
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Peter van der Meer
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Arnt V Kristen
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Michele F Mercuri
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Aubin Michalon
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Robert J A Frost
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Jan Grimm
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Roger M Nitsch
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Christoph Hock
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Peter C Kahr
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
| | - Thibaud Damy
- From Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares, Madrid, and Universidad Francisco de Vitoria, Pozuelo de Alarcón - all in Spain (P.G.-P.); the Department of Cardiology, University Hospital Heidelberg, Heidelberg (F.S.), and Cardiovascular Center Darmstadt, Darmstadt (A.V.K.) - both in Germany; the Department of Cardiology, University of Rennes, Centre Hospitalier Universitaire (CHU) de Rennes, INSERM, LTSI-UMR 1099, Rennes (E.D.), Service de Cardiologie, CHU de Toulouse-Hôpital Rangueil, Toulouse (O.L.), and the Cardiology Department and French National Reference Center for Cardiac Amyloidosis, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, and Institut Mondor de Recherche Biomédicale, INSERM, Université Paris Est Créteil, Créteil (T.D.) - all in France; the Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (P.M.); Alexion-AstraZeneca Rare Disease, Boston (M.F.M.); and Neurimmune (A.M., R.J.A.F., J.G., R.M.N., C.H., P.C.K.) and the Institute for Regenerative Medicine (R.M.N., C.H.) and the Center for Molecular Cardiology (P.C.K.), University of Zurich - all in Schlieren, Switzerland
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Rashdan L, Hodovan J, Masri A. Imaging cardiac hypertrophy in hypertrophic cardiomyopathy and its differential diagnosis. Curr Opin Cardiol 2023:00001573-990000000-00084. [PMID: 37421401 DOI: 10.1097/hco.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy. RECENT FINDINGS Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM. SUMMARY Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.
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Affiliation(s)
- Lana Rashdan
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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Baggiano A, Conte E, Spiritigliozzi L, Mushtaq S, Annoni A, Carerj ML, Cilia F, Fazzari F, Formenti A, Frappampina A, Fusini L, Gaudenzi Asinelli M, Junod D, Mancini ME, Mantegazza V, Maragna R, Marchetti F, Penso M, Tassetti L, Volpe A, Baessato F, Guglielmo M, Rossi A, Rovera C, Andreini D, Rabbat MG, Guaricci AI, Pepi M, Pontone G. Quantification of extracellular volume with cardiac computed tomography in patients with dilated cardiomyopathy. J Cardiovasc Comput Tomogr 2023; 17:261-268. [PMID: 37147147 DOI: 10.1016/j.jcct.2023.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Cardiac computed tomography (CCT) was recently validated to measure extracellular volume (ECV) in the setting of cardiac amyloidosis, showing good agreement with cardiovascular magnetic resonance (CMR). However, no evidence is available with a whole-heart single source, single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study was to test the diagnostic accuracy of ECVCCT in patients with a recent diagnosis of dilated cardiomyopathy, having ECVCMR as the reference technique. METHODS 39 consecutive patients with newly diagnosed dilated cardiomyopathy (LVEF <50%) scheduled for clinically indicated CMR were prospectively enrolled. Myocardial segment evaluability assessment with each technique, agreement between ECVCMR and ECVCCT, regression analysis, Bland-Altman analysis and interclass correlation coefficient (ICC) were performed. RESULTS Mean age of enrolled patients was 62 ± 11 years, and mean LVEF at CMR was 35.4 ± 10.7%. Overall radiation exposure for ECV estimation was 2.1 ± 1.1 mSv. Out of 624 myocardial segments available for analysis, 624 (100%) segments were assessable by CCT while 608 (97.4%) were evaluable at CMR. ECVCCT demonstrated slightly lower values compared to ECVCMR (all segments, 31.8 ± 6.5% vs 33.9 ± 8.0%, p < 0.001). At regression analysis, strong correlations were described (all segments, r = 0.819, 95% CI: 0.791 to 0.844). On Bland-Altman analysis, bias between ECVCMR and ECVCCT for global analysis was 2.1 (95% CI: -6.8 to 11.1). ICC analysis showed both high intra-observer and inter-observer agreement for ECVCCT calculation (0.986, 95%CI: 0.983 to 0.988 and 0.966, 95%CI: 0.960 to 0.971, respectively). CONCLUSIONS ECV estimation with a whole-heart single source, single energy CT scanner is feasible and accurate. Integration of ECV measurement in a comprehensive CCT evaluation of patients with newly diagnosed dilated cardiomyopathy can be performed with a small increase in overall radiation exposure.
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Affiliation(s)
- Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luigi Spiritigliozzi
- Dipartimento di Diagnostica per Immagini e Radiologia Interventistica, Policlinico Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | | | - Laura Fusini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | | | | | | | | | | | | | - Marco Penso
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Italy
| | | | | | - Francesca Baessato
- Department of Cardiology, San Maurizio Regional Hospital, Bolzano, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, the Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mark G Rabbat
- Loyola University of Chicago, Chicago, IL, USA; Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Andrea Igoren Guaricci
- Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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Ioannou A, Fontana M, Gillmore JD. Patisiran for the Treatment of Transthyretin-mediated Amyloidosis with Cardiomyopathy. Heart Int 2023; 17:27-35. [PMID: 37456349 PMCID: PMC10339464 DOI: 10.17925/hi.2023.17.1.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/24/2023] [Indexed: 07/18/2023] Open
Abstract
Transthyretin (TTR) is a tetrameric protein, synthesized primarily by the liver, that acts as a physiological transport protein for retinol and thyroxine. TTR can misfold into pathogenic amyloid fibrils that deposit in the heart and nerves, causing a life-threatening transthyretin amyloidosis cardiomyopathy (ATTR-CM), and a progressive and debilitating polyneuropathy (ATTR-PN). Recent therapeutic advances have resulted in the development of drugs that reduce TTR production. Patisiran is a small interfering RNA that disrupts the complimentary mRNA and inhibits TTR synthesis, and is the first gene-silencing medication licensed for the treatment of ATTR amyloidosis. After encouraging results following the use of patisiran for the treatment of patients with ATTR-PN, there has been increasing interest in the use of patisiran for the treatment of ATTR-CM. Various studies have demonstrated improvements across a wide range of cardiac biomarkers following treatment with patisiran, and have changed the perception of ATTR-CM from being thought of as a terminal disease process, to now being regarded as a treatable disease. These successes represent a huge milestone and have the potential to revolutionize the landscape of treatment for ATTR-CM. However, the long-term safety of patisiran and how best to monitor cardiac response to treatment remain to be determined.
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Affiliation(s)
- Adam Ioannou
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, UK
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Fontana M, Gilbertson J, Verona G, Riefolo M, Slamova I, Leone O, Rowczenio D, Botcher N, Ioannou A, Patel RK, Razvi Y, Martinez-Naharro A, Whelan CJ, Venneri L, Duhlin A, Canetti D, Ellmerich S, Moon JC, Kellman P, Al-Shawi R, McCoy L, Simons JP, Hawkins PN, Gillmore JD. Antibody-Associated Reversal of ATTR Amyloidosis-Related Cardiomyopathy. N Engl J Med 2023; 388:2199-2201. [PMID: 37285532 DOI: 10.1056/nejmc2304584] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | | | | | - Mattia Riefolo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Ornella Leone
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | - Adam Ioannou
- University College London, London, United Kingdom
| | | | - Yousuf Razvi
- University College London, London, United Kingdom
| | | | | | | | | | | | | | - James C Moon
- University College London, London, United Kingdom
| | | | | | - Laura McCoy
- University College London, London, United Kingdom
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Castiglione V, Aimo A, Todiere G, Barison A, Fabiani I, Panichella G, Genovesi D, Bonino L, Clemente A, Cademartiri F, Giannoni A, Passino C, Emdin M, Vergaro G. Role of Imaging in Cardiomyopathies. Card Fail Rev 2023; 9:e08. [PMID: 37427006 PMCID: PMC10326670 DOI: 10.15420/cfr.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 07/11/2023] Open
Abstract
Imaging has a central role in the diagnosis, classification, and clinical management of cardiomyopathies. While echocardiography is the first-line technique, given its wide availability and safety, advanced imaging, including cardiovascular magnetic resonance (CMR), nuclear medicine and CT, is increasingly needed to refine the diagnosis or guide therapeutic decision-making. In selected cases, such as in transthyretin-related cardiac amyloidosis or in arrhythmogenic cardiomyopathy, the demonstration of histological features of the disease can be avoided when typical findings are observed at bone-tracer scintigraphy or CMR, respectively. Findings from imaging techniques should always be integrated with data from the clinical, electrocardiographic, biomarker, genetic and functional evaluation to pursue an individualised approach to patients with cardiomyopathy.
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Affiliation(s)
- Vincenzo Castiglione
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Alberto Aimo
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giancarlo Todiere
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Andrea Barison
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Iacopo Fabiani
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Giorgia Panichella
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Dario Genovesi
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Lucrezia Bonino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Clemente
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Filippo Cademartiri
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
| | - Alberto Giannoni
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Claudio Passino
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Michele Emdin
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
| | - Giuseppe Vergaro
- Cardiothoracic Department, Fondazione Toscana Gabriele MonasterioPisa, Italy
- Health Science Interdisciplinary Center, Scuola Superiore Sant’AnnaPisa, Italy
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Stankowski K, Figliozzi S, Lisi C, Catapano F, Panico C, Cannata F, Mantovani R, Frontera A, Bragato RM, Stefanini G, Monti L, Condorelli G, Francone M. Solving the Riddle of Sudden Cardiac Death in Hypertrophic Cardiomyopathy: The Added Role of Cardiac Magnetic Resonance. J Cardiovasc Dev Dis 2023; 10:226. [PMID: 37367391 DOI: 10.3390/jcdd10060226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Cardiac magnetic resonance (CMR) has been recently implemented in clinical practice to refine the daunting task of establishing the risk of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). We present an exemplificative case highlighting the practical clinical utility of this imaging modality in a 24-year-old man newly diagnosed with an apical HCM. CMR was essential in unmasking a high risk of SCD, which appeared low-intermediate after traditional risk assessment. A discussion examines the essential role of CMR in guiding the patient's therapy and underlines the added value of CMR, including novel and potential CMR parameters, compared to traditional imaging assessment for SCD risk stratification.
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Affiliation(s)
- Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Stefano Figliozzi
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Federica Catapano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Cristina Panico
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Riccardo Mantovani
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Antonio Frontera
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Renato Maria Bragato
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Lorenzo Monti
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20090 Milano, Italy
- Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, Rozzano, 20089 Milano, Italy
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50
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Ismail TF, Frey S, Kaufmann BA, Winkel DJ, Boll DT, Zellweger MJ, Haaf P. Hypertensive Heart Disease-The Imaging Perspective. J Clin Med 2023; 12:jcm12093122. [PMID: 37176563 PMCID: PMC10179093 DOI: 10.3390/jcm12093122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Hypertensive heart disease (HHD) develops in response to the chronic exposure of the left ventricle and left atrium to elevated systemic blood pressure. Left ventricular structural changes include hypertrophy and interstitial fibrosis that in turn lead to functional changes including diastolic dysfunction and impaired left atrial and LV mechanical function. Ultimately, these changes can lead to heart failure with a preserved (HFpEF) or reduced (HFrEF) ejection fraction. This review will outline the clinical evaluation of a patient with hypertension and/or suspected HHD, with a particular emphasis on the role and recent advances of multimodality imaging in both diagnosis and differential diagnosis.
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Affiliation(s)
- Tevfik F Ismail
- King's College London & Cardiology Department, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Simon Frey
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - David J Winkel
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Daniel T Boll
- Department of Radiology, University Hospital Basel, University of Basel, CH-4031 Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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