[Senile systemic amyloidosis: definition, diagnosis, why thinking about?]

[Cardiac amyloidosis]

Different types of amyloid deposits involve the heart. Transthyretin and light chain amyloidosis are the most frequent. Diagnostic performance, typing and treatments have improved in the last decade, and prognosis of cardiac amyloidosis is now significantly better thanks to targeted therapies. In this article, we will describe the clinical manifestations of cardiac amyloidosis, the diagnostic approach and detail the characteristics and specific treatments of the most frequent types of cardiac amyloidosis. We will focus on the histopathological aspects, especially on the importance of amyloid typing.

The Conjoint Analysis of Microstructural and Morphological Changes of Gray Matter During Aging

Macromorphological and microstructural changes of gray matter (GM) happen during brain normal aging. However, the mechanism of macro-microstructure association is still unclear, which is of guidance for understanding many neurodegenerative diseases. In this study, adopting structural magnetic resonance imaging (sMRI) and diffusion kurtosis imaging (DKI), GM aging pattern was characterized and its macro-microstructure associations were revealed. For 60 subjects among the ages of 47-79, the DKI and T1-weighted images were investigated with voxel-based analysis. The results showed age-related overlapped patterns between morphological and microstructural alterations during normal aging. It was worth noting that morphological changes and mean diffusivity (MD) indexes abnormalities mainly overlapped in the following regions, superior frontal gyrus, inferior frontal gyrus, cingulum gyrus, superior temporal gyrus, insula, and thalamus. Besides, overlapped with GM atrophies, mean kurtosis (MK) abnormalities were observed in superior frontal gyrus, inferior frontal gyrus, transverse temporal gyrus, insula, and thalamus. What important was that intrinsic aging independent associations between macrostructure and microstructure were found especially in media superior frontal gyrus, which revealed the potential mechanisms in the process of aging. The physiological mechanism may be associated with the elimination of neurons and synapses and the shrinkage of large neurons. Understanding the associations of GM volume changes and microstructural changes can account for the underlying mechanisms of aging and age-related neurodegenerative diseases.

Noninvasive Identification of ATTRwt Cardiac Amyloid: The Re-emergence of Nuclear Cardiology

More than half of all subjects with chronic heart failure are older adults with preserved ejection fraction (HFpEF). Effective therapy for this condition is yet to be delineated by clinical trials, suggesting that a greater understanding of underlying biologic mechanisms is needed, especially for the purpose of clinical intervention and future clinical trials. Amyloid infiltration of the myocardium is an underappreciated contributing factor to HFpEF that is often caused by misfolded monomers or oligomers of the protein transthyretin. While previously called senile cardiac amyloidosis and traditionally requiring endomyocardial biopsy for diagnosis, advances in our pathophysiologic understanding of this condition, coupled with nuclear imaging techniques using bone isotopes that can diagnose this condition noninvasively and the development of potential therapies, have resulted in a renewed interest in this previously considered "rare" condition. This reviewer focuses on the re-emergence of nuclear cardiology using pyrophosphate agents that hold promise for early, noninvasive identification of affected individuals.