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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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García-Pavía P, García-Pinilla JM, Lozano-Bahamonde A, Yun S, García-Quintana A, Gavira-Gómez JJ, Aibar-Arregui MÁ, Barge-Caballero G, Núñez Villota J, Bernal L, Tarilonte P. Prevalence of transthyretin cardiac amyloidosis in patients with heart failure with preserved ejection fraction: the PRACTICA study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00240-8. [PMID: 39089574 DOI: 10.1016/j.rec.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
INTRODUCTION AND OBJECTIVES Transthyretin cardiac amyloidosis (ATTR-CA) is a frequent cause of heart failure with preserved ejection fraction (HFpEF). This study sought to determine the prevalence of ATTR-CA among HFpEF patients in a multicenter nationwide study. METHODS Consecutive ambulatory or hospitalized patients aged ≥ 50 years with HFpEF and left ventricle hypertrophy ≥ 12mm were studied at 20 Spanish hospitals. Screening for cardiac amyloidosis was initiated according to the usual clinical practice of each center. Positive scintigraphs were centrally analyzed. RESULTS 422 patients were included, of whom 387 underwent further screening for cardiac amyloidosis. A total of 65 patients (16.8%) were diagnosed with ATTR-CA, none below 75 years. There was an increase of prevalence with age. Of them, 60% were male, with a mean age of 85.3±5.2 years, mean left ventricle ejection fraction of 60.3±7.6% and a mean maximum left ventricle wall thickness of 17.2 [12-25] mm. Most of the patients were New York Heart Association class II (48.4%) or III (46.8%). Besides being older than non-ATTR-CA patients, ATTR-CA patients had higher median NT-proBNP levels (3801 [2266-7132] vs 2391 [1141-4796] pg/mL; P=.003). There was no statistical difference in the prevalence of ATTR-CA by sex (19.7% for men and 13.8% for women, P=.085). A ∼7% (4/56) of the patients exhibited a genetic variant (ATTRv). CONCLUSIONS This multicenter nationwide study found a prevalence of 16.8%, confirming that ATTR-CA is a significant contributor to HFpEF in male and female patients with left ventricle hypertrophy and more than 75 years.
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Affiliation(s)
- Pablo García-Pavía
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - José Manuel García-Pinilla
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Universidad de Málaga, Málaga, Spain
| | - Ainara Lozano-Bahamonde
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - Sergi Yun
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Bio-Heart, Grupo de Investigación en Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio García-Quintana
- Servicio de Cardiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Miguel Ángel Aibar-Arregui
- Servicio de Medicina Interna, Hospital Clínico Universitario de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS-A), Zaragoza, Spain
| | - Gonzalo Barge-Caballero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, Servicio Gallego de Salud (SERGAS), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Julio Núñez Villota
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
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de Haro Del Moral FJ, Aguadé Bruix S, Tabuenca Mateo MJ, Pilar Tamayo Alonso M, Mohamed Salem L, Bernal L, Primiano D, Tarilonte P. Assessment of incidental cardiac uptake in bone scintigraphy across Spain: The ECCINGO study. Rev Esp Med Nucl Imagen Mol 2024; 43:500020. [PMID: 38821407 DOI: 10.1016/j.remnie.2024.500020] [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: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
AIM Myocardial uptake on bone scintigraphy has become useful for the detection of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to assess the prevalence of myocardial uptake in patients over 18 years of age with no clinical suspicion of cardiac amyloidosis (CA) who had undergone bone scintigraphy. METHODS AND RESULTS This was an observational, retrospective, multicenter study across 21 Spanish hospitals (September-November 2019). Of the 9864 scans analyzed (locally and centrally), incidental cardiac uptake was observed in 71 patients (0.72%), a prevalence that increased with age. A previous diagnosis of heart failure was found in 16.9% of patients with positive uptake, with >50% in NYHA II. ATTR-CA was diagnosed in 10 patients, with a mean delay of 10.4 months (95% CI: 5.1-15.7). All were >70 years old, primarily male, and had greater left ventricular hypertrophy than patients without a confirmed diagnosis (p<0.0001). ATTR-CA patients had higher rates of orthostatic hypotension (30.0% vs. 3.8% in non-ATTR-CA; p=0.025). CONCLUSIONS This is the first retrospective, national, multicenter study evaluating the prevalence of incidental cardiac uptake in bone scintigraphy performed for non-cardiac reasons, showing a prevalence of 0.72% in this population. Referral of these patients may facilitate early diagnosis of CA with a resulting benefit for patients.
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Capeline LS. Unraveling the Challenges in Diagnosing Cardiac Amyloidosis. Arq Bras Cardiol 2024; 121:e20240107. [PMID: 38775616 PMCID: PMC11081089 DOI: 10.36660/abc.20240107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Lorena Squassante Capeline
- Universidade Federal de São PauloEscola Paulista de MedicinaSão PauloSPBrasilUniversidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP - EPM), São Paulo, SP – Brasil
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Del Carmen Mallón Araujo M, Casas EAJ, Casas CAJ, Monzonis MAM, Morell ÁR, Núñez VP. Cardiac scintigraphy and echocardiography assessment in the diagnosis of transthyretin cardiac amyloidosis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:415-424. [PMID: 37943369 DOI: 10.1007/s10554-023-02987-8] [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: 07/04/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023]
Abstract
The aim is to evaluate the diagnostic yield of echocardiography and [99mTc]Tc-DPD scintigraphy in the detection of amyloid cardiomyopathy (CM) and define potential prognostic echocardiographic parameters. 133 patients were retrospectively studied, from 2016 to 2021, with a mean age of 80.2 ± 7.5 years. The final diagnosis was established according to international consensus. Patients had a transthoracic echocardiogram (TTE) and [99mTc]Tc-DPD scintigraphy; RWT, E/e, LS, TAPSE, SAB, and IWT scores were calculated. All patients with ATTR-CM were classified into 3 prognostic stages and were compared with Perugini grades and echocardiographic parameters. CM was confirmed in 85 cases (63.9%), 76 (57.1%) ATTR-CM, and 9 (6.8%) AL-CM. The diagnostic yield of [99mTc]Tc-DPD scintigraphy and echocardiography were calculated, with a sensitivity of 90.7%, specificity of 100%, PPV of 100%, and NPV of 87.2% in myocardial scintigraphy, versus 74.6%, 62.5%, 75.6%, 61.2% in the echocardiogram. According to the IWT score, most patients were classified in the intermediate group; 33 presented with grade 2-3 uptakes. Significant results were obtained when comparing Perugini score with IWT (p: 0.02) and SAB (p: 0.03); and between biomarkers stages and LVEF (p: 0.028), E/e´ (p: 0.001), and GLS% (p: 0.022). [99mTc]Tc-DPD scintigraphy is superior in diagnosing CA. SAB could be the most reliable parameter in an early diagnostic phase, showing a strong correlation with Perugini grades 2 and 3.
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Affiliation(s)
| | - Estephany Abou Jokh Casas
- Nuclear Medicine Department, Lucus Augusti University Hospital, Rúa Dr. Ulises Romero, 1, 27003, Lugo, Spain.
| | | | | | - Álvaro Ruibal Morell
- Nuclear Medicine Department, Santiago de Compostela University Hospital, 15706, A Coruña, Spain
| | - Virginia Pubul Núñez
- Nuclear Medicine Department, Santiago de Compostela University Hospital, 15706, A Coruña, Spain
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Porres-López E, de Frutos F, Silva-Hernández L, Galán L, González-López E, García-Pavía P. Hereditary transthyretin amyloidosis caused by p.Ser43Asn variant. A new endemic variant in Ecuador. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023:S1885-5857(23)00045-2. [PMID: 36796722 DOI: 10.1016/j.rec.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/21/2022] [Indexed: 02/17/2023]
Affiliation(s)
- Elena Porres-López
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Majadahonda, Madrid, Spain
| | - Fernando de Frutos
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Majadahonda, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Lorenzo Silva-Hernández
- Servicio de Neurología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Lucía Galán
- Unidad de Neuromuscular, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - Esther González-López
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Majadahonda, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pablo García-Pavía
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Majadahonda, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain.
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de Frutos F, Gonzalez-Lopez E. New challenges in the management of patients with transthyretin cardiac amyloidosis: beyond oral anticoagulation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023:S1885-5857(23)00031-2. [PMID: 36716993 DOI: 10.1016/j.rec.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Fernando de Frutos
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Majadahonda, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Esther Gonzalez-Lopez
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHISA, Majadahonda, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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8
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de Frutos F, Gonzalez-Lopez E. Nuevos desafíos en el abordaje de pacientes con amiloidosis cardiaca por transtirretina. Más allá de la anticoagulación oral. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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9
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Porres-López E, de Frutos F, Silva-Hernández L, Galán L, González-López E, García-Pavía P. Amiloidosis hereditaria por transtirretina causada por la variante p.Ser43Asn. Una nueva variante endémica en Ecuador. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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10
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Gonzalez-Lopez E, Escobar-Lopez L, Obici L, Saturi G, Bezard M, Saith SE, AbouEzzeddine OF, Mussinelli R, Gagliardi C, Kharoubi M, Griffin JM, Dispenzieri A, Vilches S, Perlini S, Longhi S, Oghina S, Rivas A, Grogan M, Maurer MS, Damy T, Palladini G, Rapezzi C, Garcia-Pavia P. Prognosis of Transthyretin Cardiac Amyloidosis Without Heart Failure Symptoms. JACC CardioOncol 2022; 4:442-454. [DOI: 10.1016/j.jaccao.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
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Bay K, Gustafsson F, Maiborg M, Bagger‐Bahnsen A, Strand AM, Pilgaard T, Poulsen SH. Suspicion, screening, and diagnosis of wild-type transthyretin amyloid cardiomyopathy: a systematic literature review. ESC Heart Fail 2022; 9:1524-1541. [PMID: 35343098 PMCID: PMC9065854 DOI: 10.1002/ehf2.13884] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 01/15/2023] Open
Abstract
Wild-type transthyretin amyloid cardiomyopathy (ATTRwt CM) is a more common disease than previously thought. Awareness of ATTRwt CM and its diagnosis has been challenged by its unspecific and widely distributed clinical manifestations and traditionally invasive diagnostic tools. Recent advances in echocardiography and cardiac magnetic resonance (CMR), non-invasive diagnosis by bone scintigraphy, and the development of disease-modifying treatments have resulted in an increased interest, reflected in multiple publications especially during the last decade. To get an overview of the scientific knowledge and gaps related to patient entry, suspicion, diagnosis, and systematic screening of ATTRwt CM, we developed a framework to systematically map the available evidence of (i) when to suspect ATTRwt CM in a patient, (ii) how to diagnose the disease, and (iii) which at-risk populations to screen for ATTRwt CM. Articles published between 2010 and August 2021 containing part of or a full diagnostic pathway for ATTRwt CM were included. From these articles, data for patient entry, suspicion, diagnosis, and screening were extracted, as were key study design and results from the original studies referred to. A total of 50 articles met the inclusion criteria. Of these, five were position statements from academic societies, while one was a clinical guideline. Three articles discussed the importance of primary care providers in terms of patient entry, while the remaining articles had the cardiovascular setting as point of departure. The most frequently mentioned suspicion criteria were ventricular wall thickening (44/50), carpal tunnel syndrome (42/50), and late gadolinium enhancement on CMR (43/50). Diagnostic pathways varied slightly, but most included bone scintigraphy, exclusion of light-chain amyloidosis, and the possibility of doing a biopsy. Systematic screening was mentioned in 16 articles, 10 of which suggested specific at-risk populations for screening. The European Society of Cardiology recommends to screen patients with a wall thickness ≥12 mm and heart failure, aortic stenosis, or red flag symptoms, especially if they are >65 years. The underlying evidence was generally good for diagnosis, while significant gaps were identified for the relevance and mutual ranking of the different suspicion criteria and for systematic screening. Conclusively, patient entry was neglected in the reviewed literature. While multiple red flags were described, high-quality prospective studies designed to evaluate their suitability as suspicion criteria were lacking. An upcoming task lies in defining and evaluating at-risk populations for screening. All are steps needed to promote early detection and diagnosis of ATTRwt CM, a prerequisite for timely treatment.
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Affiliation(s)
- Katrine Bay
- Bay WritingCopenhagenDenmark
- Pfizer DenmarkBallerupDenmark
| | - Finn Gustafsson
- The Heart CenterCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Michael Maiborg
- Odense Amyloidosis Center & Department of CardiologyOdense University HospitalOdenseDenmark
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Rapezzi C, Vergaro G, Emdin M, Fabbri G, Cantone A, Sanguettoli F, Aimo A. The revolution of ATTR amyloidosis in cardiology: certainties, gray zones and perspectives. Minerva Cardiol Angiol 2022; 70:248-257. [PMID: 35412035 DOI: 10.23736/s2724-5683.21.05926-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Transthyretin (TTR) is a tetrameric protein synthesized mostly by the liver. As a result of gene mutations or as an ageing-related phenomenon, TTR molecules may misfold and deposit in the heart and in other organs as amyloid fibrils. Amyloid transthyretin cardiac amyloidosis (ATTR-CA) manifests typically as left ventricular pseudohypertrophy and/or heart failure with preserved ejection fraction and is an underdiagnosed disorder affecting quality of life and prognosis. This justifies the current search for novel tools for early diagnosis and accurate risk prediction, as well as for safe and effective therapies. In this review we will provide an overview of the main unsolved issues and the most promising research lines on ATTR-CA, ranging from the mechanisms of amyloid formation to therapies.
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Affiliation(s)
- Claudio Rapezzi
- Cardiologic Center, University of Ferrara, Ferrara, Italy - .,GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy -
| | - Giuseppe Vergaro
- Sant'Anna High School, Institute of Life Sciences, Pisa, Italy.,Division of Cardiology, Toscana Gabriele Monasterio Foundation, Pisa, Italy
| | - Michele Emdin
- Sant'Anna High School, Institute of Life Sciences, Pisa, Italy.,Division of Cardiology, Toscana Gabriele Monasterio Foundation, Pisa, Italy
| | - Gioele Fabbri
- Cardiologic Center, University of Ferrara, Ferrara, Italy
| | - Anna Cantone
- Cardiologic Center, University of Ferrara, Ferrara, Italy
| | | | - Alberto Aimo
- Sant'Anna High School, Institute of Life Sciences, Pisa, Italy.,Division of Cardiology, Toscana Gabriele Monasterio Foundation, Pisa, Italy
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Pedrosa RC. Amyloidosis for Cardiologists. Arq Bras Cardiol 2022; 118:433-434. [PMID: 35262577 PMCID: PMC8856688 DOI: 10.36660/abc.20210959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Roberto Coury Pedrosa
- Departamento de CardiologiaHospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroRJBrasilDepartamento de Cardiologia do Hospital Universitário Clementino Fraga Filho / Instituto do Coração Edson Saad / CEPARM. Centro Nacional de Referência em Amiloidose Brasileira – Universidade Federal do Rio de Janeiro,Rio de Janeiro, RJ – Brasil
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Electrocardiographic features and need for pacemaker in cardiac amyloidosis: Analysis of 58 cases. Med Clin (Barc) 2022; 159:78-84. [PMID: 35074177 DOI: 10.1016/j.medcli.2021.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 11/22/2022]
Abstract
AIM Amyloidosis is a disease in which amyloid fibrils can be deposited in different cardiac structures, and several electrocardiographic abnormalities can be produced by this phenomenon. The objective of this study was to describe the most common basal electrocardiographic alterations in patients diagnosed with cardiac amyloidosis (CA) and to determine if these abnormalities have an impact on the need of pacemaker. METHODS This retrospective study included patients who had an established diagnosis of CA [light-chain cardiac amyloidosis (LA-CA) or transthyretin cardiac amyloidosis (TTR-CA)] between January 2013 and March 2021. The baseline heart rate, the percentage of patients with a pseudo-infarct pattern, low-voltage pattern or cardiac conductions disturbances, and the impact of these factors on the need of pacemaker were analysed. RESULTS Fifty-eight patients with CA (20 with LA-CA and 38 with TTR-CA) were included, and the majority were male (69.0%). Twenty-one patients had atrial fibrillation (AF) at diagnosis. Thirty-five patients had a pseudo-infarct pattern, 35% had a low-voltage pattern, and 22% had criteria for ventricular hypertrophy. Two hirds had a conduction disorder: 18 patients with first degree atrioventricular block, 12 right bundle branch block, 3 left bundle branch block and 25 with a branch hemiblock. There were no differences between LA-CA and TTR-CA. Patients with TTR-CA had a greater need for pacemakers in the folow-up (39±40 meses). Bundle branch block was a predictor of the need for a permanent pacemaker (HR: 23.43; CI 95%: 4.09.134.09; P=.01). CONCLUSIONS Electrocardiographic abnormalities in patients diagnosed wich CA are heterogeneus. Most frecuent is the presence of conduction disorders, the pseudoinfarction pattern, followed by the low voltage pattern. Patients with any bundle branch block at the baseline electrocardiogram need more frecuent to require a pacemaker during follow-up, especially in TTR-CA.
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Pankuweit S, Dörr R. [Diagnosis and treatment of cardiac amyloidosis : A position statement of the ESC working group on myocardial and pericardial diseases 2021]. Herz 2021; 47:41-47. [PMID: 34878576 DOI: 10.1007/s00059-021-05085-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
Cardiac amyloidosis is still considered a rare disease, although recent data show that it is the cause of cardiac dysfunction more frequently than expected. The diagnosis of cardiac amyloidosis is based on the detection of extracellular deposits of misfolded proteins in the myocardium. This detection can be made invasively or noninvasively and is based on a tentative diagnosis that forms the foundation for further diagnostic measures. As different forms of amyloidosis may have different clinical presentations, suspicion of amyloidosis is often difficult. As not only the diagnostic possibilities have become broader but also new therapeutic possibilities have been tested in clinical studies, the working group on myocardial and pericardial diseases of the European Society of Cardiology (ESC) has set up a working group of experts to compile the current data on the clinical presentation, diagnostics and treatment of patients with cardiac amyloidosis, in order to subsequently develop diagnostic criteria and treatment options for patients with different forms of cardiac amyloidosis by consensus. The aim was to formulate a uniform Europe-wide acceptable concept for essential diagnostics and treatment for this group of patients. Only this will create the foundation for national and international registers and double-blind randomized treatment studies.
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Affiliation(s)
- Sabine Pankuweit
- Klinik für Innere Medizin - Kardiologie, Philipps-Universität Marburg, Baldinger Str. 1, 35043, Marburg, Deutschland.
| | - Rolf Dörr
- Praxisklinik Herz und Gefäße, Kardiologie • Angiologie • Radiologie • Nuklearmedizin, Akademische Lehrpraxisklinik, TU Dresden, Forststr. 3, 01099, Dresden, Deutschland
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Formiga F, García-Pavía P, Martín Sánchez FJ, Navarro-Ruiz A, Rubio-Terrés C, Peral C, Tarilonte P, López-Ibáñez de Aldecoa A, Rubio-Rodríguez D. Health and economic impact of the correct diagnosis of transthyretin cardiac amyloidosis in Spain. Expert Rev Pharmacoecon Outcomes Res 2021; 21:1127-1133. [PMID: 34047214 DOI: 10.1080/14737167.2021.1933948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To estimate the health and economic impact of the reduction in mortality and cardiovascular hospitalizations, associated with correct diagnosis of cardiac transthyretin amyloidosis (ATTR-CM), from the Spanish National Health System (NHS) perspective.Methods: A costs and effects analysis were performed (probabilistic Markov model) with time horizons between 1 and 15 years, comparing the correct diagnosis of ATTR-CM versus the non-diagnosis. Transition probabilities were obtained from the ATTR-ACT study (placebo arm) and from the literature. Costs and healthcare resources were obtained from Spanish sources (€ 2019) and from a panel of Spanish clinical experts.Results: After 1, 5, 10 and 15 years, the diagnosis of ATTR-CM would generate a gain of 0.031 (95%CI 0.025; 0.038); 0.387 (95%CI 0.329; 0.435); 0.754 (95%CI 0.678; 0.781) and 0.944 (95%CI 0.905; 0.983) life years per patient, respectively, with savings of € 212 (95%CI € -632; 633), € 2,289 (95%CI € 2,250; 2,517), € 2,859 (95%CI € 2,584; 3,149) and € 2,906 (95%CI € 2,669; 3,450) per patient, respectively, versus the non-diagnosis.Conclusions: Just by correctly diagnosing ATTR-CM, years of life would be gained, cardiovascular hospitalizations would be avoided, and savings would be generated for the NHS, compared to the non-diagnosis of the disease.
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Affiliation(s)
- Francesc Formiga
- Internal Medicine Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Pablo García-Pavía
- Heart Failure and Family Heart Disease Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
| | | | - Andrés Navarro-Ruiz
- Pharmacy Department, Hospital General Universitario de Elche , Alicante, Spain
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17
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Garcia-Pavia P, Rapezzi C, Adler Y, Arad M, Basso C, Brucato A, Burazor I, Caforio ALP, Damy T, Eriksson U, Fontana M, Gillmore JD, Gonzalez-Lopez E, Grogan M, Heymans S, Imazio M, Kindermann I, Kristen AV, Maurer MS, Merlini G, Pantazis A, Pankuweit S, Rigopoulos AG, Linhart A. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2021; 42:1554-1568. [PMID: 33825853 DOI: 10.1093/eurheartj/ehab072] [Citation(s) in RCA: 472] [Impact Index Per Article: 157.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/27/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Cardiac amyloidosis is a serious and progressive infiltrative disease that is caused by the deposition of amyloid fibrils at the cardiac level. It can be due to rare genetic variants in the hereditary forms or as a consequence of acquired conditions. Thanks to advances in imaging techniques and the possibility of achieving a non-invasive diagnosis, we now know that cardiac amyloidosis is a more frequent disease than traditionally considered. In this position paper the Working Group on Myocardial and Pericardial Disease proposes an invasive and non-invasive definition of cardiac amyloidosis, addresses clinical scenarios and situations to suspect the condition and proposes a diagnostic algorithm to aid diagnosis. Furthermore, we also review how to monitor and treat cardiac amyloidosis, in an attempt to bridge the gap between the latest advances in the field and clinical practice.
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Affiliation(s)
- Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Manuel de Falla, 2, 28222 Madrid, Spain.,Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon, Spain.,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Claudio Rapezzi
- Cardiologic Centre, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Yehuda Adler
- Leviev Heart Centre, Chaim Sheba Medical Centre (affiliated to Tel Aviv University), Israel
| | - Michael Arad
- Heart Failure Institute, Leviev Heart Centre, Sheba Hospital and Sackler School of Medicine, Tel Aviv University, Israel
| | - Cristina Basso
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Cardiovascular Pathology Unit, University Hospital, Padua, Italy.,Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonio Brucato
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi d Milano, Ospedale Fatebenefratelli, Italy
| | - Ivana Burazor
- Belgrade University School of Medicine, Cardiology, Institute for Rehabilitation, Belgrade, Serbia
| | - Alida L P Caforio
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Cardiology, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Thibaud Damy
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,French Referral Centre for Cardiac Amyloidosis, Amyloidosis Mondor Network, GRC Amyloid Research Institute, CHU Henri Mondor, Créteil, France
| | - Urs Eriksson
- GZO-Zurich Regional Health Centre, Wetzikon & Cardioimmunology, Centre for Molecular Cardiology, University of Zurich, Switzerland
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK
| | - Esther Gonzalez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Manuel de Falla, 2, 28222 Madrid, Spain.,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Martha Grogan
- Cardiac Amyloid Clinic, Division of Circulatory Failure, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Stephane Heymans
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht, Netherlands.,Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium.,ICIN-Netherlands Heart Institute, Holland Heart House, Utrecht, Netherlands
| | - Massimo Imazio
- Cardiovascular and Thoracic Department, University Cardiology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Germany.,Cardiovascular Centre Darmstadt, Heidelberg, Germany
| | - Mathew S Maurer
- Cardiac Amyloidosis Program, Centre for Advanced Cardiac Care, Columbia University Irving Medical Centre, New York Presbyterian Hospital, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Centre, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Italy
| | | | - Sabine Pankuweit
- Department Of Cardiology, Philipps-University Marburg, Marburg, Germany
| | - Angelos G Rigopoulos
- Mid-German Heart Centre, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
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18
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Garcia-Pavia P, Rapezzi C, Adler Y, Arad M, Basso C, Brucato A, Burazor I, Caforio ALP, Damy T, Eriksson U, Fontana M, Gillmore JD, Gonzalez-Lopez E, Grogan M, Heymans S, Imazio M, Kindermann I, Kristen AV, Maurer MS, Merlini G, Pantazis A, Pankuweit S, Rigopoulos AG, Linhart A. Diagnosis and treatment of cardiac amyloidosis. A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur J Heart Fail 2021; 23:512-526. [PMID: 33826207 DOI: 10.1002/ejhf.2140] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 12/22/2022] Open
Abstract
Cardiac amyloidosis is a serious and progressive infiltrative disease that is caused by the deposition of amyloid fibrils at the cardiac level. It can be due to rare genetic variants in the hereditary forms or as a consequence of acquired conditions. Thanks to advances in imaging techniques and the possibility of achieving a non-invasive diagnosis, we now know that cardiac amyloidosis is a more frequent disease than traditionally considered. In this position paper the Working Group on Myocardial and Pericardial Disease proposes an invasive and non-invasive definition of cardiac amyloidosis, addresses clinical scenarios and situations to suspect the condition and proposes a diagnostic algorithm to aid diagnosis. Furthermore, we also review how to monitor and treat cardiac amyloidosis, in an attempt to bridge the gap between the latest advances in the field and clinical practice.
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Affiliation(s)
- Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain.,Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon, Spain.,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Claudio Rapezzi
- Cardiologic Centre, University of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Yehuda Adler
- Leviev Heart Centre, Chaim Sheba Medical Centre (affiliated to Tel Aviv University), Ramat Gan, Israel
| | - Michael Arad
- Heart Failure Institute, Leviev Heart Centre, Sheba Hospital and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cristina Basso
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Cardiovascular Pathology Unit, University Hospital, and Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, University of Milan, Fatebenefratelli Hospital, Milan, Italy
| | - Ivana Burazor
- Belgrade University School of Medicine, Cardiology, Institute for Rehabilitation, Belgrade, Serbia
| | - Alida L P Caforio
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart.,Cardiology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Thibaud Damy
- French Referral Centre for Cardiac Amyloidosis, Amyloidosis Mondor Network, GRC Amyloid Research Institute, CHU Henri Mondor, Créteil, France
| | - Urs Eriksson
- GZO - Zurich Regional Health Centre, Wetzikon & Cardioimmunology, Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK
| | - Esther Gonzalez-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV, Madrid, Spain.,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart
| | - Martha Grogan
- Cardiac Amyloid Clinic, Division of Circulatory Failure, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Stephane Heymans
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands.,Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium.,ICIN-Netherlands Heart Institute, Holland Heart House, Utrecht, The Netherlands
| | - Massimo Imazio
- University Cardiology, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Centre, Saarland University, Homburg, Germany
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany.,Cardiovascular Centre Darmstadt, Heidelberg, Germany
| | - Mathew S Maurer
- Cardiac Amyloidosis Program, Centre for Advanced Cardiac Care, Columbia University Irving Medical Centre, New York Presbyterian Hospital, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Centre, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Sabine Pankuweit
- Department of Cardiology, Philipps-University Marburg, Marburg, Germany
| | - Angelos G Rigopoulos
- Mid-German Heart Centre, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
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