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Lauppe R, Liseth Hansen J, Fornwall A, Johansson K, Rozenbaum MH, Strand AM, Väkeväinen M, Kuusisto J, Gude E, Smith JG, Gustafsson F. Prevalence, characteristics, and mortality of patients with transthyretin amyloid cardiomyopathy in the Nordic countries. ESC Heart Fail 2022; 9:2528-2537. [PMID: 35560802 PMCID: PMC9288758 DOI: 10.1002/ehf2.13961] [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: 02/03/2022] [Revised: 03/15/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
Aims Transthyretin amyloid cardiomyopathy (ATTR‐CM) is a progressive condition caused by deposition of transthyretin amyloid fibrils in the heart and is associated with poor quality of life and a shortened lifespan. This study aimed to describe the prevalence, clinical characteristics, and mortality of patients with ATTR‐CM, using multiple national health registers in Denmark, Finland, Norway, and Sweden. Methods and results Transthyretin amyloid cardiomyopathy patients were identified during 2008–2018 using a combination of diagnosis codes for amyloidosis and heart disease and were matched to patients with non‐ATTR heart failure (HF). An identical study design was used in each country to facilitate comparison and aggregation of results. A total of 1930 ATTR‐CM patients were identified from national health registers in the four countries. In 2018, prevalence of ATTR‐CM per 100 000 inhabitants ranged from 1.4 in Denmark to 5.0 in Sweden; a steep increase over time was observed in Sweden and Norway. Median survival from diagnosis was 30 months for ATTR‐CM patients and 67 months for matched HF patients. Survival was significantly lower for female than for male ATTR‐CM patients (median survival: 22 and 36 months), while no significant difference was observed in the HF cohort. Conclusions This study provides the first nationwide estimates of the prevalence, clinical characteristics, and mortality of patients with ATTR‐CM, using identical study design across several countries. Findings corroborate previous case series showing high mortality in ATTR‐CM, two‐fold higher than for other HF patients and higher in women than men, highlighting the need for more precise and early diagnosis to reduce the disease burden.
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Affiliation(s)
| | - Johan Liseth Hansen
- Quantify Research, Stockholm, Sweden.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Johanna Kuusisto
- Department of Medicine and Clinical Research, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - J Gustav Smith
- Department of Cardiology, Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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Qin Q, Wei C, Piao Y, Lian F, Wu H, Zhou A, Wang F, Zuo X, Han Y, Lyu J, Guo D, Jia J. Current Review of Leptomeningeal Amyloidosis Associated With Transthyretin Mutations. Neurologist 2021; 26:189-195. [PMID: 34491937 PMCID: PMC8423141 DOI: 10.1097/nrl.0000000000000337] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Leptomeningeal amyloidosis (LA) represents a rare subtype of familial transthyretin (TTR) amyloidosis, characterized by deposition of amyloid in cranial and spinal leptomeninges. Of >120 TTR mutations identified, few have been associated with LA. CASE REPORT A 27-year-old male presented with a 2-year history of progressive symptoms including cognitive decline and right-sided weakness and numbness. Cerebrospinal fluid (CSF) analyses demonstrated high protein level. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed extensive leptomeningeal enhancement over the surface of the brain and spinal cord. Pathologic analyses revealed a TTR mutation c.113A>G (p.D38G). REVIEW SUMMARY Fifteen mutations and genotype-phenotype correlation of 72 LA patients have been summarized to provide an overview of LA associated with transthyretin mutations. The mean age of clinical onset was 44.9 years and the neurological symptoms primarily included cognitive impairment, headache, ataxia seizures and hearing, visual loss. CSF analysis showed elevated high CSF protein level and MRI revealed extensive leptomeningeal enhancement. CONCLUSION Clinicians should be aware of this rare form of familial transthyretin amyloidosis as well as its typical MRI enhancement and high CSF protein. The important role of biopsy, genetic testing and the potential early diagnosis value of contrast MRI were suggested. Early recognition of these characteristics is important to provide misdiagnosis and shorten the time before correct diagnosis. These findings expand the phenotypic spectrum of TTR gene and have implications for the diagnosis, treatment, and systematic study of LA.
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Affiliation(s)
- Qi Qin
- Department of Neurology, Innovation Center for Neurological Disorders
- Center for Cognitive Disorders, Beijing Geriatric Hospital
| | - Cuibai Wei
- Department of Neurology, Innovation Center for Neurological Disorders
| | | | | | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University
| | - Aihong Zhou
- Department of Neurology, Innovation Center for Neurological Disorders
| | - Fen Wang
- Department of Neurology, Innovation Center for Neurological Disorders
| | - Xiumei Zuo
- Department of Neurology, Innovation Center for Neurological Disorders
| | - Yue Han
- Department of Neurology, Innovation Center for Neurological Disorders
| | - Jihui Lyu
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University
| | - Dongmei Guo
- Department of Neurology, Innovation Center for Neurological Disorders
| | - Jianping Jia
- Department of Neurology, Innovation Center for Neurological Disorders
- Center of Alzheimer’s Disease, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Geriatric Cognitive Disorders
- Neurodegenerative Laboratory of Ministry of Education of the People’s Republic of China, Beijing, China
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Schettini AV, Llado L, Heimbach JK, Costello JG, Tranäng M, Van Caenegem O, Daly RC, Van den Bergh P, Casanovas C, Fabregat J, Poterucha JJ, Foguenne M, Ericzon BG, Lerut J. Symptomatic Val122del mutated hereditary transthyretin amyloidosis: Need for early diagnosis and prioritization for heart and liver transplantation. Hepatobiliary Pancreat Dis Int 2021; 20:323-329. [PMID: 34116942 DOI: 10.1016/j.hbpd.2021.05.002] [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: 10/22/2020] [Accepted: 05/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv) amyloidosis is an autosomal dominant disease linked to transthyretin gene mutations which cause instability of the transthyretin tetramer. After dissociation and misfolding they reassemble as insoluble fibrils (i.e. amyloid). Apart from the common Val30Met mutation there is a very heterogeneous group of non-Val30Met mutations. In some cases, the clinical picture is dominated by a rapidly evolving restrictive and hypertrophic cardiomyopathy. METHODS A case series of four liver recipients with the highly clinically relevant, rare and particularly aggressive Val122del mutation is presented. Medical and surgical therapeutic options, waiting list policy for ATTRv-amyloidosis, including the need for heart transplantation, and status of heart-liver transplantation are discussed. RESULTS Three patients needed a staged (1 patient) or simultaneous (2 patients) heart-liver transplant due to rapidly progressing cardiac failure and/or neurologic disability. Domino liver transplantation was impossible in two due to fibrotic hepatic transformation caused by cardiomyopathy. After a follow-up ranging from 3.5 to 9.5 years, cardiac (allograft) function was maintained in all patients, but neuropathy progressed in three patients, one of whom died after 80 months. CONCLUSIONS This is the first report in (liver) transplant literature about the rare Val122del ATTRv mutation. Due to its aggressiveness, symptomatic patients should be prioritized on the liver and, in cases with cardiomyopathy, heart waiting lists in order to avoid the irreversible neurological and cardiac damage that leads to a rapid lethal outcome.
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Affiliation(s)
- Adriano-Valerio Schettini
- Institute for Experimental and Clinical Research (IREC), Catholic University of Louvain (UCL), Avenue Hippocrate 55, Brussels 1200, Belgium
| | - Laura Llado
- Liver Transplant Unit, Department of Surgery, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - Julie K Heimbach
- Division of Transplantation Surgery, William J. von Liebig Transplant Center, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Jose Gonzalez Costello
- Advanced Heart Failure and Transplant Unit, Cardiology Department, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - Marie Tranäng
- Familial Amyloidotic Polyneuropathy World Transplant Registry (FAPWTR), Division of Transplantation Surgery, Karolinska Universitetssjukhuset Huddinge, F82, Karolinska Institutet, Stockholm 141 86, Sweden
| | - Olivier Van Caenegem
- Cardiothoracic Intensive Care Unit, Department of Cardiovascular Diseases, University Hospitals Saint-Luc - UCL, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Richard C Daly
- Cardiovascular Surgery Department, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Peter Van den Bergh
- Neuromuscular Reference Centre, University Hospital Saint-Luc - UCL, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Carlos Casanovas
- Neuromuscular Unit, Neurology Department, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - Joan Fabregat
- Liver Transplant Unit, Department of Surgery, Hospital Universitari de Bellvitge, Calle de la Feixa Llarga, Barcelona 08907, Spain
| | - John J Poterucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester MN 08907, USA
| | - Maxime Foguenne
- Institute for Experimental and Clinical Research (IREC), Catholic University of Louvain (UCL), Avenue Hippocrate 55, Brussels 1200, Belgium
| | - Bo Göran Ericzon
- Division of Transplantation Surgery, CLINTEC, Karolinska Universitetssjukhuset Huddinge, F82, Karolinska Institutet, Stockholm 14186, Sweden
| | - Jan Lerut
- Institute for Experimental and Clinical Research (IREC), Catholic University of Louvain (UCL), Avenue Hippocrate 55, Brussels 1200, Belgium.
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Obici L, Adams D. Acquired and inherited amyloidosis: Knowledge driving patients' care. J Peripher Nerv Syst 2021; 25:85-101. [PMID: 32378274 DOI: 10.1111/jns.12381] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Abstract
Until recently, systemic amyloidoses were regarded as ineluctably disabling and life-threatening diseases. However, this field has witnessed major advances in the last decade, with significant improvements in therapeutic options and in the availability of accurate and non-invasive diagnostic tools. Outstanding progress includes unprecedented hematological response rates provided by risk-adapted regimens in light chain (AL) amyloidosis and the approval of innovative pharmacological agents for both hereditary and wild-type transthyretin amyloidosis (ATTR). Moreover, the incidence of secondary (AA) amyloidosis has continuously reduced, reflecting advances in therapeutics and overall management of several chronic inflammatory diseases. The identification and validation of novel therapeutic targets has grounded on a better knowledge of key molecular events underlying protein misfolding and aggregation and on the increasing availability of diagnostic, prognostic and predictive markers of organ damage and response to treatment. In this review, we focus on these recent advancements and discuss how they are translating into improved outcomes. Neurological involvement dominates the clinical picture in transthyretin and gelsolin inherited amyloidosis and has a significant impact on disease course and management in all patients. Neurologists, therefore, play a major role in improving patients' journey to diagnosis and in providing early access to treatment in order to prevent significant disability and extend survival.
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Affiliation(s)
- Laura Obici
- Amyloidosis Research and Treatment Centre, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - David Adams
- National Reference Center for Familial Amyloid Polyneuropathy and Other Rare Neuropathies, APHP, Université Paris Saclay, INSERM U1195, Le Kremlin Bicêtre, France
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Algalarrondo V, Antonini T, Théaudin M, Chemla D, Benmalek A, Castaing D, Cauquil C, Rouzet F, Mika D, Duong E, Dinanian S, Eliahou L, Le Guludec D, Samuel D, Adams D, Slama MS. Cause of death analysis and temporal trends in survival after liver transplantation for transthyretin familial amyloid polyneuropathy. Amyloid 2018; 25:253-260. [PMID: 30632809 DOI: 10.1080/13506129.2018.1550061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hereditary transthyretin amyloidosis (ATTR) is a multisystemic disease involving mainly the peripheral nervous system and the heart. Liver transplantation (LT) is the reference treatment for ATTR neuropathy and preoperative detection of high risk patients is crucial. We aimed to document the causes of death of ATTR patients after LT, their temporal trends, and to evaluate whether the available preoperative tools that predict the risk of death after LT for hereditary ATTR amyloidosis matched with these trends. METHODS A retrospective longitudinal cohort study was performed on 215 consecutive ATTR patients who underwent LT between January 1993 and January 2011. Each patient's death cause and timing were classified. RESULTS Over a median follow up of 5.9 years, 84 patients died. The rate of death was higher in the first year following LT than thereafter (13.0 vs. 4.3 ± 1.8%/year; p = .004). Cardiac events ranked as the leading cause of death (C: 38%), followed by infections (I: 24%), graft complications (G: 17%), end stage amyloidosis, stroke and others (ASO: 7% each). Deaths due to graft complications and infections (GI) occurred earlier than those due to end stage amyloidosis and stroke. Death prediction was less accurate for GI-related mortality than for other causes, which blunted the accuracy of the early-term risk prediction scores. Conclusions In ATTR amyloidosis, cardiac events were the leading cause of death after liver transplantation. Close preoperative evaluation allowed for accurate mid-term prediction of mortality, but the high rate of graft complications and infections blunted the early-term risk prediction.
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Affiliation(s)
- Vincent Algalarrondo
- a Cardiology department , Bichat Claude Bernard Hospital, AP-HP, Université Paris Diderot , Paris , France
| | - Teresa Antonini
- b Hepato-Biliary Center, Paul Brousse hospital, AP-HP, UMR-S 785, Univ. Paris-Sud , Villejuif , France
| | - Marie Théaudin
- c FILNEMUS, Neurology Department , Kremlin Bicêtre hospital, AP-HP, Univ. Paris-Sud , Bicêtre , France
| | - Denis Chemla
- d Physiology Department , EA4533, Univ. Paris-Sud , Le Kremlin Bicêtre , France
| | - Anouar Benmalek
- e School of Pharmacy, University of Paris-Sud , Chatenay Malabry , France
| | - Denis Castaing
- b Hepato-Biliary Center, Paul Brousse hospital, AP-HP, UMR-S 785, Univ. Paris-Sud , Villejuif , France
| | - Cécile Cauquil
- c FILNEMUS, Neurology Department , Kremlin Bicêtre hospital, AP-HP, Univ. Paris-Sud , Bicêtre , France
| | - François Rouzet
- f Nuclear medicine Department and DHU FIRE , Bichat Claude Bernard hospital, AP-HP, Université Paris Diderot, U1148 , Paris , France
| | - Delphine Mika
- g INSERM UMR-S 1180, University of Paris-Sud , Chatenay-Malabry , France
| | - Eric Duong
- h Faculty of Pharmacy and Pharmaceutical Sciences , University of Alberta , Edmonton , Alberta , Canada
| | - Sylvie Dinanian
- i Cardiology department , Antoine Béclère Hospital, AP-HP , Clamart , France
| | - Ludivine Eliahou
- a Cardiology department , Bichat Claude Bernard Hospital, AP-HP, Université Paris Diderot , Paris , France
| | - Dominique Le Guludec
- f Nuclear medicine Department and DHU FIRE , Bichat Claude Bernard hospital, AP-HP, Université Paris Diderot, U1148 , Paris , France
| | - Didier Samuel
- b Hepato-Biliary Center, Paul Brousse hospital, AP-HP, UMR-S 785, Univ. Paris-Sud , Villejuif , France
| | - David Adams
- c FILNEMUS, Neurology Department , Kremlin Bicêtre hospital, AP-HP, Univ. Paris-Sud , Bicêtre , France
| | - Michel S Slama
- j Cardiology department , Bichat Claude Bernard Hospital, AP-HP, University of Paris-Sud , Paris , France
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Survival After Transplantation in Patients With Mutations Other Than Val30Met: Extracts From the FAP World Transplant Registry. Transplantation 2016; 100:373-81. [PMID: 26656838 PMCID: PMC4732012 DOI: 10.1097/tp.0000000000001021] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Liver transplantation (LTx) has been performed for hereditary transthyretin amyloidosis (ATTR) since 1990. Outcomes for a relatively large series of LTx ATTR patients with the Val30Met (mutation are available, but for non-Val30Met patients, only a few reports with a small number of patients exist. Here, we present outcomes for non-Val30Met ATTR patients after LTx, as reported to the Familial Amyloid Polyneuropathy World Transplant Registry (FAPWTR). Methods Data regarding outcome were extracted for all non-Val30Met patients reported to the registry. Survival rates were analyzed by the Kaplan-Meier method and log-rank test. Results The total number of patients with a non-Val30Met mutation in the registry was 264 (174 men and 90 women), representing 57 mutations. The 10-year survival varied markedly for the 9 most common mutations, ranging from 21% for Ser50Arg to 85% for Val71Ala. Poor survival was noted for all mutations with leptomeningeal complications except for those with the Tyr114Cys mutation. Conclusions Large differences in survival were observed relative to different mutations and between mutations with similar phenotypes. Excellent survival was noted for mutations, such as Leu111Met, Val71Ala, and Leu58His. Patients with mutations other than Val30Met are not a homogeneous group, and the term non-Val30Met should be used with caution or avoided. Moreover, for several mutations, data are too limited to allow evaluation of the efficacy of LTx, and continuous international collaboration is important for obtaining treatment guidance.
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