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Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE, Gilotra NA, Judson MA, Patton KK, Rose-Bovino L. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1197-e1216. [PMID: 38634276 DOI: 10.1161/cir.0000000000001240] [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: 04/19/2024]
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
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Malhi JK, Ibecheozor C, Chrispin J, Gilotra NA. Diagnostic and management strategies in cardiac sarcoidosis. Int J Cardiol 2024; 403:131853. [PMID: 38373681 DOI: 10.1016/j.ijcard.2024.131853] [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: 10/18/2023] [Revised: 01/11/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Abstract
Cardiac sarcoidosis (CS) is increasingly recognized in the context of with otherwise unexplained electrical or structural heart disease due to improved diagnostic tools and awareness. Therefore, clinicians require improved understanding of this rare but fatal disease to care for these patients. The cardinal features of CS, include arrhythmias, atrio-ventricular conduction delay and cardiomyopathy. In addition to treatments tailored to these cardiac manifestations, immunosuppression plays a key role in active CS management. However, clinical trial and consensus guidelines are limited to guide the use of immunosuppression in these patients. This review aims to provide a practical overview to the current diagnostic challenges, treatment approach, and future opportunities in the field of CS.
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Affiliation(s)
- Jasmine K Malhi
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chukwuka Ibecheozor
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Legeai C, Coutance G, Cantrelle C, Jasseron C, Para M, Sebbag L, Battistella P, Kerbaul F, Dorent R. Waitlist Outcomes in Candidates With Rare Causes of Heart Failure After Implementation of the 2018 French Heart Allocation Scheme. Circ Heart Fail 2024; 17:e010837. [PMID: 38299331 DOI: 10.1161/circheartfailure.123.010837] [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: 05/04/2023] [Accepted: 09/13/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND In 2018, an algorithm-based allocation system for heart transplantation (HT) was implemented in France. Its effect on access to HT of patients with rare causes of heart failure (HF) has not been assessed. METHODS In this national study, including adults listed for HT between 2018 and 2020, we analyzed waitlist and posttransplant outcomes of candidates with rare causes of HF (restrictive cardiomyopathy [RCM], hypertrophic cardiomyopathy, and congenital heart disease). The primary end point was death on the waitlist or delisting for clinical deterioration. Secondary end points included access to HT and posttransplant mortality. The cumulative incidence of waitlist mortality estimated with competing risk analysis and incidence of transplantation were compared between diagnosis groups. The association of HF cause with outcomes was determined by Fine-Gray or Cox models. RESULTS Overall, 1604 candidates were listed for HT. At 1 year postlisting, 175 patients met the primary end point and 1040 underwent HT. Candidates listed for rare causes of HF significantly differed in baseline characteristics and had more frequent score exceptions compared with other cardiomyopathies (31.3%, 32.0%, 36.4%, and 16.7% for patients with hypertrophic cardiomyopathy, RCM, congenital heart disease, and other cardiomyopathies). The cumulative incidence of death on the waitlist and probability of HT were similar between diagnosis groups (P=0.17 and 0.40, respectively). The adjusted risk of death or delisting for clinical deterioration did not significantly differ between candidates with rare and common causes of HF (subdistribution hazard ratio (HR): hypertrophic cardiomyopathy, 0.51 [95% CI, 0.19-1.38]; P=0.18; RCM, 1.04 [95% CI, 0.42-2.58]; P=0.94; congenital heart disease, 1.82 [95% CI, 0.78-4.26]; P=0.17). Similarly, the access to HT did not significantly differ between causes of HF (hypertrophic cardiomyopathy: HR, 1.18 [95% CI, 0.92-1.51]; P=0.19; RCM: HR, 1.19 [95% CI, 0.90-1.58]; P=0.23; congenital heart disease: HR, 0.76 [95% CI, 0.53-1.09]; P=0.14). RCM was an independent risk factor for 1-year posttransplant mortality (HR, 2.12 [95% CI, 1.06-4.24]; P=0.03). CONCLUSIONS Our study shows equitable waitlist outcomes among HT candidates whatever the indication for transplantation with the new French allocation scheme.
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Affiliation(s)
- Camille Legeai
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Guillaume Coutance
- Department of Cardiac and Thoracic Surgery, Cardiology Institute, Pitié Salpêtrière Hospital (G.C.), Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, France
- University of Paris, INSERM UMR 970, Paris Translational Research Centre for Organ Transplantation, France (G.C.)
| | - Christelle Cantrelle
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Carine Jasseron
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Marylou Para
- Department of Cardiac Surgery, Bichat Hospital (M.P.), Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, France
| | - Laurent Sebbag
- Department of Cardiac Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, Bron, France (L.S.)
| | - Pascal Battistella
- Department of Cardiology, Arnaud de Villeneuve Hospital, Montpellier, France (P.B.)
| | - François Kerbaul
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
| | - Richard Dorent
- Agence de la Biomédecine, Saint Denis La Plaine Cedex, France (C.L., C.C., C.J., F.K., R.D.)
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4
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Bitar A, Colvin MM. Beyond Tiers: Examination of the French Heart Allocation System. Circ Heart Fail 2024; 17:e011312. [PMID: 38299339 DOI: 10.1161/circheartfailure.123.011312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Abbas Bitar
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.B., M.M.C.)
| | - Monica M Colvin
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.B., M.M.C.)
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Maitra NS, Dugger SJ, Balachandran IC, Civitello AB, Khazanie P, Rogers JG. Impact of the 2018 UNOS Heart Transplant Policy Changes on Patient Outcomes. JACC. HEART FAILURE 2023; 11:491-503. [PMID: 36892486 DOI: 10.1016/j.jchf.2023.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/19/2022] [Accepted: 01/04/2023] [Indexed: 03/05/2023]
Abstract
In 2018, the United Network for Organ Sharing implemented a 6-tier allocation policy to replace the prior 3-tier system. Given increasing listings of critically ill candidates for heart transplantation and lengthening waitlist times, the new policy aimed to better stratify candidates by waitlist mortality, shorten waiting times for high priority candidates, add objective criteria for common cardiac conditions, and further broaden sharing of donor hearts. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy, including changes in listing practices, waitlist time and mortality, transplant donor characteristics, post-transplantation outcomes, and mechanical circulatory support use. This review aims to highlight emerging trends in United States heart transplantation practice and outcomes following the implementation of the 2018 United Network for Organ Sharing heart allocation policy and to address areas for future modification.
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Affiliation(s)
- Neil S Maitra
- Baylor College of Medicine, Department of Medicine, Houston, Texas, USA
| | - Samuel J Dugger
- Baylor College of Medicine, Department of Medicine, Houston, Texas, USA
| | - Isabel C Balachandran
- Baylor College of Medicine, Department of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Andrew B Civitello
- Baylor College of Medicine, Department of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA
| | - Prateeti Khazanie
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Joseph G Rogers
- Baylor College of Medicine, Department of Medicine, Houston, Texas, USA; Texas Heart Institute, Houston, Texas, USA.
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6
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Bart NK, Lakdawala N. Don't Miss the Boat! Determining Optimal Time of Referral for Cardiac Transplantation. Heart Lung Circ 2022; 31:1561-1562. [PMID: 36549839 DOI: 10.1016/j.hlc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nicole K Bart
- Heart Failure and Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia; School of Medicine University of Notre Dame, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
| | - Neal Lakdawala
- Brigham and Women's Hospital, Boston, MA, USA; Boston VA Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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7
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Hsich E, Singh TP, Cherikh WS, Harhay MO, Hayes D, Perch M, Potena L, Sadavarte A, Lindblad K, Zuckermann A, Stehlik J. The International thoracic organ transplant registry of the international society for heart and lung transplantation: Thirty-ninth adult heart transplantation report-2022; focus on transplant for restrictive heart disease. J Heart Lung Transplant 2022; 41:1366-1375. [PMID: 36031520 DOI: 10.1016/j.healun.2022.07.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eileen Hsich
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Tajinder P Singh
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Wida S Cherikh
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael O Harhay
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Don Hayes
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Michael Perch
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Luciano Potena
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Aparna Sadavarte
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Kelsi Lindblad
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Andreas Zuckermann
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
| | - Josef Stehlik
- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois.
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- The International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, Chicago, Illinois
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DeFilippis EM, Khush KK, Farr MA, Fiedler A, Kilic A, Givertz MM. Evolving Characteristics of Heart Transplantation Donors and Recipients: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:1108-1123. [PMID: 35300823 DOI: 10.1016/j.jacc.2021.11.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/08/2021] [Accepted: 11/22/2021] [Indexed: 12/22/2022]
Abstract
Although the burden of end-stage heart failure continues to increase, the number of available organs for heart transplantation (HT) remains inadequate. The HT community has been challenged to find ways to expand the number of donor hearts available. Recent advances include use of hearts from donors infected with hepatitis C virus as well as other previously underutilized donors, including those with left ventricular dysfunction, of older age, and with a history of cocaine use. Concurrently, emerging trends in HT surgery include donation after circulatory death, ex vivo normothermic heart perfusion, and controlled hypothermic preservation, which may enable procurement of organs from farther distances and prevent early allograft dysfunction. Contemporary HT recipients have also evolved in light of the 2018 revision to the U.S. heart allocation policy. This focus seminar discusses recent trends in donor and recipient phenotypes and management strategies for successful HT, as well as evolving areas and future directions.
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Affiliation(s)
| | - Kiran K Khush
- Stanford University Medical Center, Stanford, California, USA
| | | | - Amy Fiedler
- University of Wisconsin Hospitals, Madison, Wisconsin, USA
| | - Arman Kilic
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael M Givertz
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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9
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Kumar S, Li D, Joseph D, Trachtenberg B. State-of-the-art review on management of end-stage heart failure in amyloidosis: transplant and beyond. Heart Fail Rev 2022; 27:1567-1578. [PMID: 35112265 DOI: 10.1007/s10741-021-10209-3] [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] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
Cardiac involvement occurs in light-chain (AL), transthyretin wild-type (wtATTR), and hereditary (hATTR) amyloidosis; other types of amyloidosis account for < 5% of all cardiac amyloidosis (CA). CA can present subclinically on screening, insidiously with symptoms such as exertional dyspnea, or abruptly as cardiogenic shock. Initially, CA patients were thought to be poor candidates for transplant due to short long-term survival; however, there is a marked improvement in heart and multi-organ transplant outcomes over the past 10 years with newer treatments and improvements in support with temporary and durable mechanical circulatory support while awaiting transplant. Patients with AL CA were reported to have worse post-OHT outcomes than patients with ATTR CA, but this gap is quickly closing with improved patient selection, novel chemotherapeutics, and perhaps with selected use of bone marrow transplantation. Waitlist mortality and transplantation rates have markedly improved for CA after the United Network for Organ Sharing (UNOS) policy change in October 2018. In this review, we will evaluate contemporary data from the last 5 years on advances in the field of transplantation and mechanical circulatory support in this patient population.
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Affiliation(s)
- Salil Kumar
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Daniel Li
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Denny Joseph
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Barry Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA. .,Houston Methodist J.C. Walter Jr. Transplant Center, Houston, TX, USA.
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10
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Asleh R, Briasoulis A, Doulamis I, Alnsasra H, Tzani A, Alvarez P, Kuno T, Kampaktsis P, Kushwaha S. Outcomes after heart transplantation in patients with cardiac sarcoidosis. ESC Heart Fail 2022; 9:1167-1174. [PMID: 35032102 PMCID: PMC8934937 DOI: 10.1002/ehf2.13789] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 12/18/2022] Open
Abstract
Background The number of patients with sarcoidosis requiring heart transplantation (HT) is increasing. The aim of this study was to evaluate outcomes of isolated HT in patients with sarcoid cardiomyopathy and compare them to recipients with non‐ischaemic restrictive or dilated cardiomyopathy. Methods and results Adult HT recipients were identified in the UNOS Registry between 1990 and 2020. Patients were grouped according to diagnosis. The cumulative incidences for the all‐cause mortality and rejection were compared using Fine and Gray model analysis, accounting for re‐transplantation as a competing risk. Rejection was evaluated using logistic regression analysis. We also reviewed characteristics and outcomes of all HT recipients with previous diagnosis of sarcoid cardiomyopathy from a single centre. A total of 30 160 HT recipients were included in the present study (n = 239 sarcoidosis, n = 1411 non‐ischaemic restrictive cardiomyopathy, and n = 28 510 non‐ischaemic dilated cardiomyopathy). During a total of 194 733 patient‐years, all‐cause mortality at the latest follow‐up was not significantly different when comparing sarcoidosis to non‐ischaemic dilated cardiomyopathy [adjusted subhazard ratio (aSHR) 1.46, 95% confidence intervals (CIs): 0.9–2.4, P = 0.12] or restrictive cardiomyopathy (aSHR 1.12, 95% CI: 0.65–1.95, P = 0.67). Accordingly, multivariable analysis suggested that 1 year mortality was not significantly different between sarcoidosis and non‐ischaemic dilated cardiomyopathy (aSHR 1.56, 95% CI: 0.9–2.7, P = 0.12) or restrictive cardiomyopathy (aSHR 1.15, 95% CI: 0.61–2.18, P = 0.66). No differences were observed regarding 30 day mortality, treated and hospitalized acute rejection, and 30 day death from graft failure after HT. Thirty‐day mortality did not improve significantly in more recent HT eras whereas there was a trend towards improved 1 year mortality in the latest HT era (P = 0.06). Data from the single‐centre case review showed excellent long‐term outcomes with sirolimus‐based immunosuppression. Conclusions Short‐term and long‐term post HT outcomes among patients with sarcoid cardiomyopathy are similar to those with common types of non‐ischaemic cardiomyopathy.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart failure and Transplantation, University of Iowa, Iowa City, IA, USA.,National Kapodistrian University of Athens, Greece
| | - Ilias Doulamis
- Department of Cardiac Surgery, Boston's Children Hospital, Harvard Medical School, Boston, MA, USA
| | - Hilmi Alnsasra
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aspasia Tzani
- Department of Cardiac Surgery, Boston's Children Hospital, Harvard Medical School, Boston, MA, USA
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Toshiki Kuno
- Department of Medicine Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York University Langone Medical Center, New York, NY, USA
| | - Sudhir Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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11
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Gilotra NA, Griffin JM, Pavlovic N, Houston BA, Chasler J, Goetz C, Chrispin J, Sharp M, Kasper EK, Chen ES, Blankstein R, Cooper LT, Joyce E, Sheikh FH. Sarcoidosis-Related Cardiomyopathy: Current Knowledge, Challenges, and Future Perspectives State-of-the-Art Review. J Card Fail 2021; 28:113-132. [PMID: 34260889 DOI: 10.1016/j.cardfail.2021.06.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022]
Abstract
The prevalence of sarcoidosis-related cardiomyopathy is increasing. Sarcoidosis impacts cardiac function through granulomatous infiltration of the heart, resulting in conduction disease, arrhythmia, and/or heart failure. The diagnosis of cardiac sarcoidosis (CS) can be challenging and requires clinician awareness as well as differentiation from overlapping diagnostic phenotypes, such as other forms of myocarditis and arrhythmogenic cardiomyopathy. Clinical manifestations, extracardiac involvement, histopathology, and advanced cardiac imaging can all lend support to a diagnosis of CS. The mainstay of therapy for CS is immunosuppression; however, no prospective clinical trials exist to guide management. Patients may progress to developing advanced heart failure or ventricular arrhythmia, for which ventricular assist device therapies or heart transplantation may be considered. The existing knowledge gaps in CS call for an interdisciplinary approach to both patient care and future investigation to improve mechanistic understanding and therapeutic strategies.
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Affiliation(s)
- Nisha A Gilotra
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jan M Griffin
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Columbia University School of Medicine, New York, New York
| | - Noelle Pavlovic
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Brian A Houston
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jessica Chasler
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Colleen Goetz
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Jonathan Chrispin
- Clinical Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward K Kasper
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward S Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Emer Joyce
- Department of Cardiology, Mater Misericordiae University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Farooq H Sheikh
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
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12
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Amarelli C, Limongelli G. Cardiac amyloidosis: Watching the tip of the iceberg emerging from the "heart of the sea". Int J Cardiol 2021; 338:226-228. [PMID: 34118326 DOI: 10.1016/j.ijcard.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Cristiano Amarelli
- Department of Cardiac Surgery and Transplants, Monaldi, Azienda dei Colli, 80131 Naples, Italy.
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, 80131 Naples, Italy
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13
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Abstract
Often considered a rare disease, cardiac amyloidosis is increasingly recognized by practicing clinicians. The increased rate of diagnosis is in part due the aging of the population and increasing incidence and prevalence of cardiac amyloidosis with advancing age, as well as the advent of noninvasive methods using nuclear scintigraphy to diagnose transthyretin cardiac amyloidosis due to either variant or wild type transthyretin without a biopsy. Perhaps the most important driver of the increased awareness is the elucidation of the biologic mechanisms underlying the pathogenesis of cardiac amyloidosis which have led to the development of several effective therapies with differing mechanisms of actions. In this review, the mechanisms underlying the pathogenesis of cardiac amyloidosis due to light chain (AL) or transthyretin (ATTR) amyloidosis are delineated as well as the rapidly evolving therapeutic landscape that has emerged from a better pathophysiologic understanding of disease development.
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Affiliation(s)
- Jan M. Griffin
- Division of Cardiology, Cardiovascular Research Laboratory
for the Elderly, Columbia University Irving Medical Center, New York, NY
| | - Hannah Rosenblum
- Division of Cardiology, Cardiovascular Research Laboratory
for the Elderly, Columbia University Irving Medical Center, New York, NY
| | - Mathew S. Maurer
- Division of Cardiology, Cardiovascular Research Laboratory
for the Elderly, Columbia University Irving Medical Center, New York, NY
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