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Ibrahim AA, Gaffar Mohammed M, Elmasharaf HB, Osman IY, Ali NM. Challenges and Uncertainties in the Diagnosis of Cardiac Amyloidosis: A Case Report. Cureus 2024; 16:e60954. [PMID: 38800774 PMCID: PMC11126321 DOI: 10.7759/cureus.60954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
Amyloidosis is the condition when starch-like misfolded proteins form insoluble fibrils that deposit in tissues and cause dysfunction. Cardiac amyloidosis occurs due to the deposition of amyloid fibrils at the cardiac level and is an important cause of heart failure. This case reveals a patient with significant heart failure and arrhythmia, which later on turned out to be caused by cardiac amyloidosis. While regarded as a rare disease in practice, in retrospect, there are a lot of signs and imaging indicators, particularly in echocardiography that warrant an investigation of cardiac amyloidosis. In this case review, red flags in echocardiography that should endorse further testing for underlying cardiac amyloidosis are highlighted.
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Affiliation(s)
- Alia A Ibrahim
- Internal Medicine, Dr. Sulaiman Al-Habib Hospital - Al Sweidi Branch, Riyadh, SAU
| | | | | | - Ibrahim Y Osman
- Cardiology, Prince Sultan Military Medical City, Riyadh, SAU
| | - Nagoud M Ali
- Pathology, Prince Sultan Military Medical City, Riyadh, SAU
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Raval M, Siddiq S, Sharma K, Sanghvi L, Jain A, Patel S, Trivedi J, Uttam Chandani K, Patel D, Desai R. A review of recent advances in the diagnosis of cardiac amyloidosis, treatment of its cardiac complications, and disease-modifying therapies. F1000Res 2023; 12:192. [PMID: 36911240 PMCID: PMC9995736 DOI: 10.12688/f1000research.130285.1] [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: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
Cardiac amyloidosis (CA), a significant condition resulting in infiltrative cardiomyopathy and heart failure with preserved ejection fraction (HFpEF), is caused by extracellular deposition of amyloid fibrils in the heart. Even though this has been known for an extended period, its prevalence in elderly patients with heart failure is increasingly being recognized. Recent advances in diagnosis with non-invasive methods like technetium pyrophosphate-labeled cardiac scintigraphy (i.e., Tc-PYP scan) and treatment options with tafamidis have played a pivotal role in awareness of the burden of this disease. Management of cardiac complications like heart failure, atrial arrhythmias, conduction block, ventricular arrhythmias, coronary artery disease, and aortic stenosis is now more critical than ever. We aim to review and outline the recent advances in diagnoses of CA. We also review management strategies for cardiac complications of CA with a brief summary of disease-modifying therapies.
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Affiliation(s)
- Maharshi Raval
- Department of Internal Medicine, New York Medical College, Valhalla, New York, USA.,Department of Internal Medicine, Landmark Medical Center, Woonsocket, Rhode Island, USA
| | - Sajid Siddiq
- Department of Cardiology, New York Medical College, Valhalla, New York, USA.,Department of Cardiology, Landmark Medical Center, Woonsocket, Rhode Island, USA
| | - Kamal Sharma
- Department of Cardiology, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Labdhi Sanghvi
- Department of Pediatrics, Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, Gujarat, India
| | - Akhil Jain
- Department of Internal Medicine, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA
| | - Sagar Patel
- Department of Internal Medicine, New York Medical College, Valhalla, New York, USA.,Department of Internal Medicine, Landmark Medical Center, Woonsocket, Rhode Island, USA
| | - Jaahnavee Trivedi
- Department of Internal Medicine, New York Medical College, Valhalla, New York, USA.,Department of Internal Medicine, Landmark Medical Center, Woonsocket, Rhode Island, USA
| | - Kanishka Uttam Chandani
- Department of Internal Medicine, New York Medical College, Valhalla, New York, USA.,Department of Internal Medicine, Landmark Medical Center, Woonsocket, Rhode Island, USA
| | - Dhriti Patel
- Department of Medicine, B.J. Medical College and Civil Hospital, Ahmedabad, Gujarat, USA
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Rempakos A, Papamichail A, Loritis K, Androulakis E, Lama N, Briasoulis A. Non-LGE Cardiac Magnetic Resonance Imaging in Patients with Cardiac Amyloidosis. Curr Pharm Des 2022; 29:CPD-EPUB-128195. [PMID: 36515044 DOI: 10.2174/1381612829666221212100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
Cardiac involvement is the leading cause of death in patients with cardiac amyloidosis. Early recognition is crucial as it can significantly change the course of the disease. Until now, the imaging modality of choice for diagnosing cardiac amyloidosis has been cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE). LGE-CMR in patients with cardiac amyloidosis reveals characteristic LGE patterns that lead to a diagnosis while also correlating well with disease prognosis. However, LGE-CMR has numerous drawbacks that the newer CMR modality, T1 mapping, aims to improve. T1 mapping can be further subdivided into native T1 mapping, which does not require the use of contrast, and ECV measurement, which requires the use of contrast. Numerous T1 mapping techniques have been developed, each one with its own advantages and disadvantages when it comes to procedure difficulty and image quality. A literature review to identify relevant published articles was performed by two authors. This review aimed to present the value of T1 mapping in diagnosing cardiac amyloidosis, quantifying the amyloid burden, and evaluating the prognosis of patients with amyloidosis with cardiac involvement.
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Affiliation(s)
- Athanasios Rempakos
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Adamantia Papamichail
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Loritis
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Nikki Lama
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Briasoulis
- Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa College of Medicine, Iowa City, IA, USA
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Khella SL. Noncardiac Manifestations of Hereditary Amyloidosis. Am J Cardiol 2022; 185 Suppl 1:S17-S22. [PMID: 36369035 DOI: 10.1016/j.amjcard.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
The most common forms of cardiac amyloidosis are progressive, life threatening, and underrecognized. Symptoms affect a variety of organs and overlap with those of more common conditions, complicating and postponing diagnosis. Cardiac disease generally determines mortality, but noncardiac manifestations typically surface before cardiac symptoms, often several years before diagnosis. Familiarity with noncardiac manifestations may lead to early diagnosis, enabling treatment and improving prognosis.
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Affiliation(s)
- Sami L Khella
- Department of Neurology, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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