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Arshad S, Goldberg YH, Bhopalwala H, Dewaswala N, Miceli NS, Birks EJ, Vaidya GN. High Prevalence of Cardiac Amyloidosis in Clinically Significant Aortic Stenosis: A Meta-Analysis. Cardiol Res 2022; 13:357-371. [PMID: 36660066 PMCID: PMC9822671 DOI: 10.14740/cr1436] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background There is growing evidence of coexistence of aortic stenosis (AS) and transthyretin cardiac amyloidosis (CA). Not screening AS patients at the time of hospital/clinic visit for CA represents a lost opportunity. Methods We surveyed studies that reported the prevalence of CA among AS patients. Studies that compared patients with aortic stenosis with cardiac amyloidosis (AS-CA) and AS alone were further analyzed, and meta-regression was performed. Results We identified nine studies with 1,321 patients of AS, of which 131 patients had concomitant CA, with a prevalence of 11%. When compared to AS-alone, the patients with AS-CA were older, more likely to be males, had higher prevalence of carpal tunnel syndrome, right bundle branch block. On echocardiogram, patients with AS-CA had thicker interventricular septum, higher left ventricular mass index (LVMI), lower myocardial contraction fraction, and lower stroke volume index. Classical low-flow low-gradient (LFLG) physiology was more common among patients with AS-CA. Patients with AS-CA had higher all-cause mortality than patients with AS alone (33% vs. 22%, P = 0.02) in a follow-up period of at least 1 year. Conclusions CA has a high prevalence in patients with AS and is associated with worse clinical, imaging, and biochemical parameters than patients with AS alone.
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Affiliation(s)
- Samiullah Arshad
- Department of Medicine, University of Kentucky, Lexington, KY, USA,Corresponding Author: Samiullah Arshad, Department of Medicine, University of Kentucky, Lexington, KY, USA.
| | | | - Huzefa Bhopalwala
- Department of Medicine, Appalachian Regional Healthcare, Whitesburg, KY, USA
| | - Nakeya Dewaswala
- Division of Cardiology (Advanced Heart Failure and Transplantation), Gill Heart and Vascular Institute, University of Kentucky, Lexington KY, USA
| | - Nicholas S. Miceli
- College of Management, School of Business, Park University, Parkville, MO, USA
| | - Emma J. Birks
- Division of Cardiology (Advanced Heart Failure and Transplantation), Gill Heart and Vascular Institute, University of Kentucky, Lexington KY, USA
| | - Gaurang N. Vaidya
- Division of Cardiology (Advanced Heart Failure and Transplantation), Gill Heart and Vascular Institute, University of Kentucky, Lexington KY, USA
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2
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Oghina S, Josse C, Bézard M, Kharoubi M, Delbarre MA, Eyharts D, Zaroui A, Guendouz S, Galat A, Hittinger L, Fanen P, Teiger E, Mouri N, Montestruc F, Damy T. Prognostic Value of N-Terminal Pro-Brain Natriuretic Peptide and High-Sensitivity Troponin T Levels in the Natural History of Transthyretin Amyloid Cardiomyopathy and Their Evolution after Tafamidis Treatment. J Clin Med 2021; 10:jcm10214868. [PMID: 34768388 PMCID: PMC8584290 DOI: 10.3390/jcm10214868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We assesse the evolution and prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (cTnT-HS) in transthyretin amyloid cardiomyopathy (ATTR-CA) before and after tafamidis treatment. METHODS AND RESULTS 454 ATTR-CA patients without tafamidis (Cohort A) and 248 ATTR-CA with tafamidis (Cohort B) were enrolled. Event-free survival (EFS) events were death, heart transplant, or acute heart failure. In Cohort A, 27% of patients maintained NT-proBNP < 3000 ng/L and 14% cTnT-HS < 50 ng/L at 12 months relative to baseline levels. In Cohort B, the proportions were 49% and 29%, respectively. In Cohort A, among the 333 patients without an increased NT-proBNP > 50% relative to baseline EFS was extended compared to the 121 patients with an increased NT-proBNP > 50% (HR: 0.75 [0.57; 0.98]; p = 0.032). In Cohort A, baseline NT-proBNP > 3000 ng/L and cTnT-HS > 50 ng/L and a relative increase of NT-proBNP > 50% during follow-up were independent prognostic factors of EFS. The slopes of logs NT-proBNP and cTnT-HS increased with time before and stabilized after tafamidis. CONCLUSION ATTR-CA patients with increasing NT-proBNP had an increased risk of EFS. Tafamidis stabilize NT-proBNP and cTnT-HS increasing, even if initial NT-proBNP levels were >3000 ng/L. Thus suggesting that all patients, irrespective of baseline NT-proBNP levels, may benefit from tafamidis.
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Affiliation(s)
- Silvia Oghina
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Correspondence: ; Tel.: +33-1498-122-53; Fax: +33-1498-142-24
| | | | - Mélanie Bézard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Mounira Kharoubi
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Marc-Antoine Delbarre
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Damien Eyharts
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Amira Zaroui
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Soulef Guendouz
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Arnault Galat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Luc Hittinger
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Pascale Fanen
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Genetics Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Emmanuel Teiger
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | - Nadir Mouri
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Biochemistery Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
| | | | - Thibaud Damy
- Assistance Publique-Hôpitaux de Paris (AP-HP), Cardiology Department, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (M.B.); (M.K.); (M.-A.D.); (D.E.); (A.Z.); (S.G.); (A.G.); (L.H.); (E.T.); (T.D.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), French Referral Centre for Cardiac Amyloidosis, Cardiogen Network, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France; (P.F.); (N.M.)
- Assistance Publique-Hôpitaux de Paris (AP-HP), GRC Amyloid Research Institute, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), FHU SENEC, Henri Mondor University Hospital, 1 Rue Gustave Eiffel, F-94010 Créteil, France
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Abe T, Chang EY, De Allie G, Ajose T, Nwokike C, Bakinde N. Rapid decline in ejection fraction and persistent elevation of troponin associated with cardiac amyloidosis. SAGE Open Med Case Rep 2020; 8:2050313X20923259. [PMID: 32547758 PMCID: PMC7249551 DOI: 10.1177/2050313x20923259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/05/2020] [Indexed: 01/15/2023] Open
Abstract
Cardiac amyloidosis is an increasingly recognized cause of heart failure. It remains underdiagnosed despite a significant morbidity and mortality rate. The mean survival in patients with cardiac amyloidosis is less than 1 year in untreated primary light-chain amyloidosis and less than 4 years in wild-type transthyretin amyloidosis. We report a unique case of a 78-year-old male with transthyretin cardiac amyloidosis, who presented with persistently elevated troponin and progressive heart failure unresponsive to conventional therapy. With this case, we would like to highlight the role of cardiac biomarkers in the early diagnosis of cardiac amyloidosis.
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Affiliation(s)
| | | | | | - Taiwo Ajose
- Morehouse School of Medicine, Atlanta, GA, USA
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4
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Ochi Y, Kubo T, Baba Y, Nakashima Y, Ueda M, Takahashi A, Miyagawa K, Noguchi T, Hirota T, Yamasaki N, Kitaoka H. Prediction of Medium-Term Mortality in Japanese Patients With Wild-Type Transthyretin Amyloidosis. Circ Rep 2020; 2:314-321. [PMID: 33693246 PMCID: PMC7925325 DOI: 10.1253/circrep.cr-20-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The prognostic factors in Japanese patients with wild-type transthyretin amyloidosis (ATTRwt) have not been elucidated. Methods and Results: In this study we retrospectively analyzed the clinical characteristics and outcomes of 47 patients with ATTRwt (mean (±SD) age at diagnosis 80.3±4.6 years; 41 males). Fifteen patients died within 2 years of their diagnosis. Receiver operating characteristic and Kaplan-Meier analyses revealed that the best predictors of 2-year mortality were low serum albumin (≤3.75 g/dL), elevated high-sensitivity cardiac troponin T (hs-cTnT; >0.086 ng/mL), and reduced left ventricular ejection fraction (LVEF; <50%). According to the total number of these 3 risk factors, patients were stratified into 4 subgroups: low risk (no risk factors; n=15), intermediate-low risk (1 risk factor; n=15), intermediate-high risk (2 risk factors; n=7), and high risk (3 risk factors; n=10). The estimated 2-year survival rate of patients classified as low risk, intermediate-low risk, intermediate-high risk, and high risk was 93%, 80%, 83%, and 11%, respectively (P<0.001). Conclusions: Low serum albumin, elevated hs-cTnT, and reduced LVEF are associated with a worse prognosis in Japanese patients with ATTRwt. The combination of these factors may be useful for predicting medium-term mortality in patients with ATTRwt.
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Affiliation(s)
- Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Yasuteru Nakashima
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Motoko Ueda
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Asa Takahashi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Kazuya Miyagawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
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5
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Rigopoulos AG, Ali M, Abate E, Torky AR, Matiakis M, Mammadov M, Melnyk H, Vogt A, de Vecchis R, Bigalke B, Wohlgemuth W, Mavrogeni S, Noutsias M. Advances in the diagnosis and treatment of transthyretin amyloidosis with cardiac involvement. Heart Fail Rev 2020; 24:521-533. [PMID: 30790171 DOI: 10.1007/s10741-019-09776-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Amyloidosis is caused by extracellular deposition of insoluble abnormal fibrils constituted by misfolded proteins, which can modify tissue anatomy and hinder the function of multiple organs including the heart. Amyloidosis that can affect the heart includes mostly systemic amyloidosis (amyloid light chain, AL) and transthyretin amyloidosis (ATTR). The latter can be acquired in elderly patients (ATTRwt), or be inherited in younger individuals (ATTRm). The diagnosis is demanding given the high phenotypic heterogeneity of the disease. Therefore, "red flags," which are suggestive features giving support to diagnostic suspicion, are extremely valuable. However, the lack of broad awareness among clinicians represents a major obstacle for early diagnosis and treatment of ATTR. Furthermore, recent implementation of noninvasive diagnostic techniques has revisited the need for endomyocardial biopsy (EMB). In fact, unlike AL amyloidosis, which requires tissue confirmation and typing for diagnosis, ATTR can now be diagnosed noninvasively with the combination of bone scintigraphy and the absence of a monoclonal protein. Securing the correct diagnosis is pivotal for the newly available therapeutic options targeting both ATTRm and ATTRwt, and are directed to either stabilization of the abnormal protein or the reduction of the production of transthyretin. The purpose of this article is to review the contemporary aspects of diagnosis and management of transthyretin amyloidosis with cardiac involvement, summarizing also the recent therapeutic advances with tafamidis, patisiran, and inotersen.
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Affiliation(s)
- Angelos G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Muhammad Ali
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Elena Abate
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Abdel-Rahman Torky
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Marios Matiakis
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Mammad Mammadov
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Hannes Melnyk
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Alexander Vogt
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Renato de Vecchis
- Preventive Cardiology and Rehabilitation Unit, DSB 29, S. Gennaro dei Poveri Hospital, 80136, Naples, Italy
| | - Boris Bigalke
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany
| | - Walter Wohlgemuth
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, Palaeo Faliro, Athens, Greece
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany.
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6
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Kyriakou P, Mouselimis D, Tsarouchas A, Rigopoulos A, Bakogiannis C, Noutsias M, Vassilikos V. Diagnosis of cardiac amyloidosis: a systematic review on the role of imaging and biomarkers. BMC Cardiovasc Disord 2018; 18:221. [PMID: 30509186 PMCID: PMC6278059 DOI: 10.1186/s12872-018-0952-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cardiac Amyloidosis (CA) pertains to the cardiac involvement of a group of diseases, in which misfolded proteins deposit in tissues and cause progressive organ damage. The vast majority of CA cases are caused by light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). The increased awareness of these diseases has led to an increment of newly diagnosed cases each year. METHODS We performed multiple searches on MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews. Several search terms were used, such as "cardiac amyloidosis", "diagnostic modalities cardiac amyloidosis" and "staging cardiac amyloidosis". Emphasis was given on original articles describing novel diagnostic and staging approaches to the disease. RESULTS Imaging techniques are indispensable to diagnosing CA. Novel ultrasonographic techniques boast high sensitivity and specificity for the disease. Nuclear imaging has repeatedly proved its worth in the diagnostic procedure, with efforts now focusing on standardization and quantification of amyloid load. Because the latter would be invaluable for any staging system, those spearheading research in magnetic resonance imaging of the disease are also trying to come up with accurate tools to quantify amyloid burden. Staging tools are currently being developed and validated for ATTR CA, in the spirit of the acclaimed Mayo Staging System for AL. CONCLUSION Cardiac involvement confers significant morbidity and mortality in all types of amyloidosis. Great effort is made to reduce the time to diagnosis, as treatment in the initial stages of the disease is tied to better prognosis. The results of these efforts are highly sensitive and specific diagnostic modalities that are also reasonably cost effective.
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Affiliation(s)
- Panagiota Kyriakou
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Dimitrios Mouselimis
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Anastasios Tsarouchas
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Angelos Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle (Saale), D-06120 Germany
| | - Constantinos Bakogiannis
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle (Saale), D-06120 Germany
| | - Vasileios Vassilikos
- 3rd Cardiology Department, Ippokrateion General Hospital of Thessaloniki, Konstantinoupoleos 49, 55 642 Thessaloniki, GR Greece
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7
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Abstract
Anthracycline chemotherapy maintains a prominent role in treating many forms of cancer. Cardiotoxic side effects limit their dosing and improved cancer outcomes expose the cancer survivor to increased cardiovascular morbidity and mortality. The basic mechanisms of cardiotoxicity may involve direct pathways for reactive oxygen species generation and topoisomerase 2 as well as other indirect pathways. Cardioprotective treatments are few and those that have been examined include renin angiotensin system blockade, beta blockers, or the iron chelator dexrazoxane. New treatments exploiting the ErbB or other novel pro-survival pathways, such as conditioning, are on the cardioprotection horizon. Even in the forthcoming era of targeted cancer therapies, the substantial proportion of today's anthracycline-treated cancer patients may become tomorrow's cardiac patient.
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Affiliation(s)
- John V McGowan
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Robin Chung
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Angshuman Maulik
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Izabela Piotrowska
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - J Malcolm Walker
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, London, WC1E 6HX, UK.
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8
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Chung R, Maulik A, Hamarneh A, Hochhauser D, Hausenloy DJ, Walker JM, Yellon DM. Effect of Remote Ischaemic Conditioning in Oncology Patients Undergoing Chemotherapy: Rationale and Design of the ERIC-ONC Study--A Single-Center, Blinded, Randomized Controlled Trial. Clin Cardiol 2016; 39:72-82. [PMID: 26807534 PMCID: PMC4864751 DOI: 10.1002/clc.22507] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/15/2015] [Indexed: 01/01/2023] Open
Abstract
Cancer survival continues to improve, and thus cardiovascular consequences of chemotherapy are increasingly important determinants of long‐term morbidity and mortality. Conventional strategies to protect the heart from chemotherapy have important hemodynamic or myelosuppressive side effects. Remote ischemic conditioning (RIC) using intermittent limb ischemia‐reperfusion reduces myocardial injury in the setting of percutaneous coronary intervention. Anthracycline cardiotoxicity and ischemia‐reperfusion injury share common biochemical pathways in cardiomyocytes. The potential for RIC as a novel treatment to reduce subclinical myocyte injury in chemotherapy has never been explored and will be investigated in the Effect of Remote Ischaemic Conditioning in Oncology (ERIC‐ONC) trial (clinicaltrials.gov NCT 02471885). The ERIC‐ONC trial is a single‐center, blinded, randomized, sham‐controlled study. We aim to recruit 128 adult oncology patients undergoing anthracycline‐based chemotherapy treatment, randomized in a 1:1 ratio into 2 groups: (1) sham procedure or (2) RIC, comprising 4, 5‐minute cycles of upper arm blood pressure cuff inflations and deflations, immediately before each cycle of chemotherapy. The primary outcome measure, defining cardiac injury, will be high‐sensitivity troponin‐T over 6 cycles of chemotherapy and 12 months follow‐up. Secondary outcome measures will include clinical, electrical, structural, and biochemical endpoints comprising major adverse cardiovascular clinical events, incidence of cardiac arrhythmia over 14 days at cycle 5/6, echocardiographic ventricular function, N‐terminal pro‐brain natriuretic peptide levels at 3 months follow‐up, and changes in mitochondrial DNA, micro‐RNA, and proteomics after chemotherapy. The ERIC‐ONC trial will determine the efficacy of RIC as a novel, noninvasive, nonpharmacological, low‐cost cardioprotectant in cancer patients undergoing anthracycline‐based chemotherapy.
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Affiliation(s)
- Robin Chung
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Angshuman Maulik
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Ashraf Hamarneh
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Daniel Hochhauser
- Research Department of Oncology, The Cancer Institute, University College London, London, United Kingdom
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom.,Cardiovascular and Metabolic Disorders Program, Duke University-National University of Singapore Medical School, Singapore
| | - J Malcolm Walker
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
| | - Derek M Yellon
- The Hatter Cardiovascular Institute, University College London, London, United Kingdom
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9
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Kubo T, Baba Y, Hirota T, Tanioka K, Yamasaki N, Yamanaka S, Iiyama T, Kumagai N, Furuno T, Sugiura T, Kitaoka H. Differentiation of infiltrative cardiomyopathy from hypertrophic cardiomyopathy using high-sensitivity cardiac troponin T: a case-control study. BMC Cardiovasc Disord 2015; 15:53. [PMID: 26077897 PMCID: PMC4467071 DOI: 10.1186/s12872-015-0043-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background Because infiltrative cardiomyopathy and hypertrophic cardiomyopathy (HCM) share clinical and hemodynamic features of left ventricular (LV) hypertrophy and abnormal diastolic function, it is often difficult to distinguish these entities. Methods We investigated the potential role of high-sensitivity cardiac troponin T (hs-cTnT) for differentiation of infiltrative cardiomyopathy from HCM. Results The study group consisted of 46 consecutive patients with infiltrative cardiomyopathies or HCM in whom sarcomere protein gene mutations were identified at Kochi Medical School Hospital; of these, there were 11 patients with infiltrative cardiomyopathy (cardiac amyloidosis in 8 patients and Fabry disease in 3 patients) and 35 HCM patients. Serum hs-cTnT level was significantly higher in patients who had infiltrative cardiomyopathy than in those who had HCM (0.083 ± 0.057 ng/ml versus 0.027 ± 0.034 ng/ml, p < 0.001), whereas brain natriuretic peptide levels did not differ between the two groups. In two age-matched the 2 cohorts (patients evaluated at > 40 years at age), hs-cTnT level, maximum LV wall thickness, posterior wall thickness, peak early (E) transmitral filling velocity, peak early diastolic (Ea) velocity of tissue Doppler imaging at the lateral corner and E/Ea ratios at both the septal and lateral corners were significantly different between the two groups. As for diagnostic accuracy to differentiate the two groups by using receiver operating characteristic analysis, hs-cTnT was the highest value of area under the curve (0.939) and E/Ea (lateral) was second highest value (0.914). Conclusions Serum hs-cTnT is a helpful diagnostic indicator for accurate differentiation between infiltrative cardiomyopathy and HCM.
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Affiliation(s)
- Toru Kubo
- Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Oko-cho, Nankoku-shi, 783-8505, Kochi, Japan.
| | - Yuichi Baba
- Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Oko-cho, Nankoku-shi, 783-8505, Kochi, Japan.
| | - Takayoshi Hirota
- Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Oko-cho, Nankoku-shi, 783-8505, Kochi, Japan.
| | - Katsutoshi Tanioka
- Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Oko-cho, Nankoku-shi, 783-8505, Kochi, Japan.
| | - Naohito Yamasaki
- Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Oko-cho, Nankoku-shi, 783-8505, Kochi, Japan.
| | - Shigeo Yamanaka
- Department of Laboratory Medicine, Kochi Medical School, Kochi, Japan.
| | - Tatsuo Iiyama
- Clinical Trial Center, Kochi Medical School, Kochi, Japan.
| | - Naoko Kumagai
- Clinical Trial Center, Kochi Medical School, Kochi, Japan.
| | - Takashi Furuno
- Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Oko-cho, Nankoku-shi, 783-8505, Kochi, Japan.
| | - Tetsuro Sugiura
- Department of Laboratory Medicine, Kochi Medical School, Kochi, Japan.
| | - Hiroaki Kitaoka
- Department of Cardiology, Neurology and Aging Science, Kochi Medical School, Oko-cho, Nankoku-shi, 783-8505, Kochi, Japan.
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