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Erschienen in: Heart Failure Reviews 4/2021

15.01.2021

Practical recommendations for the diagnosis and management of transthyretin cardiac amyloidosis

verfasst von: Vasiliki Bistola, John Parissis, Emmanouil Foukarakis, Pipitsa N. Valsamaki, Aris Anastasakis, Georgios Koutsis, Georgios Efthimiadis, Efstathios Kastritis

Erschienen in: Heart Failure Reviews | Ausgabe 4/2021

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Abstract

Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by accumulation in the heart interstitium of amyloid fibrils formed by misfolded proteins. Most common CA types are light chain amyloidosis (AL) caused by monoclonal immunoglobulin light chains and transthyretin amyloidosis (ATTR) caused by either mutated or wild-type transthyretin aggregates. Previously considered a rare disease, CA is increasingly recognized among patients who may be misdiagnosed as undifferentiated heart failure with preserved ejection fraction (HFPEF), paradoxical low-flow/low-gradient aortic stenosis, or otherwise unexplained left ventricular hypertrophy. Progress in diagnosis has been due to the refinement of cardiac echocardiographic techniques (speckle tracking imaging) and magnetic resonance (T1 mapping) and mostly due to the advent of bone scintigraphy that has enabled noninvasive diagnosis of ATTR, limiting the need for endomyocardial biopsy. Importantly, proper management of CA starts from early recognition of suspected cases among high prevalence populations, followed by advanced diagnostic evaluation to confirm diagnosis and typing, preferentially in experienced amyloidosis centers. Differentiating ATTR from other types of amyloidosis, especially AL, is critical. Emerging targeted ATTR therapies offer the potential to improve outcomes of these patients previously treated only palliatively.
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Metadaten
Titel
Practical recommendations for the diagnosis and management of transthyretin cardiac amyloidosis
verfasst von
Vasiliki Bistola
John Parissis
Emmanouil Foukarakis
Pipitsa N. Valsamaki
Aris Anastasakis
Georgios Koutsis
Georgios Efthimiadis
Efstathios Kastritis
Publikationsdatum
15.01.2021
Verlag
Springer US
Erschienen in
Heart Failure Reviews / Ausgabe 4/2021
Print ISSN: 1382-4147
Elektronische ISSN: 1573-7322
DOI
https://doi.org/10.1007/s10741-020-10062-w

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