Cardiac amyloidosis: Description of a series of 143 cases

Barge‐Caballero, Gonzalo; Barge‐Caballero, Eduardo; López‐Pérez, Manuel J.; Bilbao-Quesada, Raquel; Gómez-Otero, Inés; López‐López, Andrea; Gutiérrez-Feijoo, Mario; Varela-Román, Alfonso; González‐Juanatey, Carlos; Dı́az-Castro, Óscar; Crespo‐Leiro, María G.

doi:10.1016/j.medcle.2022.08.001

Cited by 5 publications

(20 citation statements)

References 19 publications

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“…Although data are limited, a study that analyzed positive scintigraphies for TTR deposits showed that 31% of them had reduced LVEF [ 26 ]. Consistent with our data, a Spanish cohort of patients with CA has shown that up to a third of patients may have heart failure with a reduced left ventricular ejection fraction [ 27 ], reaching even 50% in other studies that include older patients [ 17 ]. In our study, almost 30% of the patients with CA had ischemic heart disease, so the reduced LVEF could be related to this fact, in addition to progressive CA.…”

Section: Discussionsupporting

confidence: 92%

Estimating the Prevalence of Cardiac Amyloidosis in Old Patients with Heart Failure—Barriers and Opportunities for Improvement: The PREVAMIC Study

Ruiz-Hueso

Salamanca‐Bautista

Quesada-Simón

et al. 2023

JCM

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Background: Cardiac amyloidosis (CA) could be a common cause of heart failure (HF). The objective of the study was to estimate the prevalence of CA in patients with HF. Methods: Observational, prospective, and multicenter study involving 30 Spanish hospitals. A total of 453 patients ≥ 65 years with HF and an interventricular septum or posterior wall thickness > 12 mm were included. All patients underwent a 99mTc-DPD/PYP/HMDP scintigraphy and monoclonal bands were studied, following the current criteria for non-invasive diagnosis. In inconclusive cases, biopsies were performed. Results: The vast majority of CA were diagnosed non-invasively. The prevalence was 20.1%. Most of the CA were transthyretin (ATTR-CM, 84.6%), with a minority of cardiac light-chain amyloidosis (AL-CM, 2.2%). The remaining (13.2%) was untyped. The prevalence was significantly higher in men (60.1% vs 39.9%, p = 0.019). Of the patients with CA, 26.5% had a left ventricular ejection fraction less than 50%. Conclusions: CA was the cause of HF in one out of five patients and should be screened in the elderly with HF and myocardial thickening, regardless of sex and LVEF. Few transthyretin-gene-sequencing studies were performed in older patients. In many patients, it was not possible to determine the amyloid subtype.

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Section: Discussionsupporting

confidence: 92%

Estimating the Prevalence of Cardiac Amyloidosis in Old Patients with Heart Failure—Barriers and Opportunities for Improvement: The PREVAMIC Study

Ruiz-Hueso

Salamanca‐Bautista

Quesada-Simón

et al. 2023

JCM

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“…In addition to CTS, it is consistently more prevalent among patients with ATTRwt with cardiac involvement; for patients with ATTRv the prevalence is more variable, depending on the mutation. While no cases of CTS were recorded in patients with the Val30Met mutation (a variant without cardiac involvement), [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] it was described in the 19.7% of those with the Ile68Leu mutation. 34 With reference to the prognostic implication of CTS, Milandri et al 34 showed that CTS might be an independent risk factor for mortality in patients with ATTR, especially when secondary to deposits of the ATTRwt form (HR 3.36, 95% CI 1.27-10.3).…”

Section: Discussionmentioning

confidence: 99%

“…26 In terms of SS, the lumbar spinal canal stenosis is the correlated with ATTR-CM. Several studies only looked for SS in the lumbar section, 20,25,30,31 some others did not specify where the stenosis was located 24,27,33 and just Nakagawa et al 17 studied all the spinal sections. They observed four patients with SS in their series, two of them had lumbar spinal canal stenosis, and the other two had cervical spinal canal stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of CTS ranged from 10.6-75%, with a huge variation between them. 13,18,22,[25][26][27]29,30,33 From those studies that evaluated bilateral CTS, its prevalence was between 19% and 60% according to the series and the amyloidosis subtype. 23,24,26,27 Only two studies differentiated between the ATTR subtype.…”

Section: Carpal Tunnel Syndromementioning

confidence: 99%

“…The prevalence of SS in those studies which did not specify ATTR subtype ranged from 7.3 to 40%. 25,27,30,33 Brachial biceps tendon rupture Only three studies reported information about brachial biceps tendon rupture 15,25,26 and in all of them, the presence of tendon rupture was defined by the presence of the Popeye sign upon flexion of each arm against gentle resistance. The prevalence of BBTR in ATTR patients ranged from 33.3% to 44%.…”

Section: Spinal Stenosismentioning

confidence: 99%

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Musculoskeletal co‐morbidities in patients with transthyretin amyloid cardiomyopathy: a systematic review

Formiga,

Baeza,

Chivite

et al. 2023

ESC Heart Failure

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The prevalence of transthyretin‐associated amyloidosis cardiomyopathy (ATTR‐CM) has grown because of newer non‐invasive diagnosis tools. Detecting the presence of extra‐cardiac ATTR manifestations such as musculoskeletal pathologies considered ‘red flags’, when there is minimal or non‐cardiac clinical involvement is primordial to carry out an early diagnosis. The aim of this systematic review is to examine the prevalence of musculoskeletal, ATTR‐deposition‐related co‐morbidities in patients already diagnosed with ATTR‐CM, specifically carpal tunnel syndrome, ruptured biceps tendon, spinal stenosis, and trigger finger. We performed a systematic review using PRISMA guidelines. Inclusion criteria were all studies in English and Spanish language and participants had to be patients diagnosed with ATTR‐CM, by any diagnostic method, with the musculoskeletal co‐morbidities subject of this review. The quality of the studies was based on the Risk of Bias Tool. This systematic review included 22 studies for final analysis. Carpal tunnel syndrome is reported in 21 studies, brachial biceps tendon rupture is reported in three, and spinal stenosis in eight studies. No articles that accomplished all the inclusion criteria for trigger finger were found. Regarding to the quality of the studies, all of them were categorized as being of high and moderate quality. The frequent association between ATTR‐CM and carpal tunnel syndrome, ruptured biceps tendon, and lumbar spinal is confirmed, and the onset of these co‐morbidities usually precedes the diagnosis of by years. This association defines them as red flags that should be search proactively due to the current treatment possibilities and the severity of the presentation of cardiac amyloidosis.

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