Effectiveness and Safety of Oral Anticoagulants in Cardiac Amyloidosis: Lights and Shadows

Lisi, Daniela Di; Caccamo, Leandro Di; Damerino, Giuseppe; Portelli, Maria Cristina; Comparato, Francesco; Stefano, Vincenzo Di; Brighina, Filippo; Corrado, Egle; Galassi, Alfredo Ruggero; Novo, Giuseppina

doi:10.1016/j.cpcardiol.2022.101188

Cited by 14 publications

(14 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Also, the assessment of atrial function in patients with cardiac amyloidosis is very important in evaluating the need for anticoagulant therapy in patients with sinus rhythm and electromechanical dissociation [32,33]. It is known that patients with cardiac amyloidosis have a high thromboembolic risk and that anticoagulant therapy is needed in patients with atrial fibrillation regardless of the CHA2DS2 VASC score [34].…”

Section: Discussionmentioning

confidence: 99%

Hereditary Transthyretin Amyloidosis: How to Differentiate Carriers and Patients Using Speckle-Tracking Echocardiography

Di Lisi,

Brighina,

Manno

et al. 2023

Diagnostics

Self Cite

View full text Add to dashboard Cite

Background: Hereditary transthyretin amyloidosis is a rare disease caused by transthyretin (TTR) gene mutations. The aim of our study was to identify early signs of cardiac involvement in patients with a TTR gene mutation in order to differentiate carriers from patients with neurological or cardiac disease. Methods: A case–control study was carried out on 31 subjects with the TTR mutation. Patients were divided into three groups: 23% with cardiac amyloidosis and polyneuropathy (group A), 42% with only polyneuropathy (group B) and 35% carriers (group C). Speckle-tracking echocardiography (left-ventricular global longitudinal strain—GLS, atrial stiffness) was performed in all patients. The apical/basal longitudinal strain ratio (SAB) and relative apical sparing (RAS) were assessed in all subjects. Results: Analyzing groups C and B, we only found a significant difference in the SAB (p-value 0.001) and RAS (p-value 0.039). These parameters were significantly more impaired in group A compared to group B (SAB p-value 0.008; RAS p-value 0.002). Also, atrial stiffness was significantly impaired in groups A and B compared to group C. Conclusions: Our study suggests the diagnostic role of the SAB and RAS in cardiac amyloidosis. The SAB and RAS showed a gradual increase from carriers to patients with neurological and cardiac diseases. Thus, these parameters, in addition to atrial stiffness, could be used to monitor carriers. More extensive data are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Hereditary Transthyretin Amyloidosis: How to Differentiate Carriers and Patients Using Speckle-Tracking Echocardiography

Di Lisi,

Brighina,

Manno

et al. 2023

Diagnostics

Self Cite

View full text Add to dashboard Cite

show abstract

“…The European Society of Cardiology Guidelines propose that CA patients with AF should be initiated on anticoagulation therapy according to the CHA2DS2-VASc risk score [63]. However, the score has proven to be ineffective for CA patients who present with an increased risk of intracardiac thrombus, independent of the CHA2DS2-VASc score [63].…”

Section: Clinical Implications and Future Directionsmentioning

confidence: 99%

Anticoagulation in Atrial Fibrillation Associated With Cardiac Amyloidosis: A Narrative Review

Monga,

Ekong,

Patrick

et al. 2024

Cureus

View full text Add to dashboard Cite

Cardiac amyloidosis (CA) involves the abnormal deposition and accumulation of amyloid proteins in the heart muscle. A hallmark of disease progression is declining heart function, which can lead to structural irregularities, arrhythmias, and ultimately heart failure. Atrial fibrillation (AF) is the most common arrhythmia that presents in CA patients, and this arrhythmia is significant because it can moderately increase the risk of patients developing intracardiac thrombi, thereby putting them at risk for thromboembolic events. The management of this complication entails the use of anticoagulants like vitamin K antagonists and direct oral anticoagulants to reduce the risk of thrombus formation. This article seeks to review AF in CA and the use of anticoagulation therapy for the management and reduction of thromboembolic risk. The major conclusions of this review are centered around the need for safe administration of anticoagulant therapy to CA patients, regardless of their CHA2DS2-VASc risk score. This review highlights the importance of taking a multidisciplinary or collaborative approach to CA treatment to ensure that all aspects of this multifaceted disease can be properly managed while minimizing adverse events like bleeding risk and drug-drug interactions.

show abstract

“…According to 2023 European Society of Cardiology (ESC) guidelines for the management of cardiomyopathies, oral anticoagulation, unless contraindicated, is recommended in all patients with CA and AF, regardless of their CHA 2 DS 2 -VASc score, in order to reduce the risk of stroke and thrombo-embolic events (class I level of evidence B) [45]. Conversely, the role of anticoagulation in CA patients on sinus rhythm remains a gray area [48].…”

Section: Pharmacological Management Of Af In Camentioning

confidence: 99%

“…Among anti-arrhythmic drugs, amiodarone appears to be welltolerated in the CA population and is the anti-arrhythmic of choice [45]. However, from a clinical viewpoint, there is no solid evidence to confirm the superiority of a rhythm control strategy over a rate control strategy in terms of clinical outcomes [48].…”

Section: Pharmacological Management Of Af In Camentioning

confidence: 99%

Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy and Cardiac Amyloidosis: From Clinical Management to Catheter Ablation Indication

Mistrulli,

Ferrera,

Muthukkattil

et al. 2024

JCM

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common arrhythmia in patients affected by cardiomyopathies. Reports estimate a prevalence of 27% in patients with hypertrophic cardiomyopathy (HCM) and 40% in patients with cardiac amyloidosis (CA). The presence of AF typically results in progressive functional decline, an increased frequency of hospitalizations for heart failure, and a higher thromboembolic risk. Medical management using mainly beta-blockers or amiodarone has produced variable outcomes and a high rate of recurrence. Catheter ablation reduces symptom burden and complications despite a moderate rate of recurrence. Recent evidence suggests that an early rhythm control strategy may lead to more favorable short- and long-term outcomes. In this review, we summarize contemporary data on the management of AF in patients with cardiomyopathy (HCM and CA) with particular reference to the timing and outcomes of ablation procedures.

show abstract

Effectiveness and Safety of Oral Anticoagulants in Cardiac Amyloidosis: Lights and Shadows

Cited by 14 publications

References 46 publications

Hereditary Transthyretin Amyloidosis: How to Differentiate Carriers and Patients Using Speckle-Tracking Echocardiography

Hereditary Transthyretin Amyloidosis: How to Differentiate Carriers and Patients Using Speckle-Tracking Echocardiography

Anticoagulation in Atrial Fibrillation Associated With Cardiac Amyloidosis: A Narrative Review

Atrial Fibrillation in Patients with Hypertrophic Cardiomyopathy and Cardiac Amyloidosis: From Clinical Management to Catheter Ablation Indication

Contact Info

Product

Resources

About