It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

Saad, Jean Michel; Ahmed, Ahmed Ibrahim; Anugula, Dixitha; Han, Yushui; Alfawara, Moath Said; Al-Mallah, Mouaz

doi:10.14797/mdcvj.1072

Cited by 5 publications

(3 citation statements)

References 80 publications

(101 reference statements)

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“…While echocardiography is an essential first-line diagnostic tool that raises a suspicion for CA, cardiac MRI has an important diagnostic role in the workup of CA (25). Cardiac MRI enables a more comprehensive investigation of CA via high-resolution imaging, functional assessment, and superior tissue characterization (25). However, it appears to be underutilized.…”

Section: Assessment Of the Myocardiummentioning

confidence: 99%

A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice

Sabbour,

Al-Humood,

Al Taha

et al. 2024

Front. Cardiovasc. Med.

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Aesop's fable of the wolf in sheep's clothing encourages us to look beneath the exterior appearance of a situation and evaluate the truth that lies beneath. This concept should be applied when managing older patients with severe aortic stenosis. This population of patients is increasingly being identified as having concomitant cardiac amyloidosis, which is an underrecognized cause of common cardiac conditions. The presence of cardiac amyloidosis negatively affects the outcome of patients with aortic stenosis, these patients undergo transcatheter aortic valve replacement (TAVR) with increasing frequency and have a significantly higher overall mortality rate than patients with aortic stenosis alone. Although left ventricular wall hypertrophy is expected in patients with aortic stenosis, it should not be assumed that this is caused only by aortic stenosis. A suspicion of cardiac amyloidosis should be raised in patients in whom the degree of hypertrophy is disproportionate to the degree of aortic stenosis severity. The remodeling, age, injury, systemic, and electrical (RAISE) score was developed to predict the presence of cardiac amyloidosis in patients with severe aortic stenosis. This article highlights the value of increased clinical suspicion, demonstrates the use of the multiparameter RAISE score in daily clinical practice, and illustrates the scoring system with case studies. In elderly patients being considered for TAVR, systematic testing for cardiac amyloidosis should be considered as part of the preoperative workup.

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Section: Assessment Of the Myocardiummentioning

confidence: 99%

A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice

Sabbour,

Al-Humood,

Al Taha

et al. 2024

Front. Cardiovasc. Med.

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“…The use of novel tracers using positron emission tomography (PET) have shown promise in not only diagnosing amyloid but also differentiating the types of amyloidosis. 3 It is likely that PET imaging, in addition to nuclear scintigraphy and MRI, will be a very useful tool for diagnosis and serial monitoring of response to treatment.…”

Section: Diagnosis and Treament Of Attrmentioning

confidence: 99%

Future Directions in Cardiac Amyloidosis

Trachtenberg

2022

Methodist DeBakey Cardiovascular Journal

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Just a few years ago, cardiac amyloidosis (CA) was rarely diagnosed. With poor treatment options and delayed and infrequent diagnoses, most patients who were eventually recognized to have CA were referred for hospice care. Now, the availability of sponsored genetic testing, increased use of nuclear scintigraphy, and widespread recognition have contributed to an increasing number of patients being diagnosed with transthyretin amyloid cardiomyopathy (ATTR-CM). Concomitantly, with the increased recognition of concurrent conditions (eg, carpal tunnel syndrome, lumbar stenosis, and low-flow, low-gradient aortic stenosis), specialists such as orthopedic surgeons and structural cardiologists are increasingly involved in diagnosing ATTR-CM. Although the majority of patients are still being diagnosed either too late or having their diagnosis missed altogether, we have entered an exciting new era in the treatment of cardiac amyloidosis with improved diagnostic tools, disease recognition, and different therapeutic options for both ATTR and light-chain amyloidosis (AL). As a result, survival is improving, and we are no longer faced with a dualistic choice between hospice or organ transplant. The future goal is to develop anti-fibril therapies that will be safe and effective at removing deposited amyloid fibrils and restoring organs to their pre-amyloid state. For the millions of carriers of variant ATTR, enhanced testing followed by genetic editing may allow a cure even before patients develop clinical signs of the disease.

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“…]. The diagnostic approach for cardiac amyloidosis integrates various advanced imaging modalities, each contributing distinct perspectives and critical diagnostic information [2,3].…”

mentioning

confidence: 99%

Nuclear imaging techniques for cardiac amyloidosis

Saad,

Al-Mallah

2024

Current Opinion in Cardiology

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Purpose of review Cardiac amyloidosis is a condition marked by the misfolding of precursor proteins into insoluble amyloid fibrils, leading to restrictive cardiomyopathy and heart failure symptoms. This review discusses advancements in nuclear imaging techniques that enhance the diagnosis and guide the management of cardiac amyloidosis, addressing the critical need for early and accurate detection in clinical practice. Recent findings Recent studies and guidelines emphasizes the pivotal role of nuclear imaging techniques in diagnosing cardiac amyloidosis. Cardiac scintigraphy, using bone-avid tracers like 99mTc-PYP, 99mTc-DPD, and 99mTc-HMDP, is instrumental in distinguishing between transthyretin amyloidosis and light chain amyloidosis. PET, with tracers such as 11C-Pittsburgh Compound B (11C-PiB) and 18F-Florbetapir, offers significant potential in measuring amyloid burden and monitoring disease progression, providing detailed insights into the myocardial involvement. Summary The advancements in nuclear imaging techniques significantly impact the management of cardiac amyloidosis. These methods allow for a more accurate diagnosis, detailed assessment of disease extent, and better differentiation between amyloidosis types, which are crucial for tailoring treatment approaches. The integration of these techniques into clinical practice is essential for improving patient outcomes and advancing research in cardiac amyloidosis.

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It Takes a Village: Multimodality Imaging of Cardiac Amyloidosis

Cited by 5 publications

References 80 publications

A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice

A wolf in sheep's clothing—aortic stenosis and cardiac amyloidosis: “RAISE”ing awareness in clinical practice

Future Directions in Cardiac Amyloidosis

Nuclear imaging techniques for cardiac amyloidosis

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