No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis

Donnellan, Eoin; El‐Shazly, Mohamed; Vakamudi, Sneha; Wazni, Oussama; Cohen, Joshua; Kanj, Mohamed; Hanna, Mazen; Baranowski, Bryan; Saliba, Walid; Jaber, Wael A.

doi:10.1016/j.jacep.2019.10.013

Cited by 52 publications

(44 citation statements)

References 5 publications

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“…35 The same group demonstrated that a transmitral A wave velocity Progress and challenges in cardiac amyloidosis 2383 of <30 cm/s was associated with intracardiac thrombi in AL patients in the absence of AF, concluding that in the presence of atrial mechanical dysfunction (especially with coexisting restrictive LV filling), intracardiac thrombosis can be detected and anticoagulation should be carefully considered. 36 In a cohort of ATTR-CA patients and AF, Donnellan et al 37 found no association between the CHA 2 DS 2 -VASc score and the presence of left atrial appendage thrombus on transesophageal echocardiogram. Therefore, anticoagulation of patients with CA and AF is recommended irrespective of the CHA 2 DS 2 -VASc score.…”

Section: Anticoagulant Therapymentioning

confidence: 98%

Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature

et al. 2021

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Cardiac amyloidosis is a restrictive cardiomyopathy determined by the accumulation of amyloid, which is represented by misfolded protein fragments in the cardiac extracellular space. The main classification of systemic amyloidosis is determined by the amyloid precursor proteins causing a very heterogeneous disease spectrum, but the main types of amyloidosis involving the heart are light chain (AL) and transthyretin amyloidosis (ATTR). AL, in which the amyloid precursor is represented by misfolded immunoglobulin light chains, can involve almost any system carrying the worst prognosis among amyloidosis patients. This has however dramatically improved in the last few years with the increased usage of the novel therapies such as proteasome inhibitors and haematopoietic cell transplantation, in the case of timely diagnosis and initiation of treatment. The treatment for AL is directed by the haematologist working closely with the cardiologist when there is a significant cardiac involvement. Transthyretin (TTR) is a protein that is produced by the liver and is involved in the transportation of thyroid hormones, especially thyroxine and retinol binding protein. ATTR results from the accumulation of transthyretin amyloid in the extracellular space of different organs and systems, especially the heart and the nervous system. Specific therapies for ATTR act at various levels of TTR, from synthesis to deposition: TTR tetramer stabilization, oligomer aggregation inhibition, genetic therapy, amyloid fibre degradation, antiserum amyloid P antibodies, and antiserum TTR antibodies. Treatment of systemic amyloidosis has dramatically evolved over the last few years in both AL and ATTR, improving disease prognosis. Moreover, recent studies revealed that timely treatment can lead to an improvement in clinical status and in a regression of amyloid myocardial infiltration showed by imaging, especially by cardiac magnetic resonance, in both AL and ATTR. However, treating cardiac amyloidosis is a complex task due to the frequent association between systemic congestion and low blood pressure, thrombo-embolic and haemorrhagic risk balance, patient frailty, and generally poor prognosis. The aim of this review is to describe the current state of knowledge regarding cardiac amyloidosis therapy in this constantly evolving field, classified as treatment of the cardiac complications of amyloidosis (heart failure, rhythm and conduction disturbances, and thrombo-embolic risk) and the disease-modifying therapy.

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Section: Anticoagulant Therapymentioning

confidence: 98%

Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature

et al. 2021

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“…La infiltración amiloide puede afectar también al nodo sinusal y al nodo auriculoventricular, originando enfermedad sintomática del nodo y bloqueos auriculoventriculares de alto grado, que pueden ser incluso la primera manifestación de la enfermedad 14,15,21 . La prevalencia de fibrilación auricular varía según las series, desde un 10.6% en la ATTRv a un 76% en la ATTRwt 22,23 . La aparición de fibrilación auricular se ve favorecida por la dilatación auricular y la fisiología restrictiva.…”

Section: Presíncope O Síncope Y Anomalías De La Conducciónunclassified

“…En cuanto al riesgo tromboembólico, ante la presencia de fibrilación auricular en pacientes con AC se recomienda siempre la anticoagulación, con independencia de la puntuación CHA 2 DS 2 -VAS c , ya que esta no es válida en la AC 23,61 .…”

Section: Manejo De Las Arritmias Auricularesunclassified

Amiloidosis cardiaca

González-Robledo¹,

Buitrago-Sandoval²,

González-López³

2022

RCCAR

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La amiloidosis cardiaca es una enfermedad infradiagnosticada pese a los importantes avances desde el punto de vista diagnóstico y terapéutico, que determinan un cambio en la perspectiva clásica de una enfermedad considerada hasta ahora poco frecuente, no tratable y con mal pronóstico. Son dos los principales subtipos de amiloidosis que pueden producir compromiso cardiaco: la amiloidosis por cadenas ligeras y la amiloidosis por transtiretina, tanto en su forma hereditaria como en su forma wild-type. Su pronóstico y su tratamiento son muy diferentes. Es preciso un alto índice de sospecha clínica para evitar retrasos diagnósticos y poder ofrecer opciones terapéuticas que mejoren la supervivencia de estos pacientes. En este artículo revisamos cómo realizar el diagnóstico de esta enfermedad, incluyendo la posibilidad de diagnóstico no invasivo, en qué escenarios clínicos buscar a estos pacientes y cuáles son las actuales opciones de tratamiento y manejo.

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“…Some leading experts suggest that all patients with AF and cardiac amyloidosis be offered oral anticoagulation regardless of CHA2DS2-VASc score. 26 One-half (50%) of patients with cardiac amyloid die suddenly. Guidelines do not strongly support implantable cardioverter-defibrillator (ICD) placement for both primary and secondary prevention in cardiac amyloid currently due to the following reasons:…”

Section: Arrhythmic Manifestations Of Attr-ca and Their Managementmentioning

confidence: 99%

Cardiac Amyloidosis Wild Type (ATTR-CAwt) and Associated Cardiac Arrhythmias: A Case Report and Literature Review

Nagarakanti

Sankaramangalam

Nagarakanti

et al. 2021

Indian Journal of Clinical Cardiology

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Cardiac amyloidosis wild type (ATTR-CAwt) is often the underdiagnosed cause of heart failure with preserved ejection fraction (HFpEF) and has a high mortality rate. There is usually a long delay between the appearance of clinical signs and the diagnosis of ATTR-CAwt but a short duration between diagnosis and death. ATTR-CAwt was associated with significant clinical arrhythmias. We report a case of ATTR-CAwt, the process of its diagnosis, and the associated clinical arrhythmias and their management. We also reviewed the literature of this underdiagnosed and potentially fatal condition and the current existing therapies.

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No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis

Cited by 52 publications

References 5 publications

Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature

Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature

Amiloidosis cardiaca

Cardiac Amyloidosis Wild Type (ATTR-CAwt) and Associated Cardiac Arrhythmias: A Case Report and Literature Review

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