ATTR-CM is characterised by multiorgan involvement, and it can manifest in many ways1,3. It is important to include a multidisciplinary healthcare team in the diagnostic process. Coordinated care and effective communication among the team can help ensure that the patient receives the right diagnosis.2
Routine heart failure assessments such as echo and CMR can help identify clues on the diagnostic pathway.4
HFpEF or other cardiac conditions (e.g. severe AS* and arrhythmias) in patients typically >60 years of age5-7
Intolerance to standard heart failure therapies such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and beta-blockers8
Discordance between QRS voltage on ECG and LV wall thickness9,10
Diagnosis of orthopaedic conditions such as carpal tunnel syndrome, lumbar spinal stenosis, biceps tendon ruptures and/or hip/knee arthroplasty11-14
Echo showing increased LV wall thickness9
Nervous system dysfunction1 (e.g. polyneuropathy) and autonomic dysfunction (e.g. gastrointestinal symptoms and/or unexplained weight loss)15
The ESC working group recommends screening for ATTR-CM if the LV wall thickness is ≥12 mm along with the presence of ≥1 red flag or clinical scenario.
ABE is an interactive experience designed to help locate various TTR amyloid deposition sites and to identify cardiac and noncardiac clues throughout the body.
Echo, including TDI and strain analysis, can play a role in the non-invasive diagnosis of ATTR-CM due to4:
Transthoracic echo of the parasternal long axis view showing LV hypertrophy with preserved ejection fraction.
Adapted from Filiale d'Imagerie Cardiovasculaire.
Echo findings that are strongly suggestive of cardiac amyloidosis and should be reported include4:
Patient A: Normal heart.
Patient B: Heart shows a significantly high amyloid burden (elevated native T1, transmural late gadolinium enhancement and increased extracellular volume).
Meet Dr. Detective, a cardiologist who is specialised in diagnosing tough cases. Watch as he suspects that his patient has ATTR-CM.
Encountering ATTR-CM
Raising suspicion of ATTR-CM
Detecting ATTR-CM
Review the evidence and consensus recommendations for diagnosis.
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