Pubblicazioni recenti - cardiac amyloidosis
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(Non)-Exertional Variables of Cardiopulmonary Exercise Testing in Heart Failure with and Without Cardiac Amyloidosis.
Curr Heart Fail Rep2024 Apr;():. doi: 10.1007/s11897-024-00661-1.
Wernhart Simon, Michel Lars, Carpinteiro Alexander, Luedike Peter, Rassaf Tienush,
Abstract
PURPOSE OF REVIEW:
Cardiac amyloidosis (CA) constitutes an important etiology of heart failure with preserved ejection fraction (HFpEF) or heart failure with mildly reduced ejection fraction (HFmrEF). Since patients with CA show early exhaustion, we aimed to investigate whether non-exertional variables of cardiopulmonary exercise testing (CPET) provide additional information in comparison to traditional peak oxygen consumption (VO).
RECENT FINDINGS:
We retrospectively investigated CPET variables of patients with HFpEF and HFmrEF with (n?=?21) and without (n?=?21, HF) CA at comparable age and ejection fraction. Exertional and non-exertional CPET variables as well as laboratory and echocardiographic markers were analyzed. The primary outcome was the difference in CPET variables between groups. The secondary outcome was rehospitalization in patients with CA during a follow-up of 24 months. Correlations between CPET, NTproBNP, and echocardiographic variables were calculated to detect patterns of discrimination between the groups. HF patients with CA were inferior to controls in most exertional and non-exertional CPET variables. Patients with CA were hospitalized more often (p?=?0.002), and rehospitalization was associated with VE/VCO (p?=?0.019), peak oxygen pulse (p?=?0.042), the oxygen equivalent at the first ventilatory threshold (p?=?0.003), circulatory (p?=?0.024), and ventilatory power (p?.001), but not VO (p?=?0.127). Higher performance was correlated with lower E/e' and NTproBNP as well as higher resting heart rate and stroke volume in CA. Patients with CA displayed worse non-exertional CPET performance compared to non-CA HF patients, which was associated with rehospitalization. Differences between correlations of resting echocardiography and CPET variables between groups emphasize different properties of exercise physiology despite comparable ejection fraction.
© 2024. The Author(s).
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Preoperative diagnosis and safe surgical approach in gallbladder amyloidosis: a case report.
Surg Case Rep2024 Apr;10(1):89. doi: 10.1186/s40792-024-01897-8.
Shinohara Makoto, Hashimoto Masakazu, Kitamura Yoshihito, Nakashima Keigo, Hamaoka Michinori, Miguchi Masashi, Misumi Toshihiro, Fujikuni Nobuaki, Ikeda Satoshi, Matsugu Yasuhiro, Hattori Yui, Nishisaka Takashi, Nakahara Hideki,
Abstract
BACKGROUND:
Preoperative diagnosis of gallbladder amyloidosis is usually difficult. In our case, the patient exhibited gallbladder dyskinesia, which led us to suspect cholecystic amyloidosis. We were able to safely perform surgery before cholecystitis onset.
CASE PRESENTATION:
A 59-year-old male patient with a history of multiple myeloma and cardiac amyloidosis presented to our hospital with a chief complaint of epicardial pain. Abdominal ultrasonography and computed tomography revealed an enlarged gallbladder and biliary sludge without any specific imaging findings of cholecystitis. After percutaneous transhepatic gallbladder aspiration (PTGBA), the patient experienced recurrent bile retention and right upper quadrant pain. Flopropione was effective in relieving these symptoms. Based on his symptoms and laboratory findings, we diagnosed the patient with dyskinesia of the gallbladder. Considering his medical history, we suspected that it was caused by amyloidosis of the gallbladder. A laparoscopic cholecystectomy was performed. The histopathological examination showed amyloid deposits in the gallbladder mucosa, from the intrinsic layer to the submucosa, and in the peripheral nerves of the gallbladder neck. The patient was discharged on postoperative day 5 and has had no recurrence of abdominal pain since then.
CONCLUSION:
In our case, gallbladder dyskinesia symptoms led us to suspect gallbladder amyloidosis. We safely surgically treated the patient before cholecystitis onset.
© 2024. The Author(s).
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Acute Exacerbation of Idiopathic Pulmonary Fibrosis With Concurrent Cardiac Amyloidosis: A Technetium Pyrophosphate Study.
Cureus2024 Mar;16(3):e56358. doi: 10.7759/cureus.56358.
Yanagihara Toyoshi, Hatashima Hikaru, Ogata Hiroaki, Moriuchi Yuki, Ishimatsu Akiko, Otsuka Junji, Taguchi Kazuhito, Moriwaki Atushi, Yoshida Makoto,
Abstract
Amyloidosis presents a diagnostic challenge, particularly when concomitant with severe conditions like acute exacerbations of idiopathic pulmonary fibrosis (IPF). In this report, we detail the case of a 73-year-old patient with acute exacerbation of IPF and simultaneous emergence of cardiac amyloidosis. The patient's clinical journey began with persistent exertional dyspnea, progressing to hypoxemia on admission. Chest CT scans showed extensive ground-glass opacities, consolidations, and pre-existing honeycombing-like cysts and reticular shadows, accompanied by a right-sided pleural effusion. The therapeutic strategy for acute exacerbation of IPF encompassed methylprednisolone pulse therapy, tacrolimus, and nintedanib, augmented with intravenous immunoglobulin and recombinant thrombomodulin. Concurrently, heart failure with preserved ejection fraction was managed with a pharmacological trio: empagliflozin, diuretics, and eplerenone. A hypertrophied heart and low limb voltage prompted an investigation for cardiac amyloidosis, which Technetium pyrophosphate (Tc-PYP) scintigraphy confirmed, yielding a probable diagnosis. Following steroid tapering, the patient was discharged home. This case prompted an investigation into the potential role of amyloidosis in pulmonary pathology. Our retrospective review of 10 patients, including four with cardiac amyloidosis, who underwent Tc-PYP scintigraphy, revealed a nonsignificant yet notable trend of increased pulmonary accumulation in cardiac amyloidosis cases (median (interquartile range): 5.4×10 (5.3-13.1×10) vs. 3.6×10 (2.4-5.1×10), p=0.0667). Notably, the pulmonary counts in this patient exceeded the negative cohort's mean values, hinting at a possible contribution of amyloid deposition to pulmonary pathology. This study, pioneering in evaluating lung field accumulation of Tc-PYP in cardiac amyloidosis, may provide novel insights into the influence of amyloidosis on pulmonary conditions.
Copyright © 2024, Yanagihara et al.
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Thermal evaporation as sample preparation for silver-assisted laser desorption/ionization mass spectrometry imaging of cholesterol in amyloid tissues.
Analyst2024 Apr;():. doi: 10.1039/d4an00181h.
Strnad ?t?pán, Vrkoslav Vladimír, Mengr Anna, Fabián Ond?ej, Rybá?ek Ji?í, Kubánek Milo?, Melenovský Vojt?ch, Maletínská Lenka, Cva?ka Josef,
Abstract
Cholesterol plays an important biological role in the body, and its disruption in homeostasis and synthesis has been implicated in several diseases. Mapping the locations of cholesterol is crucial for gaining a better understanding of these conditions. Silver deposition has proven to be an effective method for analyzing cholesterol using mass spectrometry imaging (MSI). We optimized and evaluated thermal evaporation as an alternative deposition technique to sputtering for silver deposition in MSI of cholesterol. A silver layer with a thickness of 6 nm provided an optimal combination of cholesterol signal intensity and mass resolution. The deposition of an ultrathin nanofilm of silver enabled high-resolution MSI with a pixel size of 10 ?m. We used this optimized method to visualize the distribution of cholesterol in the senile plaques in the brains of APP/PS1 mice, a model that resembles Alzheimer's disease pathology. We found that cholesterol was evenly distributed across the frontal cortex tissue, with no evidence of plaque-like accumulation. Additionally, we investigated the presence and distribution of cholesterol in myocardial sections of a human heart affected by wild-type ATTR amyloidosis. We identified the presence of cholesterol in areas with amyloid deposition, but complete colocalization was not observed.
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The changing landscape of heart failure treatment in transthyretin amyloid cardiomyopathy: Is the time ripe for clinical use of sodium-glucose cotransporter 2 inhibitors?
Eur J Heart Fail -
Chest pain in a patient with transthyretin cardiac amyloidosis: A case report.
Clin Case Rep2024 Apr;12(4):e8763. doi: e8763.
Xie Linfeng, Luo Suxin, Huang Bi,
Abstract
KEY CLINICAL MESSAGE:
Patients with transthyretin cardiac amyloidosis (ATTR-CM) commonly present with dyspnea, fatigue, and edema. In our case, the main presentation was exertional angina, which was atypical in patients with ATTR-CM and should be paid more attention to.
ABSTRACT:
A 54-year-old woman was admitted with a complaint of exertional chest pain, and she had a history of hypertension. The results of the electrocardiogram and echocardiography revealed the clues of cardiac amyloidosis, and the patient was finally diagnosed with transthyretin cardiac amyloidosis, then she received tafamidis, and the symptoms improved significantly.
© 2024 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
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Minimal residual disease in systemic light chain amyloidosis: a systematic review and meta-analysis.
J Cancer Res Clin Oncol2024 Apr;150(4):193. doi: 193.
Li Xuefeng, Yu Yan, Yu Hongbin, Chen Mengran, Zhang Xin, Wu Yu,
Abstract
PURPOSE:
Minimal residual disease (MRD) is a validated prognostic factor in several hematological malignancies. However, its role in systemic light chain (AL) amyloidosis remains controversial, and this systematic review and meta-analysis aims to fill this gap.
METHODS:
We searched for relevant studies on Pubmed, Embase, and Cochrane Controlled Register of Trials, nine studies involving 451 patients were included and meta-analyzed. This systematic review has been registered in PROSPERO (CRD42023494169).
RESULTS:
Our study found that in the group of patients who achieved very good partial response (VGPR) or better, MRD negativity was correlated with higher cardiac and renal response rates [pooled risk ratio (RR)?=?0.74 (95% CI 0.62-0.89), 0.74 (95% CI 0.64-0.87), respectively]. Patients with MRD positivity had a higher hematologic progression rate within two years after MRD detection [pooled RR?=?10.31 (95% CI 2.02-52.68)]; and a higher risk of hematologic?+?organ progression in the first year [pooled RR?=?12.57 (95% CI 1.73-91.04)]. Moreover, MRD negativity was correlated with a better progression-free survival (PFS) [pooled hazard ratio (HR)?=?0.27 (95% CI 0.17-0.45)]; but it did not significantly improve the overall survival (OS) [pooled HR?=?0.34 (95% CI 0.11-1.07)].
CONCLUSION:
In AL amyloidosis, our study supports that MRD negativity correlates with higher cardiac or renal response rates and indicates a better PFS in the follow-up. However, the correlation between OS and the status of MRD is not significant.
© 2024. The Author(s).
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Value of multi-modality small fiber assessments in a genotypically diverse cohort of transthyretin-related amyloidosis in the early stages of disease.
Med Clin (Barc)2024 Apr;():. doi: S0025-7753(24)00159-3.
Alcantara Monica, Mannan Shabber, de la Cruz James, Bril Vera,
Abstract
INTRODUCTION:
Transthyretin-related amyloidosis (ATTRv) is a progressive multisystem disorder, predominantly involving the peripheral nerve system (PNS) and heart. Quantification of small fiber damage may help guide treatment decisions, as amyloid deposits frequently affect those fibers early in disease course. Corneal confocal microscopy (CCM) is a promising method to monitor patients with ATTRv, due to similarities between corneal nerves and PNS, as the cornea is innervated by A? and C fibers.
METHODS:
We compared CCM measures from ATTRv patients to a group of healthy individuals, matched by age and gender. We then investigated the correlations between small fiber tests (SFT): CCM, LDI-Flare and CDT, COMPASS-31 and disability scales (RODS and ONLS) in patients.
RESULTS:
Of 20 patients (6 with V30M), mean age 50.3±15.3Y, 7 female (35%), six (30%) had polyneuropathy and 10 (50%) carpal tunnel syndrome. CDT was abnormal in 9 and LDI-flare in 6 patients. CCM was abnormal in 19 tested patients and significantly reduced when compared to controls (CNFL: 6.31±0.31 vs. 15.21±1.02mm/mm, p
CONCLUSIONS:
In a diverse cohort of ATTRv patients, CCM was the most frequent abnormal measurement. CCM can be a useful test to triage patients in the early disease stages and with few or equivocal symptoms.
Copyright © 2024 The Authors. Published by Elsevier España, S.L.U. All rights reserved.
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Beta-blocking patients with cardiac amyloidosis: Adelante cum juicio.
Int J Cardiol2024 Apr;():132039. doi: 10.1016/j.ijcard.2024.132039.
Emdin Michele, Aimo Alberto, Vergaro Giuseppe, Castiglione Vincenzo,
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Clinical suspicion, diagnosis and management of cardiac amyloidosis: Update document and executive summary.
Rev Clin Esp (Barc)2024 Apr;():. doi: S2254-8874(24)00056-0.
Yun S, Casado J, Pérez-Silvestre J, Salamanca P, Llàcer P, Quirós R, Ruiz-Hueso R, Méndez M, Manzano L, Formiga F,
Abstract
In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the "red flags" to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.
Copyright © 2024 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.
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Transthyretin amyloid cardiomyopathy among patients with heart failure and preserved ejection fraction: the AMY score.
ESC Heart Fail2024 Apr;():. doi: 10.1002/ehf2.14786.
Gioia Guglielmo, Schrutka Lore, Jozwiak-Nozdrzykowska Joanna, Kresoja Karl-Patrik, Gunold Hilka, Klingel Karin, Thiele Holger, Bonderman Diana, Lurz Philipp, Rommel Karl-Philipp,
Abstract
AIMS:
Transthyretin 'wild-type' amyloid cardiomyopathy (ATTRwt-CM) is a differential diagnosis of heart failure with preserved ejection fraction (HFpEF). The clinical work-up for ATTRwt-CM is challenging. Considering a combination of clinical variables specific for ATTRwt-CM might aid in identifying patients at risk.
METHODS AND RESULTS:
Sixty patients (78 ± 6 years, 8% female) were diagnosed with ATTRwt-CM by endomyocardial biopsy. Preserved ejection fraction (LVEF >45%) was present in 41 of the patients. Those were 1:1 propensity score age- and sex-matched to a cohort of patients with HFpEF. ATTRwt-CM patients had less obesity (P = 0.01) and higher septal thickness (IVSd, P 14 mm, E/e' > 14 and absence of obesity (P > 0.01 for all) were identified as predictors for ATTRwt-CM. A weighted point-based score was derived with IVSd > 14 mm = 1 point; absence of obesity = 2 points; and E/e' > 14 = 3 points. Area under the curve (AUC) for the summation score was 0.91 (0.84-0.97, P
CONCLUSIONS:
A score based on basic clinical and echocardiographic features helps to distinguish ATTRwt-CM from typical HFpEF. This could facilitate the diagnostic work-up for these patients and enable earlier disease screening on a large scale.
© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Role of Palliative Care in the Supportive Management of AL Amyloidosis-A Review.
J Clin Med2024 Mar;13(7):. doi: 1991.
Habib Muhammad Hamza, Tiger Yun Kyoung Ryu, Dima Danai, Schlögl Mathias, McDonald Alexandra, Mazzoni Sandra, Khouri Jack, Williams Louis, Anwer Faiz, Raza Shahzad,
Abstract
Light chain amyloidosis is a plasma-cell disorder with a poor prognosis. It is a progressive condition, causing worsening pain, disability, and life-limiting complications involving multiple organ systems. The medical regimen can be complex, including chemotherapy or immunotherapy for the disease itself, as well as treatment for pain, gastrointestinal and cardiorespiratory symptoms, and various secondary symptoms. Patients and their families must have a realistic awareness of the illness and of the goals and limitations of treatments in making informed decisions about medical therapy, supportive management, and end-of-life planning. Palliative care services can thus improve patients' quality of life and may even reduce overall treatment costs. Light chain (AL) amyloidosis is a clonal plasma cell disorder characterized by the excessive secretion of light chains by an indolent plasma cell clone that gradually accumulates in vital organs as amyloid fibrils and leads to end-organ damage. With progressive disease, most patients develop diverse clinical symptoms and complications that negatively impact quality of life and increase mortality. Complications include cardiac problems including heart failure, hypotension, pleural effusions, renal involvement including nephrotic syndrome with peripheral edema, gastrointestinal symptoms leading to anorexia and cachexia, complex pain syndromes, and mood disorders. The prognosis of patients with advanced AL amyloidosis is dismal. With such a complex presentation, and high morbidity and mortality rates, there is a critical need for the establishment of a palliative care program in clinical management. This paper provides an evidence-based overview of the integration of palliative care in the clinical management of AL amyloidosis as a means of reducing ER visits, rehospitalizations, and in-hospital mortality. We also discuss potential future collaborative directions in various aspects of clinical care related to AL amyloidosis.
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Molecular Imaging of Heart Failure: An Update and Future Trends.
Semin Nucl Med2024 Apr;():. doi: S0001-2998(24)00028-X.
Saraste Antti, Ståhle Mia, Roivainen Anne, Knuuti Juhani,
Abstract
Molecular imaging can detect and quantify pathophysiological processes underlying heart failure, complementing evaluation of cardiac structure and function with other imaging modalities. Targeted tracers have enabled assessment of various cellular and subcellular mechanisms of heart failure aiming for improved phenotyping, risk stratification, and personalized therapy. This review outlines the current status of molecular imaging in heart failure, accompanied with discussion on novel developments. The focus is on radionuclide methods with data from clinical studies. Imaging of myocardial metabolism can identify left ventricle dysfunction caused by myocardial ischemia that may be reversible after revascularization in the presence of viable myocardium. In vivo imaging of active inflammation and amyloid deposition have an established role in the detection of cardiac sarcoidosis and transthyretin amyloidosis. Innervation imaging has well documented prognostic value in predicting heart failure progression and arrhythmias. Tracers specific for inflammation, angiogenesis and myocardial fibrotic activity are in earlier stages of development, but have demonstrated potential value in early characterization of the response to myocardial injury and prediction of cardiac function over time. Early detection of disease activity is a key for transition from medical treatment of clinically overt heart failure towards a personalized approach aimed at supporting repair and preventing progressive cardiac dysfunction.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
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Acute ischemic stroke as initial manifestation of cardiac amyloidosis.
Neurol Sci -
Determinants of health status in older patients with transthyretin cardiac amyloidosis: a prospective cohort study.
Aging Clin Exp Res2024 Apr;36(1):89. doi: 89.
Fumagalli Carlo, Ponti Lucia, Smorti Martina, Pozza Francesca, Argirò Alessia, Zampieri Mattia, Di Mario Carlo, Marfella Raffaele, Sardu Celestino, Paolisso Giuseppe, Olivotto Iacopo, Perfetto Federico, Ungar Andrea, Marchionni Niccolò, Cappelli Francesco,
Abstract
BACKGROUND:
Whether, and to what extent, frailty and other geriatric domains are linked to health status in patients with transthyretin cardiac amyloidosis (ATTR-CA) is unknown.
AIMS:
To determine the association of frailty with health status [defined by the Kansas City Cardiomyopathy Questionnaire (KCCQ)] in patients with ATTR-CA.
METHODS:
Consecutive ATTR-CA patients undergoing cardiovascular assessment at a tertiary care clinic from September 2021 to September 2023 were invited to participate. KCCQ, frailty and social environment were recorded. Frailty was assessed using the modified Frailty Index (mFI), mapping 11 variables from the Canadian Study of Health and Aging (frailty ?0.36).
RESULTS:
Of 168 screened ATTR-CA patients, 138 [83% men, median age of 79 (75-84) years] were enrolled in the study. Median KCCQ was 66 (50-75). wtATTR-CA was the most prevalent form (N = 113, 81.9%). The most frequent cardiac variant was Ile68Leu (17/25 individuals with vATTR-CA). Twenty (14.5%) patients were considered frail, and prevalence of overt disability was 6.5%. At multivariable linear regression analysis, factors associated with worsening KCCQ were age at evaluation, the mFI, NYHA Class, and NAC Score. Gender, ATTR-CA type, phenotype, and LVEF were not associated with health status.
DISCUSSION:
In older patients diagnosed with ATTR-CA, frailty, symptoms, and disease severity were associated with KCCQ.
CONCLUSIONS:
Functional status is a determinant of quality of life and health status in older individuals with a main diagnosis of ATTR-CA. Future research may provide more in-depth knowledge on the association of frailty in patients with ATTR-CA with respect to quality of life and prognosis.
© 2024. The Author(s).
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Unraveling Transthyretin Cardiac Amyloidosis: Updates on Diagnosis, Treatment, and Prevalence Insights.
Eur J Prev Cardiol2024 Apr;():. doi: zwae133.
Disabato Giandomenico, Attanasio Andrea, Guida Gianluigi, Piepoli Massimo,
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Cardio-Hepatic Interaction in Cardiac Amyloidosis.
J Clin Med2024 Mar;13(5):. doi: 1440.
Ihne-Schubert Sandra Michaela, Goetze Oliver, Gerstendörfer Felix, Sahiti Floran, Schade Ina, Papagianni Aikaterini, Morbach Caroline, Frantz Stefan, Einsele Hermann, Knop Stefan, Sommer Claudia, Müllhaupt Beat, Schubert Torben, Störk Stefan, Geier Andreas,
Abstract
Congestion is associated with poor prognosis in cardiac amyloidosis (CA). The cardio-hepatic interaction and the prognostic impact of secondary liver affection by cardiac congestion in CA are poorly understood and require further characterisation. Participants of the amyloidosis cohort study AmyKoS at the Interdisciplinary Amyloidosis Centre of Northern Bavaria with proven transthyretin (ATTR-CA) and light chain CA (AL-CA) underwent serial work-up including laboratory tests, echocardiography, and in-depth hepatic assessment by vibration-controlled transient elastography (VCTE) and C-methacetin breath test. In total, 74 patients with AL-CA (n = 17), ATTR-CA (n = 26) and the controls (n = 31) were analysed. ATTR-CA patients showed decreased microsomal liver function expressed by maximal percentage of dose rate (PDR) related to hepatic congestion. Reduced PDR in AL-CA could result from altered pharmacokinetics due to changed hepatic blood flow. Liver stiffness as a combined surrogate of chronic liver damage and congestion was identified as a predictor of all-cause mortality. Statistical modelling of the cardio-hepatic interaction revealed septum thickness, NT-proBNP and PDR as predictors of liver stiffness in both CA subtypes; dilatation of liver veins and the fibrosis score FIB-4 were only significant for ATTR-CA. Non-invasive methods allow us to characterise CA-associated hepatic pathophysiology. Liver stiffness might be promising for risk stratification in CA.
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Arrhythmias and Device Therapies in Cardiac Amyloidosis.
J Clin Med2024 Feb;13(5):. doi: 1300.
Bukhari Syed, Khan Syed Zamrak, Ghoweba Mohamed, Khan Bilal, Bashir Zubair,
Abstract
Cardiac amyloidosis is caused by amyloid fibrils that deposit in the myocardial interstitium, causing restrictive cardiomyopathy and eventually death. The electromechanical, inflammatory, and autonomic changes due to amyloid deposition result in arrhythmias. Atrial fibrillation is by far the most common arrhythmia. The rate control strategy is generally poorly tolerated due to restrictive filling physiology and heart rate dependance, favoring adoption of the rhythm control strategy. Anticoagulation for stroke prophylaxis is warranted, irrespective of CHADS-VASc score in patients with a favorable bleeding profile; data on left appendage closure devices are still insufficient. Ventricular arrhythmias are also not uncommon, and the role of implantable cardioverter-defibrillator in cardiac amyloidosis is controversial. There is no evidence of improvement in outcomes when used for primary prevention in these patients. Bradyarrhythmia is most commonly associated with sudden cardiac death in cardiac amyloidosis. Pacemaker implantation can help provide symptomatic relief but does not confer mortality benefit.
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Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey.
Int J Cardiol Heart Vasc2024 Jun;52():101404. doi: 101404.
Bremner Luca, Vitola Joao, Cerci Rodrigo, Campisi Roxana, Araujo Ríos Raúl, Massardo Teresa, Gutierrez-Villamil Claudia, Solis Felix, Peix Amalia, Speckter Herwin, Sanchez Velez Mayra, Flores Ana Camila, Madu Ernest, Alexánderson-Rosas Erick, Ortellado José, Morales Rosanna, Mut Fernando, Vera Luisa, Hirschfeld Cole B, Shaw Leslee J, Williams Michelle C, Villines Todd C, Better Nathan, Dorbala Sharmila, Karthikeyan Ganesan, Malkovskiy Eli, Cohen Yosef A, Randazzo Michael, Pascual Thomas N B, Pynda Yaroslav, Dondi Maurizio, Paez Diana, Einstein Andrew J, , , ,
Abstract
BACKGROUND:
The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak.
METHODS:
The International Atomic Energy Agency (IAEA) surveyed 669 centers in 107 countries worldwide, including 135 facilities in 19 LATAM countries, to assess cardiovascular procedure volumes in March 2019, April 2020, and April 2021, and changes in center practices and staffing conditions one year into the COVID-19 pandemic.
FINDINGS:
LATAM centers reported a 21 % decrease in procedure volumes in April 2021 from pre-pandemic-baseline, vs. a 0 % change in the rest of the world (RoW), and greater volume reductions for almost all procedure types. Centers in Central America and Mexico reported the largest procedure reductions (47 % reduction) compared to the Caribbean (15 %), and South America (14 %, p = 0.01), and this LATAM region was a significant predictor of lower procedure recovery in multivariable regression. More LATAM centers reported reduced salaries and increased layoffs of clinical staff compared to RoW, and LATAM respondents estimated that half of physician and non-physician staff experienced excess psychological stress related to the pandemic, compared to 25 % and 30 % in RoW (p
CONCLUSIONS:
Cardiovascular testing recovery in LATAM trailed behind RoW for most procedure types, with centers in Central America and Mexico reporting the greatest volume reductions. This study found lasting impacts of COVID-19 on cardiovascular care in LATAM and the need for mental health support for LATAM healthcare workers in current and future pandemics.
Published by Elsevier B.V.
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Novel monoclonal antibodies: A really specific therapy for light chain amyloidosis.
Hematol Oncol2024 May;42(3):e3270. doi: 10.1002/hon.3270.
Del Giudice Maria Livia, Galimberti Sara, Buda Gabriele,
Abstract
Light chain amyloidosis is a rare disease caused by clonal plasma cells in the bone marrow generating an excessive amount of immunoglobulin light chains. These chains misfold and produce insoluble fibrils that deposit in various organs, including the heart, kidneys, liver, nervous system, and digestive tract. Life expectancy and symptoms during the course of the disease vary depending on which and how many organs are affected. Targeted plasma cell therapy has significantly advanced the clinical management of amyloidosis, with ongoing progress. However, current clinical studies are investigating innovative targets, drug combinations and treatment strategies to improve therapeutic outcomes by minimizing adverse effects and refining patient prognosis in these challenging hematological conditions. In this paper, we review the state of the art regarding the use of anti-amyloid antibodies, as a revolutionary and innovative approach in the current scenario of amyloid treatment.
© 2024 John Wiley & Sons Ltd.
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