Cardiac amyloidosis in severe aortic stenosis: we can find it but what should we do?

European Journal of Heart Failure, EarlyView.
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Editorial Comment Source Type: research

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Cardiac scintigraphy with 99mTc pyrophosphate (PYP) has a high diagnostic accuracy for transthyretin (ATTR) cardiac amyloidosis (CA) and is being increasingly used to diagnose this condition noninvasively.1-3 Multisocietal guidelines recommend performing 99mTc PYP scintigraphy in patients with heart failure and left ventricular (LV) hypertrophy on transthoracic echocardiography (TTE).1,2 Other features on TTE (increased interatrial septal thickness, pericardial effusion, and biatrial enlargement) and electrocardiography (low voltage, conduction abnormalities, and a pseudo-infarct pattern) may increase the suspicion for CA ...
Source: Journal of the American Society of Echocardiography - Category: Cardiology Authors: Tags: Letters to the Editor Source Type: research
ConclusionBoth TTR ‐ and AL‐CA can accompany severe AS. Parameters solely based on ECG and echocardiography allow for the identification of the majority of CA‐AS. In the present cohort, CA did not significantly worsen prognosis 15.3 months after TAVR.
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
CHAD-STOP is the mnemonic for the initial steps in the management of cardiac amyloidosis: C: Conduction and rhythm disorder prevention H: High heart rate maintenance A: Anticoagulation D: Diuretics STOP: STOP beta receptor and calcium channel blockers, digoxin and renin-angiotensin-aldosterone inhibitors Preload reserve is limited in cardiac amyloidosis due to severe diastolic dysfunction. Hence the only way to increase the cardiac output is by the heart rate reserve and hence it should not be cut down by beta blockade or calcium channel blockade. Renin-angiotensin-aldosterone inhibitors carry the risk of severe hypotens...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs
ConclusionTakotsubo cardiomyopathy may develop in critically ill cardiac diseases but are often underdiagnosed. Careful echocardiographic examination is needed to unveil these “hidden” TC.
Source: Journal of Echocardiography - Category: Cardiology Source Type: research
We present the data on the prevalence of ATTR-CA in AS and their prognostic associations. Since diagnosis of ATTR-CA may be challenging, special attention is paid to the diagnostic utility of different imaging modalities, echocardiography, cardiovascular magnetic resonance, nuclear imaging, and distinctive imaging features in patients with dual pathology. We also present a flow diagram summarizing integrated imaging in patients with suspected ATTR-CA. PMID: 31740363 [PubMed - as supplied by publisher]
Source: Hellenic Journal of Cardiology - Category: Cardiology Tags: Hellenic J Cardiol Source Type: research
Cardiac amyloidosis – most commonly resulting from deposition of misfolded light chain (AL) or transthyretin (ATTR) protein - is an underappreciated cause of heart failure.[1, 2] Commonly thought to be a rare disease, undiagnosed cardiac amyloidosis has been identified in numerous populations including 10-20% of elde rly patients with heart failure and preserved ejection fraction (HFpEF),[3] severe aortic stenosis,[4] and Afro-Caribbean patients with decompensated heart failure.[5] Despite this recent evidence, many clinicians indicate that they have never seen a case of cardiac amyloidosis, suggesting that the diagn...
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: Editorial Source Type: research
Conclusions— Occult wild-type transthyretin cardiac amyloid had a prevalence of 6% among patients with AS aged>65 years undergoing surgical aortic valve replacement and was associated with a poor outcome.
Source: Circulation: Cardiovascular Imaging - Category: Radiology Authors: Tags: Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) Cardiomyopathies Source Type: research
Left ventricular hypertrophy with dysfunction M-mode echocardiogram showing gross left ventricular hypertrophy and moderate to severe left ventricular dysfunction. Inset shows short axis view of left ventricle demonstrating severe concentric left ventricular hypertrophy. IVS: interventricular septum. LVPW: left ventricular posterior wall. IVSd: interventricular septum in diastole; LVIDd: left ventricular diastolic dimension in diastole; LVPWD: left ventricular posterior wall in diastole; IVSs: interventricular septum in systole; LVIDs: left ventricular internal dimension in systole Left ventricular systolic dysfunction occ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Echocardiogram Library Source Type: blogs
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