Certain "red flags" should prompt screening for transthyretin amyloid cardiomyopathy (ATTR-CM), according to consensus recommendations.
Increased wall thickness with either heart failure or "red flag" signs and symptoms in men over age 65 years and women over 70 warrant screening, Pablo Garcia-Pavia, MD, PhD, of the Hospital Universitario Puerta de Hierro in Madrid, and colleagues wrote in JACC: Heart Failure.
Those red flags that should further heighten suspicion were:
- Reduced longitudinal strain with apical sparing
- Left ventricular hypertrophy on imaging but normal, low-normal, or low voltages on electrocardiography
- Atrioventricular block when there's increased left ventricular wall thickness
- Infiltrative features on ECG, such as thicker atrioventricular valves, interatrial septum, and right ventricular free wall
- On cardiac MRI, marked extracellular volume expansion, abnormal nulling time, or diffuse late gadolinium enhancement
- Polyneuropathy, dysautonomia (orthostatic hypotension, diarrhea/constipation, and erectile dysfunction), or both
- Bilateral carpal tunnel syndrome
- Persistent mildly elevated troponin levels
"Early accurate diagnosis is ... key to improving patient outcomes, particularly in the context of the positive phase 3 trial of tafamidis for the treatment of ATTR-CM and other promising therapies under development," Garcia-Pavia's group noted.
"With the availability of scintigraphy as an inexpensive, non-invasive diagnostic tool, the rationale to screen for ATTR-CM in high risk populations of patients is increasingly warranted," the team added.
FDA approved tafamidis meglumine (Vyndaqel) and tafamidis (Vyndamax) in May for the treatment of wild-type or hereditary ATTR cardiomyopathy, the first agents to get the greenlight for this rare disease.
The number of patients identified with the condition "will undoubtedly rise" now that there is "a convenient and relatively inexpensive imaging modality, bone scintigraphy, having strong evidence as an accurate, non-invasive approach to diagnosing ATTR-CM," the group wrote.
Sorting out diagnosis is important, because treating for conditions it is frequently misdiagnosed as, such as congestive heart failure, with beta-blockers, ACE inhibitors, or angiotensin II receptor antagonists is not only ineffective but often leads to clinical worsening.
The manuscript was developed based on discussions at an expert scientific meeting for which each author received an honorarium from Pfizer for their participation.
Garcia-Pavia reported financial relationships with Pfizer, Eidos, Alnylam, Prothena, Akcea, Neuroinmmune, Alnylam, Prothena and Akcea.
Medical writing support for the study was funded by Pfizer.
Attr Cardiomyopathy: Red Flags for Screening Medpage Today
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Vincenz Krankenhaus Datteln, Medizinische Klinik II, Datteln, Germany, 45711, contact: Marcus Bauer, MD, klinikum Dortmund gGmbH, Stroke-Unit und Neurologische Intensivstation. As predicted, patanol age indication 100 of patients with amyloidosis had a history of bilateral carpal tunnel syndrome, but so did 83 of those without amyloidosis. Patient with cardiac TTR amyloid, positive cardiac uptake of tracer (grade 2). Garcia-Pavia reported financial relationships with Pfizer, Eidos, Alnylam, Prothena, Akcea, Neuroinmmune, Alnylam, Prothena and Akcea.
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1,3 PYP scanning shows 97 sensitivity bayer levitra wiki and 100 specificity for identifying TTR in the heart. 4 PYP scanning visualizes cardiac transthyretin amyloid deposits. Physicians treating transthyretin amyloid aTTR ) cardiomyopathy will now have access to the first FDA-approved agents on the market for this rare disease. The FDA simultaneously approved tafamidis. Screening for Hereditary Transthyretin Related Amyloidosis - an Internationales, Multicentre, Epidemiological Protocol (tram) (tram2) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Attr Amyloidosis attr amyloidosis means A for Amyloid and the.Reply
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