Progress in noninvasive assessment of cardiac amyloidosis

doi:10.16138/j.1673-6087.2025.06.12

Abstract

Abstract:

Amyloidosis is a group of disorders caused by misfolded proteins that deposit in tissues and impair the function of vital organs. Systemic amyloidosis frequently involves the heart and is a leading cause of death in affected patients. Cardiac amyloidosis is difficult to diagnose and carries a poor prognosis, making early diagnosis and assessment crucial for treatment and prognosis. This article reviews several noninvasive techniques for diagnosing and evaluating cardiac amyloidosis.

Key words: Cardiac amyloidosis, Cardiac magnetic resonance, Electrocardiogram, Echocardiography, Radionuclide imaging

CLC Number:

R542.2

ZHANG Maosen, CHE Zigang, GUO Wanhua, ZHONG Yeming, FENG Chengyan, WEI Xuan. Progress in noninvasive assessment of cardiac amyloidosis[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(06): 495-499.

References 37

[1]	Gertz MA, Dispenzieri A. Systemic amyloidosis recognition, prognosis, and therapy: a systematic review[J]. JAMA, 2020, 324(1):79-89. doi: 10.1001/jama.2020.5493
[2]	Bloom MW, Gorevic PD. Cardiac amyloidosis[J]. Ann Intern Med, 2023, 176(3):ITC33-ITC48. doi: 10.7326/AITC202303210
[3]	Garcia-Pavia P, Rapezzi C, Adler Y, et al. Diagnosis and treatment of cardiac amyloidosis. A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases [J]. Eur J Heart Fail, 2021, 23(4): 512-526.
[4]	Gertz MA. Cardiac amyloidosis[J]. Heart Fail Clin, 2022, 18(3):479-488. doi: 10.1016/j.hfc.2022.02.005
[5]	Ioannou A, Patel RK, Martinez-Naharro A, et al. Tracking multiorgan treatment response in systemic AL-amyloidosis with cardiac magnetic resonance derived extracellular volume mapping[J]. JACC Cardiovasc Imaging, 2023, 16(8):1038-1052. doi: 10.1016/j.jcmg.2023.02.019
[6]	Lee C, Lam A, Kangappaden T, et al. Systematic literature review of evidence in amyloid light-chain amyloidosis[J]. J Comp Eff Res, 2022, 11(6):451-472. doi: 10.2217/cer-2021-0261
[7]	Muchtar E, Dispenzieri A, Magen, et al. Systemic amyloidosis from A (AA) to T (ATTR): a review[J]. J Intern Med, 2021, 289(3):268-292. doi: 10.1111/joim.13169
[8]	Silvetti E, Lanza O, Romeo F, et al. The pivotal role of ECG in cardiomyopathies[J]. Front Cardiovasc Med, 2023, 10: 1178163. doi: 10.3389/fcvm.2023.1178163
[9]	宋爽. 临床诊断AL型心肌淀粉样变性的影像学特征分析 [D]. 2020. 长春: 吉林大学.
	Song S. Analysis imaging features of amyloid light chain myocardial amyloidosis diagnosed clinically [D]. 2020. Changchun: Jilin University.
[10]	Slivnick JA, Wallner AL, Vallakati A, et al. Indexed left ventricular mass to QRS voltage ratio is associated with heart failure hospitalizations in patients with cardiac amyloidosis[J]. Int J Cardiovasc Imaging, 2021, 37(3):1043-1051. doi: 10.1007/s10554-020-02059-1
[11]	Dominguez F. Predicting pacemaker implantation in cardiac amyloidosis: let's start with an ECG[J]. Eur J Heart Fail, 2022, 24(7):1237-1238. doi: 10.1002/ejhf.2591
[12]	Boldrini M, Cappelli F, Chacko L, et al. Multiparametric echocardiography scores for the diagnosis of cardiac amyloidosis[J]. JACC Cardiovasc Imaging, 2020, 13(4):909-920. doi: 10.1016/j.jcmg.2019.10.011
[13]	Liang S, Liu Z, Li Q, et al. Advance of echocardiography in cardiac amyloidosis[J]. Heart Fail Rev, 2023, 28(6):1345-1356. doi: 10.1007/s10741-023-10332-3
[14]	Damy T, Costes B, Hagège AA, et al. Prevalence and clinical phenotype of hereditary transthyretin amyloid cardiomyopathy in patients with increased left ventricular wall thickness[J]. Eur Heart J, 2016, 37(23):1826-1834. doi: 10.1093/eurheartj/ehv583
[15]	AbouEzzeddine OF, Davies DR, Scott CG, et al. Prevalence of transthyretin amyloid cardiomyopathy in heart failure with preserved ejection fraction[J]. JAMA Cardiol, 2021, 6(11):1267-1274. doi: 10.1001/jamacardio.2021.3070
[16]	Hotta VT, Giorgi MCP, Fernandes F, et al. Cardiac amyloidosis: non-invasive diagnosis[J]. Rev Assoc Med Bras (1992), 2020, 66(3):345-352. doi: 10.1590/1806-9282.66.3.345
[17]	Stricagnoli M, Cameli M, Incampo E, et al. Speckle tracking echocardiography in cardiac amyloidosis[J]. Heart Fail Rev, 2019, 24(5):701-707. doi: 10.1007/s10741-019-09796-z
[18]	Scheel PJ 3rd, Mukherjee M, Hays AG, et al. Multimodality imaging in the evaluation and prognostication of cardiac amyloidosis[J]. Front Cardiovasc Med, 2022, 9: 787618. doi: 10.3389/fcvm.2022.787618
[19]	Lei C, Zhu X, Hsi DH, et al. Predictors of cardiac involvement and survival in patients with primary systemic light-chain amyloidosis: roles of the clinical, chemical, and 3-D speckle tracking echocardiography parameters[J]. BMC Cardiovasc Disord, 2021, 21(1):43. doi: 10.1186/s12872-021-01856-3
[20]	Dorbala S, Cuddy S, Falk RH. How to image cardiac amyloidosis: a practical approach[J]. JACC Cardiovasc Imaging, 2020, 13(6):1368-1383. doi: 10.1016/j.jcmg.2019.07.015
[21]	Hou W, Wang Z, Huang J, et al. Early diagnostic and prognostic value of myocardial strain derived from cardiovascular magnetic resonance in patients with cardiac amyloidosis[J]. Cardiovasc Diagn Ther, 2023, 13(6):979-993. doi: 10.21037/cdt-23-205
[22]	Yilmaz A. Interpretation of CMR-based mapping findings in cardiac amyloidosis: please act with caution[J]. JACC Cardiovasc Imaging, 2022, 15(4):604-606. doi: 10.1016/j.jcmg.2021.12.006
[23]	Sanchorawala V. Systemic light chain amyloidosis[J]. N Engl J Med, 2024, 390(24):2295-2307. doi: 10.1056/NEJMra2304088
[24]	Wan K, Sun J, Han Y, et al. Increased prognostic value of query amyloid late enhancement score in light-chain cardiac amyloidosis[J]. Circ J, 2018, 82(3):739-746. doi: 10.1253/circj.CJ-17-0464
[25]	Lin L, Li X, Feng J, et al. The prognostic value of T1 mapping and late gadolinium enhancement cardiovascular magnetic resonance imaging in patients with light chain amyloidosis[J]. J Cardiovasc Magn Reson, 2018, 20(1):2. doi: 10.1186/s12968-017-0419-6
[26]	Briasoulis A, Lama N, Rempakos A, et al. Diagnostic and prognostic value of non-late gadolinium enhancement cardiac magnetic resonance parameters in cardiac amyloidosis[J]. Curr Probl Cardiol, 2023, 48(4):101573. doi: 10.1016/j.cpcardiol.2022.101573
[27]	Baggiano A, Boldrini M, Martinez-Naharro A, et al. Noncontrast magnetic resonance for the diagnosis of cardiac amyloidosis [J]. JACC Cardiovasc Imaging, 2020, 13(1 Pt 1):69-80.
[28]	Martinez-Naharro A, Kotecha T, Norrington K, et al. Native T1 and extracellular volume in transthyretin amyloidosis[J]. JACC Cardiovasc Imaging, 2019, 12(5):810-819. doi: 10.1016/j.jcmg.2018.02.006
[29]	Dorbala S, Kijewski MF. Molecular imaging of systemic and cardiac amyloidosis: recent advances and focus on the future[J]. J Nucl Med, 2023, 64(Suppl 2):20S-28S.
[30]	中华医学会心血管病学分会心力衰竭学组, 中华心血管病杂志编辑委员会. 转甲状腺素蛋白心脏淀粉样变诊断与治疗中国专家共识[J]. 中华心血管病杂志, 2021, 49(4):324-332.
	Heart Failure Group of Chinese Society of Cardiology, Editorial Board of Chinese Journal of Cardiology. Chinese expert consensus on the diagnosis and treatment of transthyretin cardiac amyloidosis[J]. Chin J Cardiol, 2021, 49(4):324-332.
[31]	Clerc OF, Vijayakumar S, Dorbala S. Radionuclide imaging of cardiac amyloidosis: an update and future aspects[J]. Semin Nucl Med, 2024, 54(5):717-732. doi: 10.1053/j.semnuclmed.2024.05.012
[32]	Gillmore JD, Maurer MS, Falk RH, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis[J]. Circulation, 2016, 133(24):2404-2412. doi: 10.1161/CIRCULATIONAHA.116.021612
[33]	王雪竹, 任超, 黄政海, 等. 核医学显像在系统性轻链型淀粉样变诊疗中的应用进展[J]. 中华核医学与分子影像杂志, 2022, 42(4):243-247. doi: 10.3760/cma.j.cn321828-20201012-00369
	Wang XZ, Ren C, Huang ZH, et al. Advances in the application of nuclear medicine imaging in the diagnosis and treatment of systematic light chain amyloidosis[J]. Chin J Nucl Med Mol Imaging, 2022, 42(4):243-247. doi: 10.3760/cma.j.cn321828-20201012-00369
[34]	Vergaro G, Aimo A, Barison A, et al. Keys to early diagnosis of cardiac amyloidosis: red flags from clinical, laboratory and imaging findings[J]. Eur J Prev Cardiol, 2020, 27(17):1806-1815. doi: 10.1177/2047487319877708
[35]	Arvanitis M, Koch CM, Chan GG, et al. Identification of transthyretin cardiac amyloidosis using serum retinol-binding protein 4 and a clinical prediction model[J]. JAMA Cardiol, 2017, 2(3):305-313. doi: 10.1001/jamacardio.2016.5864
[36]	Gillmore JD, Damy T, Fontana M, et al. A new staging system for cardiac transthyretin amyloidosis[J]. Eur Heart J, 2018, 39(30):2799-2806. doi: 10.1093/eurheartj/ehx589
[37]	Argon A, Nart D, Yilmazbarbet F. Cardiac amyloidosis: clinical features, pathogenesis, diagnosis, and treatment[J]. Turk Patoloji Derg, 2024, 40(1):1-9.