Cardiac amyloidosis in Latin America: Gaps and opportunities to increase awareness of the disease. Findings from the AMILO-LATAM research group

Abstract

Background Cardiac amyloidosis (CA) is an under-diagnosed disease presenting as a restrictive cardiomyopathy with high morbidity and mortality. Wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) is mostly seen in elderly patients, with increasing prevalence as life expectancy is growing. New diagnostic imaging techniques and treatments allow for a better prognosis, but lack of clinical awareness delays timely diagnosis and appropriate management. Our purpose was to investigate the knowledge of clinicians regarding ATTR-CM and to assess the availability of imaging resources in the Latin-American region. Methods and Results Two online surveys were distributed among clinicians and nuclear medicine professionals, respectively: one asking about awareness of CA in different clinical scenarios, and the other about the availability of diagnostic resources and studies performed. 406 responses were received for the first survey and 82 for the second, representing 17 and 14 countries, respectively. A significant lack of awareness was identified among clinicians, although appropriate diagnostic resources are generally available. Survey data showed that very few patients are evaluated for ATTR-CM in most Latin-American countries. Conclusions The surveys demonstrated the need for educational programs and other measures to increase clinical awareness and early detection of CA, so patients receive timely treatment and management of the disease. Supplementary Information The online version contains supplementary material available at 10.1007/s12350-022-03005-5.

Quantitation in ATTR cardiac amyloidosis: the next step is almost there!

“…Among 82 centers that answered a survey, 39% performed 1 to 5 scans to search for ATTR-CA in the previous year, 16% reported 6 to 10, 21% more than 10, and 24% none. 11 At this point in our knowledge, it is important to win the third challenge. Making earlier diagnoses, when the disease is mild, determining prognosis and the response to treatment are challenges that can be overcome with more accurate diagnostic techniques.…”

Current status of nuclear cardiology practice in Latin America and the Caribbean, in the era of multimodality cardiac imaging approach: 2022 update

“…The management of microvascular disease, highly prevalent in women, can significantly benefit from the assessment of coronary flow reserve by PET MPI [22]. Although 78% of these 14 countries use 18 F-FDG, it is not dedicated to cardiac studies but to cancer. Regarding PET myocardial perfusion with 13 N-ammonia, only 21% have the capability of performing the study and assessing myocardial blood flow (Fig.…”

“…A significant lack of awareness was identified among clinicians, although appropriate diagnostic resources are generally available. AMILO-LATAM data showed that very few patients are evaluated for wild-type transthyretin amyloid cardiomyopathy (ATTR-CM) in most Latin-American countries [18].…”

“…According to AMILO-LATAM researchers, these surveys indicate enough qualified professionals in Latin America to carry out imaging studies for cardiac amyloidosis following current guidelines, as well as necessary tracers and equipment (PYP and SPECT), but some state-of-the-art technology [SPECT/CT, echo-strain imaging (ESI), CMR with parametric mapping (PM)], and light-chains quantification] is lacking in some areas. Only 39% of scans are performed in high-complexity hospitals, which could explain in part the limited accessibility to ESI and PM mapping in many centers [18]. Further education about red flags, diagnostic methods, and treatment algorithms are still necessary.…”

“…All 14 countries have 18 F-FDG even though only 85.7% of countries have cyclotrons. Both countries without cyclotrons import 18 F-FDG from neighboring countries and can perform PET studies. 18 F-FDG, Fluor-deoxy-glucose.…”