Utility of Biomarkers in Cardiac Amyloidosis

Pregenzer-Wenzler, Arianna; Abraham, Jo; Barrell, Kelsey; Kovacsovics, Tibor; Nativi-Nicolau, José

doi:10.1016/j.jchf.2020.03.007

Cited by 23 publications

(21 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…amyloidotic precursors and associated proteins); (ii) biomarkers of organ involvement. In current clinical practice, biomarkers are not only important tools for risk stratification and evaluating the response to therapy in AL amyloidosis, as recently revised, 12 but also for disease screening, diagnosis and treatment tailoring. The role of biomarkers has been less extensively investigated in ATTR amyloidosis, and their clinical usefulness is poorly codified.…”

Section: Figurementioning

confidence: 99%

Use of biomarkers to diagnose and manage cardiac amyloidosis

Castiglione

Franzini

Aimo

et al. 2021

European J of Heart Fail

View full text Add to dashboard Cite

Amyloidoses are characterized by the tissue accumulation of misfolded proteins into insoluble fibrils. The two most common types of systemic amyloidosis result from the deposition of immunoglobulin light chains (AL) and wild-type or variant transthyretin (ATTRwt/ATTRv). Cardiac involvement is the main determinant of outcome in both AL and ATTR, and cardiac amyloidosis (CA) is increasingly recognized as a cause of heart failure. In CA, circulating biomarkers are important diagnostic tools, allow to refine risk stratification at baseline and during follow-up, help to tailor the therapeutic strategy and monitor the response to treatment. Among amyloid precursors, free light chains are established biomarkers in AL amyloidosis, while the plasma transthyretin assay is currently being investigated as a tool for supporting the diagnosis of ATTRv amyloidosis, predicting outcome and monitor response to novel tetramer stabilizers or small interfering RNA drugs in ATTR CA. Natriuretic peptides (NPs) and troponins are consistently elevated in patients with AL and ATTR CA. Plasma NPs, troponins and free light chains hold prognostic significance in AL amyloidosis, and are evaluated for therapy decision-making and follow-up, while the value of NPs and troponins in ATTR is less well established. Biomarkers can be usefully integrated with clinical and imaging variables at all levels of the clinical algorithm of systemic amyloidosis, from screening to diagnosis and prognosis, and treatment tailoring.

show abstract

Section: Figurementioning

confidence: 99%

Use of biomarkers to diagnose and manage cardiac amyloidosis

Castiglione

Franzini

Aimo

et al. 2021

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

“…The definite diagnosis of ATTR-AC does not rely upon specific biomarkers, but different parameters are currently under evaluation to aid in the identification of the disease and to monitor response to new disease-modifying drugs, including plasmatic concentration of TTR, retinol-binding protein-4 (RBP4), measurements of TTR kinetic stability and non-antibody peptide probes [22] , [23] , [24] .…”

Section: Changing Perspectives On Attr-acmentioning

confidence: 99%

Transthyretin amyloid cardiomyopathy: An uncharted territory awaiting discovery

Porcari

Merlo

Rapezzi

et al. 2020

European Journal of Internal Medicine

View full text Add to dashboard Cite

Highlights Transthyretin amyloid cardiomyopathy (ATTR-AC) is an under-diagnosed disease. Many grey areas are emerging in clinical management and prognostic stratification. Candidates’ selection for novel drugs is crucial, but response criteria are lacking. The impact of evidence-based therapies for HF in ATTR-AC should be investigated. Multidisciplinary team is the way to deliver the best clinical management.

show abstract

“…Troponins and NT pro BNP are cardiac biomarkers that have been studied in CA ATTR in relation with myocardial damage and cardiac function. Later, they have been used for staging and their prognostic significance (21).…”

Section: Cardiac Biomarkersmentioning

confidence: 99%

Amyloid Cardiopathy and Aortic Stenosis

Gherasim

2021

Maedica

View full text Add to dashboard Cite

Cardiac amyloidosis (amyloid cardiomyopathy, CA) is an increasingly diagnosed condition which is most frequently seen in older patients with heart failure and preserved ejection fraction as well as in those with biventricular hypertrophies and tight aortic stenosis (AS). Almost 15% of patients with tight AS can also have CA ATTR, an element with diagnostic, prognostic and therapeutic significance.The CA diagnostic, associated with AS or not, is laborious and it should be made on the basis of determining the severity of the associated AS, depending on the case. The presence of both ventricular hypertrophy (≥15 mm) and red flags indicates a high suspicion of CA. Extra tests, bone scintigraphy and an absence of light free chains in blood or urine have a high specificity and sensitivity for diagnostic. Genetic investigations identify the senile or hereditary ATTR type.Pharmacologic treatment of CA with heart failure has some peculiarities, including stopping or careful usage of beta-blockers, non-dihydropyridine calcium blockers, and angiotensin system inhibitors. Diuretic treatment, which is almost always necessary, must preserve euvolemia.Replacing the aortic valves through transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is recommended in tight AS associated with CA. The comparative results between the two methods of AVR favor TAVR, although perioperative complications are more frequent when the latter is used. Ongoing comparative studies of TAVR versus SAVR could define the options.Lately, pharmacological agents targeting CA ATTR can significantly change the management of ATTR amyloidosis.

show abstract

Utility of Biomarkers in Cardiac Amyloidosis

Cited by 23 publications

References 54 publications

Use of biomarkers to diagnose and manage cardiac amyloidosis

Use of biomarkers to diagnose and manage cardiac amyloidosis

Transthyretin amyloid cardiomyopathy: An uncharted territory awaiting discovery

Amyloid Cardiopathy and Aortic Stenosis

Contact Info

Product

Resources

About