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. 2021 May 6;11(5):834.
doi: 10.3390/diagnostics11050834.

Current Challenges of Cardiac Amyloidosis Awareness among Romanian Cardiologists

Robert Adam  1   2 , Gabriela Neculae  1 , Claudiu Stan  2   3 , Ruxandra Jurcut  1   2
Affiliations

Current Challenges of Cardiac Amyloidosis Awareness among Romanian Cardiologists

Robert Adam et al. Diagnostics (Basel). .

Abstract

Cardiac amyloidosis (CA) is a restrictive cardiomyopathy characterized by deposition of amyloid in the myocardium and recent studies revealed it is more frequently seen than we thought. Advances in diagnosis and treatment have been made over the last few years that make it desirable to diagnose CA without delay, and that may require extra education. An online survey was conducted among cardiologists from Romania, representing the first assessment of the knowledge of CA among them, with 195 cardiologists answering the questionnaire. There was a wide variation in their knowledge regarding CA. Our participants had limited experience with CA and reported a significant delay between first cardiac symptoms and diagnosis. We address the gaps in knowledge that were identified as educational opportunities in the main identified areas: prevalence and treatment of wild type transthyretin amyloidosis (ATTRwt), prevalence of variant transthyretin amyloidosis (ATTRv) in Romania, diagnosis of CA, the delay in CA diagnosis and available treatment options. Awareness among cardiologists is the most important challenge in diagnosing CA. Romanian cardiologists are partially aware of this topic, but there are still gaps in their knowledge. Educational programs can improve screening of patients with a high suspicion for this progressive condition the prognosis of which has been dramatically changed by the new treatment options.

Keywords: ATTR; amyloidosis; awareness; cardiologist; survey.

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Conflict of interest statement

Ruxandra Jurcut reports speaker fees and unrestricted grants from Pfizer, non-competing with the present work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
(A) Number of general cardiology weekly patients treated by surveyed cardiologists. (B) Number of patients presenting with cardiac amyloidosis managed by cardiologists answering the survey.
Figure 2
Figure 2
(A) Most frequently seen etiologies of cardiac amyloidosis in the clinical practice of the surveyed cardiologists. (B) Mean delay from the first presentation with cardiac symptoms to diagnosis of cardiac amyloidosis reported by the surveyed cardiologists.
Figure 3
Figure 3
Diagnostic tests considered by the survey participants in patients with heart failure and suspicion of cardiac amyloidosis. CMR cardiac magnetic resonance, ECG electrocardiogram, LC light chain. Cardiac biomarkers are represented by NT-pro BNP and troponin.
Figure 4
Figure 4
(A) Electrocardiographic hallmarks of cardiac amyloidosis chosen by the survey participants. (B) Echocardiographic hallmarks of cardiac amyloidosis chosen by the survey participants. LV—left ventricle.
Figure 5
Figure 5
Participants’ options for heart failure treatment in patients with cardiac amyloidosis. ACEi—angiotensin converting enzyme inhibitor; ARB—angiotensin receptor blocker; ICD—implantable cardioverter defibrillator.
See this image and copyright information in PMC

References

    1. Siddiqi O.K., Ruberg F.L. Cardiac amyloidosis: An update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc. Med. 2018;28:10–21. doi: 10.1016/j.tcm.2017.07.004. - DOI - PMC - PubMed
    1. Sipe J.D., Benson M.D., Buxbaum J.N., Ikeda S.I., Merlini G., Saraiva M.J., Westmark P. Amyloid fibril proteins and amyloidosis: Chemical identification and clinical classification International Society of Amyloidosis 2016 Nomenclature Guidelines. Amyloid. 2016;23:209–213. doi: 10.1080/13506129.2016.1257986. - DOI - PubMed
    1. Falk R.H., Alexander K.M., Liao R., Dorbala S. AL (Light-Chain) Cardiac Amyloidosis: A Review of Diagnosis and Therapy. J. Am. Coll. Cardiol. 2016;68:1323–1341. doi: 10.1016/j.jacc.2016.06.053. - DOI - PubMed
    1. Quock T.P., Yan T., Chang E., Guthrie S., Broder M.S. Epidemiology of AL amyloidosis: A real-world study using US claims data. Blood Adv. 2018;2:1046–1053. doi: 10.1182/bloodadvances.2018016402. - DOI - PMC - PubMed
    1. Duhamel S., Mohty D., Magne J., Lavergne D., Bordessoule D., Aboyans V., Jaccard A. Incidence and Prevalence of Light Chain Amyloidosis: A Population-Based Study. Blood. 2017;130(Suppl. 1):5577.

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