Transthyretin Amyloid Cardiomyopathy (ATTR-CM)
- PMID: 34662045
- Bookshelf ID: NBK574531
Transthyretin Amyloid Cardiomyopathy (ATTR-CM)
Excerpt
Transthyretin amyloid cardiomyopathy (ATTR-CM) is one of the types of systemic amyloidosis in which misfolded transthyretin (TTR) protein gets deposited in the myocardium. Another pertinent etiology of cardiac amyloidosis is due to the deposition of immunoglobulin light-chain (AL) aggregates. Several other amyloidogenic proteins may get deposited in various organs and tissues but rarely involve the myocardium.
Transthyretin amyloidosis (ATTR) is a systemic disease. Due to amyloid deposition in extracardiac tissues, patients often have associated extracardiac signs and symptoms. However, isolated cardiac involvement has been reported as well. Diagnosis of ATTR-CM was often missed or delayed due to previously lacking optimal diagnostic modalities. ATTR-CM often progresses to advanced stages with minimal clinical signs and symptoms initially and is therefore associated with poor prognosis.
With improving bone avid radiotracer scintigraphy technology and the advent of new therapeutic options, diagnosis and treatment of ATTR-CM have become possible. As diagnostic capabilities are getting better, studies have shown a higher prevalence of ATTR-CM in patients with heart failure with preserved ejection fraction than previously perceived.
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Sections
- Continuing Education Activity
- Introduction
- Etiology
- Epidemiology
- Pathophysiology
- Histopathology
- History and Physical
- Evaluation
- Treatment / Management
- Differential Diagnosis
- Pertinent Studies and Ongoing Trials
- Staging
- Prognosis
- Complications
- Deterrence and Patient Education
- Enhancing Healthcare Team Outcomes
- Review Questions
- References
References
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- AbouEzzeddine OF, Davies DR, Scott CG, Fayyaz AU, Askew JW, McKie PM, Noseworthy PA, Johnson GB, Dunlay SM, Borlaug BA, Chareonthaitawee P, Roger VL, Dispenzieri A, Grogan M, Redfield MM. Prevalence of Transthyretin Amyloid Cardiomyopathy in Heart Failure With Preserved Ejection Fraction. JAMA Cardiol. 2021 Nov 01;6(11):1267-1274. - PMC - PubMed
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- Kelly JW, Colon W, Lai Z, Lashuel HA, McCulloch J, McCutchen SL, Miroy GJ, Peterson SA. Transthyretin quaternary and tertiary structural changes facilitate misassembly into amyloid. Adv Protein Chem. 1997;50:161-81. - PubMed
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