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Cardiac amyloidosis screening: Still a long way to go
Session:
Comunicações Orais - Sessão 26 - Doenças do Miocárdio
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Filipa Gerardo; Carolina Saca; Aurora Monteiro; Pedro Santos; Carolina Carvalho; Mariana Passos; Inês Fialho; Inês Miranda; Carolina Mateus; Joana Lima Lopes; Marco Beringuilho; Daniel Faria; Renata Ribeiro; João Augusto
Abstract
<p style="text-align:center"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Title</strong>: Cardiac amyloidosis screening: Still a long way to go</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">Background</span></span></strong><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">: There are several red flags for cardiac amyloidosis (CA) that can be used for a stepwise amyloidosis screening strategy based on cardiac and extracardiac findings.</span></span></span></span><br /> <span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529"><strong>Purpose</strong>: To identify the incidence of patients that meet the screening criteria for CA in a real-world population, as defined by consensus document from the European Society of Cardiology (ESC) Working Group on Myocardial and Pericardial Diseases.</span></span></span></span></span><br /> <span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529"><strong>Methods</strong>: <span style="background-color:white">We conducted a single-centre retrospective study during a 2-year time frame</span> to identify suspected cases of CA and determine the incidence of in-hospital screening criteria</span></span><span style="font-size:8.0pt"> </span><span style="background-color:white"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">. Demographic, clinical and echocardiography data was reviewed for all cases. Keeping with the aforementioned ESC consensus documents, patients were considered appropriate for screening if the left ventricular posterior wall thickness </span></span></span><span style="background-color:white"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">was ≥ 12mm and if one of the following was present: heart failure</span></span></span> <span style="background-color:white"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">≥65 years; aortic stenosis</span></span></span> <span style="background-color:white"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">≥65 years; hypotension or normotensive if previously hypertensive; sensory involvement or autonomic dysfunction; peripheral polyneuropathy; proteinuria; skin bruising; bilateral carpal tunnel syndrome; ruptured byceps tendon, subendocardial/transmural late gadolinium enhancement or increased extracellular volume; reduced longitudinal strain with apical sparing; decreased QRS voltage to mass ratio; pseudo Q waves on ECG; atrioventricular conduction disease or possible family history.</span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">Results</span></span></strong><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">: A total of 221 electronic medical charts were reviewed. Of these, 133 (60.2%) met the criteria for screening for CA and 68 (32.4%) had at least 2 criteria. 104 patients (49.5%) had heart failure </span></span><span style="background-color:white"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">≥6</span></span></span><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">5 years, 57 patients (27.1%) had proteinuria and 50 patients (23.8%) had aortic stenosis </span></span><span style="background-color:white"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">≥</span></span></span><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">65 years. Of this cohort, only 5 patients (2.8%) underwent screening for TTR CA with diphosphonate (HMDP) scintigraphy and free light chain screening and 2 met the criteria for CA (2 out of 5, 40%). These 5 patients fulfilled a total of 14 criteria. Of interest, global longitudinal strain < -15% was found in 20 patients (10%) and 9 of these (45%) had apical sparing pattern.</span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529"> </span></span></span></span></p> <p><br /> <span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529"><strong>Conclusions</strong>: </span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Interstate WGL Light",serif"><span style="color:#212529">There is a notably high proportion of patients that meet the screening criteria for cardiac amyloidosis in the real-world. However, appropriate work-up and screening is still lacking for most, suggesting a need for increased awareness amongst physicians.</span></span></span></span></p>
Slides
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