Morgan ALR* and Azad N
Department of Medicine and Geriatrics, University of Ottawa, CanadaFulltext PDF
Heart Failure is a common condition in the aged population with a multitude of underlying causes. Cardiac Amyloidosis (CA) is now known to play a significant role in the development of heart failure in aged patients. However, CA remains underappreciated as a cause of heart failure and continues to go undiagnosed. The clinical manifestations of CA are non-specific cardiac findings (e.g. heart failure, dyspnea, atrial arrythmias) and potential multi-system dysfunction (liver, kidney, and/or nervous system) making a high index of suspicion crucial to CA diagnosis. Some laboratory results and electrocardiographic findings can increase suspicion of CA in aged patients. However, none of those findings are diagnostic nor can their absence rule out the disease. Several echocardiographic findings should increase suspicion for CA, but of these, depressed global longitudinal strain with relative apical sparing is the most sensitive and specific to CA and warrants further investigation. Cardiac MRI can accurately identify all types of CA, even in early-stage disease. Diffuse late gadolinium enhancement as well as increased T1 native and extracellular volume on cardiac MRI are highly sensitive and specific markers but cannot yet definitively type the off ending amyloid protein. Nuclear bone scintigraphy can diagnose one type of CA, but all other suspected cases require endomyocardial biopsy for diagnosis. Recently, several promising disease-modifying therapies have emerged that can improve outcomes in CA patients. These treatments are most effective in earlystage disease, further emphasizing the need for more frequent early-diagnosis.
Morgan ALR, Azad N. Are we under Diagnosing Cardiac Amyloidosis in the Aged Population? Am J Gerentol Geriatr. 2018; 1(2): 1009.