1
|
Alqarni A, Aljizeeri A, Bakhsh AM, El-Zeftawy HAM, Farghaly HR, Alqadhi MAM, Algarni M, Asiri ZM, Osman A, Haddadin H, Alayary I, Al-Mallah MH. Best Practices in Nuclear Imaging for the Diagnosis of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in KSA: The Eagle Eyes of Local Experts. Diagnostics (Basel) 2024; 14:212. [PMID: 38248088 PMCID: PMC10814030 DOI: 10.3390/diagnostics14020212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a complex and serious form of heart failure caused by the accumulation of transthyretin amyloid protein in the heart muscle. Variable symptoms of ATTR-CM can lead to a delayed diagnosis. Recognizing the diagnostic indicators is crucial to promptly detect this condition. A targeted literature review was conducted to examine the latest international consensus recommendations on a comprehensive diagnosis of ATTR-CM. Additionally, a panel consisting of nuclear medicine expert consultants (n = 10) and nuclear imaging technicians (n = 2) convened virtually from the Kingdom of Saudi Arabia (KSA) to formulate best practices for ATTR-CM diagnosis. The panel reached a consensus on a standard diagnostic pathway for ATTR-CM, which commences by evaluating the presence of clinical red flags and initiating a cardiac workup to assess the patient's echocardiogram. Cardiac magnetic resonance imaging may be needed, in uncertain cases. When there is a high suspicion of ATTR-CM, patients undergo nuclear scintigraphy and hematologic tests to rule out primary or light-chain amyloidosis. The expert panel emphasized that implementing best practices will support healthcare professionals in KSA to improve their ability to detect and diagnose ATTR-CM more accurately and promptly. Diagnosing ATTR-CM accurately and early can reduce morbidity and mortality rates through appropriate treatment.
Collapse
Affiliation(s)
- Abdullah Alqarni
- Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia; (A.A.); (H.R.F.)
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of the National Guard Health Affairs, Riyadh 14626, Saudi Arabia;
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh 21423, Saudi Arabia
| | | | | | - Hussein R. Farghaly
- Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia; (A.A.); (H.R.F.)
| | | | - Mushref Algarni
- King Fahad Military Medical Complex, Dhahran 34313, Saudi Arabia;
| | | | - Ahmed Osman
- Pfizer Inc., Riyadh 13244, Saudi Arabia; (A.O.)
| | - Haya Haddadin
- Pfizer Gulf FZ LLC, Dubai 29553, United Arab Emirates;
| | | | - Mouaz H. Al-Mallah
- Houston Methodist, Weill Cornell Medical College, Houston, TX 77030, USA
| |
Collapse
|
2
|
Bampatsias D, Theodorakakou F, Briasoulis A, Georgiopoulos G, Dimoula A, Papantoniou V, Papantoniou I, Skiadaresi C, Valsamaki P, Repasos E, Petropoulos I, Delialis D, Papathoma A, Koutsis G, Tselegkidi ME, Stamatelopoulos K, Kastritis E. Transthyretin Amyloidosis Cardiomyopathy in Greece: Clinical Insights from the National Referral Center. Hellenic J Cardiol 2023:S1109-9666(23)00190-2. [PMID: 37805173 DOI: 10.1016/j.hjc.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Clinical characteristics and outcomes of patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM) vary by region, necessitating the acquisition of country-specific evidence for proper management. METHODS This is an observational study including sequential patients presenting in the Amyloidosis Reference Center of Greece, from 01/2014 to 12/2022. ATTR-CM was diagnosed by positive scintigraphy and exclusion of light-chain amyloidosis or positive biopsy typing. Genetic testing was performed in all cases. RESULTS One-hundred and nine ATTR-CM patients were included (median age, 81 years) of which 15 carried TTR mutations (27% Val30Met). Most patients (82%) presented with heart failure and 59% with atrial fibrillation, while 10% had aortic stenosis. Importantly, 78 (71.6%) had clinically significant extracardiac manifestations (45% musculoskeletal disorder, 40% peripheral neuropathy and 33% gastrointestinal symptoms). Sixty-five (60%) received disease-specific treatment with tafamidis. Estimated median survival was 48 months; advanced NYHA class, National Amyloidosis Center stage, eGFR<45 ml/kg/1.73m2, NT-pro-BNP>5000 pg/mL were associated with worse survival, while tafamidis treatment was associated with improved survival in patients with IVS≥ 12 mm. DISCUSSION These are the first data describing the characteristics, management, and outcomes of patients with ATTR-CM in Greece, which could influence local guidelines. SHORT TITLE Transthyretin cardiomyopathy in Greece.
Collapse
Affiliation(s)
- Dimitrios Bampatsias
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Foteini Theodorakakou
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Alexandros Briasoulis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Georgios Georgiopoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Anna Dimoula
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - Chaido Skiadaresi
- Nuclear Medicine Department, Alexandra General Hospital, Athens, Greece
| | - Pipitsa Valsamaki
- Nuclear Medicine Department, Alexandra General Hospital, Athens, Greece; Nuclear Medicine Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelos Repasos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Ioannis Petropoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Dimitrios Delialis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Georgios Koutsis
- Neurogenetics Unit, 1st Department of Neurology, Eginitio University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Eirini Tselegkidi
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Kimon Stamatelopoulos
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Efstathios Kastritis
- Amyloidosis Center, Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| |
Collapse
|