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Diagnosing ATTR-CM is usually a difficult and potentially dangerous process, but non-invasive novel modalities could significantly reduce the risk.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative disease characterized by deposits of amyloid fibrils. It tends to have high morbidity, poor treatment outcomes, and high treatment expenditure. Recent advances in therapeutic strategies for ATTR-CM have shown that treatment during the early stages of the disease is the most beneficial, and this has resulted in a shift in the screening, diagnostic algorithm, and risk classification of patients with ATTR-CM. This study, published in the Journal of Clinical Medicine, aims to explore the use of novel specific non-invasive imaging parameters and biomarkers of ATTR-CM, from screening to diagnosis, prognosis, risk stratification, and monitoring of therapy response.

Cardiac amyloidosis (CA) shows high clinical heterogeneity, which often results in delayed diagnoses. Active screening for CA using new biomarkers and imaging modalities can be a better strategy to aid in the early identification of ATTR-CM. Parameters related to ATTR-CM can be evaluated in many ways, the pros and cons of which include cardiac magnetic resonance for risk stratification and CA prognosis, conventional 2D echocardiography to detect increased LV wall thickness, and nuclear imaging techniques such as cardiac scintigraphy to aid in ATTR-CM diagnosis.

For now, invasive methods such as endomyocardial biopsy are the gold standard for ATTR-CM diagnosis, but this has some downsides such as failure to diagnose amyloid infiltration and potentially fatal complications, such as cardiac tamponade. The authors conclude that ATTR-CM is very challenging to diagnose for this reason, but non-invasive imaging modalities, such as those described above, when used in conjunction with each other, may enable superior quantification of disease activity and prognosis prediction. They note that longitudinal follow-up is required to understand the value of each of these modalities, as well as how they can work together to provide optimal results.

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Rimbas, R. C., Balinisteanu, A., Magda, S. L., Visoiu, S. I., Ciobanu, A. O., Beganu, E., . . . Vinereanu, D. (2022). New Advanced Imaging Parameters and Biomarkers-A Step Forward in the Diagnosis and Prognosis of TTR Cardiomyopathy. J Clin Med, 11(9). doi:10.3390/jcm11092360