Amyloid cardiomyopathy

Cardiac amyloidosis is a heterogeneous group of diseases characterized by extracellular deposition of amyloid fibrils in many different organs finally resulting in organ failure. Cardiac involvement is common for immunoglobulin light chain amyloidosis (AL) or transthyretin amyloidosis (ATTR); the latter is caused by a transthyretin gene variant or wild-type protein. Precise diagnostic assessment including laboratory tests, electrocardiography, echocardiography, cardiac magnetic resonance imaging, biopsy, and/or bone scintigraphy is mandatory for definition of the amyloid type and finally for treatment initiation. Treatment of cardiac amyloidosis includes symptomatic therapy of heart failure as well as the underlying disease. Causative treatment of AL amyloidosis is according to regimens used for multiple myeloma. For many years, orthotopic liver transplantation was the only treatment available for hereditary ATTR amyloidosis, but important advances have been made after approval of a novel class of medication, namely, RNA silencers. However, currently no treatment is available to remove amyloid deposited in the tissue. Thus, early diagnosis is still critical to afford the best efficacy of available therapies.