[Hypertrophic cardiomyopathies and ATTR amyloidosis - a current review for clinical practice]

Carsten Tschöpe1,2,3, Ahmed Elsanhoury1, Sonja Diekmann2

  • 1Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany.

Insights

Hypertrophic cardiomyopathies (HCM) involve left ventricular wall thickening (≥15 mm). Distinguishing HCM from genetic sarcomeric diseases and cardiac amyloidoses is crucial for patient prognosis and effective treatment strategies.

Area of Science:

  • Cardiology
  • Genetics
  • Pathology

Background:

  • Cardiomyopathies encompass dilated, restrictive, and hypertrophic forms.
  • Hypertrophic cardiomyopathy (HCM) is defined by left ventricular wall thickness ≥15 mm.
  • HCM can be obscured by genetic sarcomeric diseases, storage diseases, or syndromes.

Purpose of the Study:

  • To highlight the diagnostic challenges in differentiating HCM subtypes.
  • To emphasize the clinical significance of distinguishing between sarcomere mutations and cardiac amyloidoses.
  • To underscore the importance of early diagnosis for improved patient prognosis.

Main Methods:

  • Review of clinical definitions and diagnostic criteria for cardiomyopathies.
  • Discussion of underlyingPathophysiological mechanisms including genetic and storage diseases.
  • Analysis of differential diagnostic approaches in clinical practice.

Main Results:

  • HCM diagnosis relies on specific left ventricular wall thickness measurements.
  • Genetic sarcomeric diseases and cardiac amyloidoses present overlapping features with HCM.
  • Accurate differentiation is often challenging due to shared clinical presentations.

Conclusions:

  • Distinguishing between genetic sarcomeric diseases and cardiac amyloidoses is critical for HCM management.
  • Early and accurate diagnosis significantly impacts patient prognosis.
  • Further research into specific biomarkers and diagnostic tools may improve differentiation.

Related Concept Videos

Cardiomyopathy III: Hypertrophic Cardiomyopathy01:29

Cardiomyopathy III: Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
38
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
29
Cardiomyopathy I: Introduction and Classification01:25

Cardiomyopathy I: Introduction and Classification

Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
42
Cardiomyopathy IV: Restrictive Cardiomyopathy01:29

Cardiomyopathy IV: Restrictive Cardiomyopathy

Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
22
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
19
Myocarditis II: Clinical Features and Diagnostic Tests01:27

Myocarditis II: Clinical Features and Diagnostic Tests

Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
19