Cardiac Amyloidosis: A Contemporary Review of Medical and Surgical Therapy
Drew Brownell1, Aiswarya J Pillai1, Nandini Nair1
1Division of Cardiology, Department of Medicine, Texas Tech Health Science Center, Lubbock, TX 79430, USA.
Insights
Cardiac amyloidosis, a serious condition from protein buildup, is increasingly manageable with new medical and surgical treatments. Advances in AI and genetic engineering promise even better outcomes for patients with this infiltrative cardiomyopathy.
Area of Science:
- Cardiology
- Internal Medicine
- Genetics
Background:
- Amyloidosis involves misfolded protein deposition, often affecting multiple organs.
- Cardiac amyloidosis is a significant cause of mortality due to infiltrative/restrictive cardiomyopathy.
- Key types include transthyretin amyloidosis (ATTR) and light chain amyloidosis (AL).
Purpose of the Study:
- To review current medical and surgical therapies for cardiac amyloidosis.
- To highlight advancements in managing transthyretin and light chain amyloidosis.
- To discuss the role of emerging technologies in future treatment strategies.
Main Methods:
- Review of contemporary medical and surgical treatment options.
- Analysis of current understanding of cardiac amyloidosis pathophysiology.
- Exploration of future research directions, including AI and genetic engineering.
Main Results:
- Significant progress has been made in medical therapies for common cardiac amyloidosis types.
- Surgical interventions like mechanical support and transplantation are viable options for select patients.
- Emerging technologies show potential for improved diagnosis and treatment outcomes.
Conclusions:
- Cardiac amyloidosis requires comprehensive management strategies.
- Both medical and surgical approaches are crucial for patient care.
- Future innovations in AI and genetic engineering are expected to revolutionize cardiac amyloidosis treatment.
Abstract:
Amyloidosis is a systemic disease initiated by deposition of misfolded proteins in the extracellular space, due to which multiple organs may be affected concomitantly. Cardiac amyloidosis, however, remains a major cause of morbidity and mortality in this population due to infiltrative /restrictive cardiomyopathy. This review attempts to focus on contemporary medical and surgical therapies for the different types of cardiac amyloidosis. Amyloidosis affecting the heart are predominantly of the transthyretin type (acquired in the older or genetic in the younger patients), and the monoclonal immunoglobulin light chain (AL) type which is solely acquired. A rare form of secondary amyloidosis AA type can also affect the heart due to excessive production and accumulation of the acute-phase protein called Serum Amyloid A" (SAA) in the setting of chronic inflammation, cancers or autoinflammatory disease. More commonly AA amyloidosis is seen in the liver and kidney. Other rare types are Apo A1 and Isolated Atrial Amyloidosis (AANF). Medical therapies have made important strides in the clinical management of the two common types of cardiac amyloidosis. Surgical therapies such as mechanical circulatory support and cardiac transplantation should be considered in appropriate patients. Future research using AI driven algorithms for early diagnosis and treatment as well as development of newer genetic engineering technologies will drive improvements in diagnosis, treatment and patient outcomes.
