What Cardiologists Should Know About Amyloidosis.

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Amyloidosis Research

Background:

• Cardiac amyloidosis (CA) is an underdiagnosed cause of heart failure with preserved ejection fraction (HFpEF).
• Caused by extracellular deposition of misfolded proteins (ATTR or AL), leading to myocardial dysfunction.
• Often presents as restrictive cardiomyopathy with potential multi-organ involvement.

Purpose of the Study:

• Provide a cardiology-focused review of cardiac amyloidosis.
• Emphasize early recognition, diagnostic strategies, and subtype differentiation.
• Discuss evolving and emerging therapies for ATTR and AL amyloidosis.

Main Methods:

• Review of epidemiology, pathophysiology, and clinical manifestations of ATTR and AL CA.
• Evaluation of key diagnostic tools: echocardiography, cardiac MRI, bone scintigraphy, protein screening, biopsy.
• Analysis of clinical presentation, ECG/imaging "red flags," and differentiation from mimics like HCM.

Main Results:

• Detailed review of diagnostic tools and a stepwise approach.
• Highlighting prognostic significance of staging systems and cardiac biomarkers.
• Exploration of subtype-specific therapies (daratumumab, tafamidis, gene silencers) and novel treatments (CRISPR).

Conclusions:

• Timely recognition and accurate diagnosis of CA are critical for improved outcomes.
• Cardiologists must lead multidisciplinary care amidst rapidly evolving diagnostics and therapeutics.
• A structured, biomarker- and imaging-guided approach enhances diagnosis, prognosis, and patient management.