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HIDDEN in plain sight

SUSPECT ATTR-CM

The diagnosis of ATTR-CM is often delayed or missed. Routine heart failure assessments such as echo and electrocardiogram (ECG), along with advanced imaging techniques, can help identify clues on the diagnostic pathway. By increasing your suspicion of ATTR-CM, you can identify patients who may require further testing to make a diagnosis.1-4

CONSIDER THE FOLLOWING CLINICAL CLUES, ESPECIALLY IN COMBINATION, TO RAISE SUSPICION FOR ATTR-CM AND THE NEED FOR FURTHER TESTING

The HIDDEN clinical clues of ATTR-CM

Discover how a cardiologist suspects ATTR-CM.  

In the first video, a colleague asked Dr. Detective for help with a tough case. Watch to see how looking for certain signs and symptoms can point to ATTR-CM.

 

ADDITIONAL KEY CONSIDERATIONS

There are several additional signs/symptoms that could be clues for cardiac amyloidosis and ATTR-CM, which include:

  • Strain imaging showing apical sparing or apical preservation21 (Click here to see an example)
    • Longitudinal strain seen on echocardiography is reduced in the basal and midwall area; however, the apical strain is spared or preserved21
  • A history of bicep tendon rupture22
  • A diagnosis of hypertrophic cardiomyopathy3
  • Arrhythmias such as atrial fibrillation (most common) and conduction abnormalities, which may require a pacemaker11,13,23
  • Aortic stenosis (AS) and ATTR-CM may occur in elderly patients, notably those with a low-flow, low-gradient AS pattern24
  • Hip and knee arthroplasty25

 

EXAMPLES OF STRAIN IMAGING SHOWING APICAL SPARING

Apical preservation of longitudinal strain (commonly referred to as apical sparing)1

ex-apical-sparing

Reprinted from Can J Cardiol, 32/9, Narotsky DL, Castaño A, Weinsaft JW, Bokhari S, Maurer MS, Wild-type transthyretin cardiac amyloidosis: novel insights from advanced imaging, 1166.e1-1166.e10, 2016, with permission from Elsevier.

Bull's-eye plot of longitudinal strain showing apical sparing. This is often referred to as a "cherry on top" pattern1

ex-cherry-on-top

Reprinted from Can J Cardiol, 32/9, Narotsky DL, Castaño A, Weinsaft JW, Bokhari S, Maurer MS, Wild-type transthyretin cardiac amyloidosis: novel insights from advanced imaging, 1166.e1-1166.e10, 2016, with permission from Elsevier.

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