ACTFAST

Because ATTR-CM may be the underlying cause

If your patient is experiencing HFpEF or other heart disease symptoms, ATTR-CM could be an underlying cause.^1,2

EXPLORE SIGNS OF ATTR

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ATTR=transthyretin-mediated amyloidosis; ATTR-CM=cardiomyopathy of transthyretin-mediated amyloidosis; HCP=healthcare professional; HFpEF=heart failure with preserved ejection fraction.

References:

Maurer MS et al. J Am Coll Cardiol. 2016;68(2):161-172.
Kittleson MM et al. J Am Coll Cardiol. 2023;81(11):1076-1126.

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AL amyloidosis screening¹¹

The diagnostic algorithm should always begin with a monoclonal protein screen to assess for AL amyloidosis. If AL amyloidosis is suspected, initiate laboratory testing to assess for monoclonal protein production and evidence of vital organ involvement or dysfunction. In AL amyloidosis, free lambda or free kappa levels are elevated.

A chart showing a diagnostic algorithm for ATTR-CM amyloidosis

ASNC Guidance for ^99mTc-PYP Grading¹⁴

Two approaches for quantifying cardiac uptake of ^99mTc-PYP using planar & SPECT imaging:

Quantitative heart to contralateral lung (H/CL) ratio of uptake at one hour: ATTR-positive if ≥1.5 in the presence of myocardial PYP uptake confirmed on SPECT
Semi-quantitative, visual scoring method to compare myocardial uptake to bone uptake at three hours: ATTR‑positive if ≥Grade 2

Guidance recommends using SPECT or SPECT/CT in addition to planar imaging to confirm diagnosis and avoid false positives.

Review ASNC Guidance

Biopsy of affected tissues can detect TTR amyloid deposition^2,5,10-12

Tissue biopsy can help confirm a diagnosis of ATTR when noninvasive screenings are unavailable or inconclusive.

Standard technique

Biopsy of affected tissue with Congo red staining can detect TTR amyloid deposition.

Use in cardiology

Cardiac tissue biopsy is used when nuclear scintigraphy is negative/equivocal despite a high clinical suspicion of ATTR-CM, or if scintigraphy is unavailable.

Use in neurology

Tissue biopsy is used in the absence of a family history of ATTR, or when genetic testing is inconclusive despite family history, and a high clinical suspicion of hATTR-PN remains.