THE PRESENCE OF RED-FLAG SYMPTOMS MAY

help identify patients
with ATTR‑CM

ALREADY IN YOUR PRACTICE

In 13% to 19% of people aged 60 and older with HFpEF, ATTR-CM was an underlying cause.1-4

However, diagnosis is typically delayed by an average of ~6 years,* in part because the symptoms of ATTR-CM are associated with a variety of cardiovascular conditions such as hypertrophic cardiomyopathy or generic, undifferentiated HFpEF. The disease often presents with complex manifestations.2,5-7

*In a targeted literature review, mean time to diagnosis ranged from 1.3 to 7.2 years.5

red-flag symptoms of attr-CM3,6-12

The following signs and symptoms should prompt additional assessments:

  • Elevated NT-proBNP
  • Unexplained left ventricular wall thickening in the absence of hypertension
  • Conduction system disease/atrial fibrillation
  • Hypertension that resolves over time
  • Diastolic dysfunction
  • Aortic stenosis
  • HFpEF in combination with other noncardiac red-flag symptoms
  • Suboptimal response to common cardiovascular medications, including heart failure treatments (eg, beta blockers)
  • History of musculoskeletal symptoms (eg, carpal tunnel syndrome, lumbar spinal stenosis, or biceps tendon rupture)
  • Past orthopedic surgery
  • Past or current neurologic symptoms, including sensory-motor neuropathy and autonomic neuropathy
  • Family history of hATTR amyloidosis symptoms or diagnosis

Not a comprehensive list of all the symptoms associated with ATTR amyloidosis.

Each patient may not experience all of these symptoms or may not experience them at the same time.

NEXT Diagnose ATTR-CM

ATTR=transthyretin-mediated amyloidosis; ATTR‑CM=cardiomyopathy of transthyretin-mediated amyloidosis; hATTR=hereditary transthyretin-mediated amyloidosis; HFpEF=heart failure with preserved ejection fraction; NT-proBNP=N-terminal prohormone of brain type natriuretic peptide.

References:

  1. Lo Presti S, Horvath SA, Mihos CG, Rajadhyaksha C, McCloskey V, Santana O. Transthyretin cardiac amyloidosis as diagnosed by 99mTc-PYP scanning in patients with acute heart failure and preserved ejection fraction. Crit Pathw Cardiol. 2019;18(4):195‑199. doi:10.1097/hpc.0000000000000183
  2. Nativi-Nicolau JN, Karam C, Khella S, Maurer MS. Screening for ATTR amyloidosis in the clinic: overlapping disorders, misdiagnosis, and multiorgan awareness. Heart Fail Rev. 2021;27(3):785‑793. doi:10.1007/s10741‑021‑10080‑2
  3. González-López E, Gallego-Delgado M, Guzzo-Merello G, et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J. 2015;36(38):2585‑2594. doi:10.1093/eurheartj/ehv338
  4. Garcia-Pavia P, et al. Prevalence of transthyretin cardiac amyloidosis in patients with heart failure with preserved ejection fraction: the PRACTICA study. Rev Esp Cardiol. 2024. https://doi.org/10.1016/j.rec.2024.07.005
  5. Rozenbaum MH, Large S, Bhambri R, et al. Impact of delayed diagnosis and misdiagnosis for patients with transthyretin amyloid cardiomyopathy (ATTR-CM): a targeted literature review. Cardiol Ther. 2021;10(1):141‑159. doi:10.1007/s40119‑021‑00219‑5
  6. Maurer MS, Bokhari S, Damy T, et al. Expert consensus recommendations for the suspicion and diagnosis of transthyretin cardiac amyloidosis. Circ Heart Fail. 2019;12(9). doi:10.1161/circheartfailure.119.006075
  7. Kittleson MM, Ruberg FL, Ambardekar AV, et al. 2023 ACC Expert Consensus decision pathway on comprehensive multidisciplinary care for the patient with cardiac amyloidosis. J Am Coll Cardiol. 2023;81(11):1076‑1126. doi:10.1016/j.jacc.2022.11.022
  8. Kittleson MM, Maurer MS, Ambardekar AV, et al. Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American Heart Association. Circulation. 2020;142(1). doi:10.1161/cir.0000000000000792
  9. Maloberti A, Ciampi C, Politi F, Fabbri S, Musca F, Giannattasio C. Cardiac amyloidosis red flags: What all the cardiologist have to know. Int J Cardiol Cardiovasc Risk Prev. 2024;21:200271. doi:10.1016/j.ijcrp.2024.200271
  10. Dharmarajan K, Maurer MS. Transthyretin cardiac amyloidoses in older North Americans. J Am Geriatr Soc. 2012;60(4):765‑774. doi:10.1111/j.1532‑5415.2011.03868.x
  11. Castaño A, Narotsky DL, Hamid N, et al. Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Heart J. 2017;38(38):2879-2887. doi:10.1093/eurheartj/ehx350
  12. Witteles RM, Bokhari S, Damy T, et al. Screening for transthyretin amyloid cardiomyopathy in everyday practice. JACC Heart Fail. 2019;7(8):709‑716. doi:10.1016/j.jchf.2019.04.010