A substantial increase in the interest in
transthyretin cardiac
amyloidosis (ATTR-CA) is a result of the constantly growing number of patients, the use of clear diagnostic protocols and the availability of the first selective
drug for these patients. This has also raised the awareness of the disease among physicians of all specialties. The topic is particularly relevant to cardiologists, who use non-invasive multimodal imaging in their daily practice. The differential diagnosis of the causes of myocardial
hypertrophy includes arterial
hypertension,
hypertrophic cardiomyopathy,
aortic stenosis (AS), athletic heart syndrome,
Fabry disease, and cardiac
amyloidosis (CA). It turns out that in patients with myocardial
hypertrophy >15 mm,
amyloidosis is the most common cause of left ventricular (LV)
hypertrophy. In parallel, CA is one of the most common infiltrative diseases leading to a clinical picture that may mimic
heart failure with preserved ejection fraction (HFpEF). The accumulation of
amyloid in the extracellular space impairs the diastolic function of the myocardium, which is observed as the
restrictive cardiomyopathy phenotype. In advanced cases, the LV systolic function is also impaired. Moreover,
protein deposits contribute to the disturbances of
calcium metabolism and cell metabolism as well as to
cardiotoxicity, leading to
edema and damage to cardiomyocytes.