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心脏淀粉样变性无创诊断策略的最新进展

Recent advances in the noninvasive strategies of cardiac amyloidosis.

作者信息

Zhao Lei, Fang Quan

机构信息

Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China.

出版信息

Heart Fail Rev. 2016 Nov;21(6):703-721. doi: 10.1007/s10741-016-9580-5.

Abstract

The heart, like any organ in the body, is susceptible to amyloid deposition. Although more than 30 types of protein can cause amyloidosis, only two types commonly deposit in the ventricular myocardium: amyloid light chain and amyloid transthyretin. Amyloid cardiomyopathy is usually a major determinant of patient outcomes, and the diagnosis of heart involvement can be often relatively under-diagnosed, owing to nonspecific presenting symptoms and signs at a subclinical stage. The diagnosis of cardiac amyloidosis is usually performed by endomyocardial biopsy; however, the invasive nature and related high-risk complications restrict its wide use in clinical settings. Recently, with the advent of innovative techniques used for evaluating cardiac amyloidosis, noninvasive methods become increasingly important, especially in earlier diagnosis, distinguishing typing, risk prediction and response to treatment. Here, we will review recent developments in the noninvasive methods used in the assessment of cardiac amyloidosis, focused on the laboratory biomarkers and imaging modalities.

摘要

心脏与身体的任何器官一样,易受淀粉样蛋白沉积的影响。尽管有30多种蛋白质可导致淀粉样变性,但通常只有两种类型会沉积在心室心肌中:淀粉样轻链和转甲状腺素蛋白淀粉样变。淀粉样心肌病通常是患者预后的主要决定因素,由于在亚临床阶段症状和体征不具特异性,心脏受累的诊断常常相对漏诊。心脏淀粉样变性的诊断通常通过心内膜心肌活检进行;然而,其侵入性本质和相关的高风险并发症限制了它在临床环境中的广泛应用。近年来,随着用于评估心脏淀粉样变性的创新技术的出现,非侵入性方法变得越来越重要,尤其是在早期诊断、区分类型、风险预测和治疗反应方面。在此,我们将回顾用于评估心脏淀粉样变性的非侵入性方法的最新进展,重点关注实验室生物标志物和成像方式。

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