Giovannetti Alessandro, Accietto Antonella, Massa Paolo, Leone Ornella, Guaraldi Pietro, Saturi Giulia, Caponetti Angelo Giuseppe, Sguazzotti Maurizio, Ponziani Alberto, Gagliardi Christian, Galiè Nazzareno, Cortelli Pietro, Longhi Simone, Biagini Elena
U.O. Cardiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna - Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum Università di Bologna - Network europeo per la gestione delle malattie miocardiche rare e/o complesse (ERN GUARD-Heart).
Network europeo per la gestione delle malattie miocardiche rare e/o complesse (ERN GUARD-Heart) - Unità Patologia Cardiovascolare e Trapianti Cardiaci, Divisione di Patologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna.
G Ital Cardiol (Rome). 2022 Sep;23(9):676-685. doi: 10.1714/3860.38451.
Systemic amyloidosis is a hereditary or acquired disease characterized by deposition of amyloid insoluble fibrils into body organs and tissues, causing structural abnormalities and organ dysfunction, i.e. heart failure. This disease is classified according to the precursor protein involved; immunoglobulin light chains, transthyretin and apolipoprotein A1 underlie the cardiac involvement. Amyloid cardiomyopathy is characterized by symmetric biventricular hypertrophy, preserved systolic function, and pronounced diastolic dysfunction. Although transthyretin-related cardiac amyloidosis has always been considered a rare disease, in the last few years it has been found to be one of the most common causes of hypertrophic cardiomyopathy, thanks to better diagnostic algorithms and considerable improvements in cardiac imaging. Achieving an early diagnosis is a challenge for the modern cardiologist since new disease-modifying therapies have been developed in recent years. This article aims to answer to the main questions about transthyretin-related cardiac amyloidosis: when to suspect it, how to diagnose it and how to treat it.
系统性淀粉样变性是一种遗传性或获得性疾病,其特征是淀粉样不溶性纤维沉积于身体器官和组织,导致结构异常和器官功能障碍,即心力衰竭。该疾病根据所涉及的前体蛋白进行分类;免疫球蛋白轻链、转甲状腺素蛋白和载脂蛋白A1是心脏受累的基础。淀粉样心肌病的特征是双心室对称性肥厚、收缩功能保留以及明显的舒张功能障碍。尽管转甲状腺素蛋白相关的心脏淀粉样变性一直被认为是一种罕见疾病,但在过去几年中,由于更好的诊断算法和心脏成像技术的显著进步,它已被发现是肥厚型心肌病最常见的病因之一。由于近年来已开发出新的疾病改善疗法,实现早期诊断对现代心脏病专家来说是一项挑战。本文旨在回答有关转甲状腺素蛋白相关心脏淀粉样变性的主要问题:何时怀疑该病、如何诊断以及如何治疗。