Bart Nicole K, Bianchi Giada, Cuddy Sarah A M, Goyal Parag, Griffin Jan M, Hummel Scott L, Macdonald Peter, Maurer Mathew, Montgomery Elyn, Nanne Michael G, Orkaby Ariela R, Sanchorawala Vaishali, Damluji Abdulla A
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia; The Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; University of New South Wales Sydney, Sydney, NSW, Australia.
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, Massachusetts, USA; Division of Hematology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
JACC Adv. 2025 May 14;4(6 Pt 1):101784. doi: 10.1016/j.jacadv.2025.101784.
Amyloidosis, which is caused by misfolded proteins that form amyloid fibrils, is predominantly diagnosed in older adults. Although previously considered a rare disease, increased awareness and noninvasive diagnostic methods have resulted in a rise in diagnoses. As a multisystem disease that affects multiple organ systems (cardiac, gastrointestinal, renal, and neurological), there is significant overlap with both geriatric conditions and common conditions in heart failure. Frailty is recognized as a distinct biological syndrome of declines across multiple physiological systems, which prevents maintenance of homeostasis and limits the ability to respond to stressors. Frailty was initially characterized as physical frailty alone; however, it is increasingly recognized that it is multidimensional with components including nutrition, cognitive, psychological, and social. Frailty in cardiovascular disease has become an important risk factor, indicator for disease severity, and can help guide decisions around intervention. In certain patients, frailty may be reversible. Given the lack of consensus definitions, tools, and implementation of frailty in both clinical and research settings in the field of amyloidosis, we convened a group of experts from cardiology, geriatric cardiology, geriatrics, hematology, and allied health to form this state-of-the-art review. There are many points of intersectionality between amyloidosis, aging, and frailty which herald a need for multidisciplinary care. This review document aims to provide guidance in how to understand and address frailty in older patients with a specific focus on cardiac amyloidosis.
淀粉样变性是由错误折叠的蛋白质形成淀粉样原纤维所致，主要在老年人中被诊断出来。尽管以前被认为是一种罕见疾病，但随着认识的提高和非侵入性诊断方法的出现，诊断数量有所增加。作为一种影响多个器官系统（心脏、胃肠道、肾脏和神经系统）的多系统疾病，它与老年疾病和心力衰竭的常见疾病有很大重叠。衰弱被认为是一种独特的生物学综合征，涉及多个生理系统功能衰退，这会妨碍体内平衡的维持，并限制对压力源的反应能力。衰弱最初仅被描述为身体衰弱；然而，人们越来越认识到它是多维度的，包括营养、认知、心理和社会等方面。心血管疾病中的衰弱已成为一个重要的危险因素、疾病严重程度的指标，并有助于指导干预决策。在某些患者中，衰弱可能是可逆的。鉴于淀粉样变性领域在临床和研究环境中对衰弱缺乏共识定义、工具和应用，我们召集了一组来自心脏病学、老年心脏病学、老年医学、血液学和相关健康领域的专家，形成了这份最新综述。淀粉样变性、衰老和衰弱之间存在许多交叉点，这预示着需要多学科护理。本综述文件旨在为如何理解和解决老年患者的衰弱问题提供指导，特别关注心脏淀粉样变性。
