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Troponins in cardiac amyloidosis: multipurpose markers

Nature Reviews Cardiology volume 11, page 179 (2014)Cite this article

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We read the Review by Giannitsis and Katus (Giannitsis, E. & Katus, H. Cardiac troponin level elevations not related to acute coronary syndromes. Nat. Rev. Cardiol. 10, 623–634 [2013])1 with great interest. We believe that a few points need to be discussed in greater detail. We were surprised to note the absence of any mention of amyloidosis among the chronic conditions not related to acute coronary syndrome (ACS) that can be associated with substantial elevation in cardiac troponin (cTn) levels.

Light chain amyloidosis is a plasma cell dyscrasia characterized by extracellular deposition of toxic β-fibrillar immunoglobulin light chain in several organs, including the heart.2 Cardiac biomarkers, including cTn, have been studied extensively in light chain amyloidosis, because cardiac involvement is the most-important determinant of clinical outcome.3 Persistently elevated cTn levels are frequently found in patients with amyloidosis, and are an indication of cardiac amyloid infiltration.2 In our experience, cTnI levels >0.09 μg/l at presentation were recorded in 34% of 64 patients with light chain amyloidosis, and in 58% of 38 patients with transthyretin-related cardiac amyloidosis (F. Perfetto, unpublished work). Notably, patients with amyloidosis often present with misleading symptoms and signs, such as chest pain or a psuedoinfarction pattern (QS waves in consecutive leads) on the electrocardiogram, which can suggest a diagnosis of ischaemic heart disease, as well as regional radionuclide uptake defects on myocardial perfusion scintigraphy, owing to severe, localized amyloid infiltration. Patients with cardiac amyloidosis, therefore, often undergo unnecessary coronary angiography, which usually shows normal epicardial arteries.3,4,5 Interestingly, serial cTn assays in patients with amyloidosis do not show a crescendo–decrescendo pattern of elevation.6 This feature distinguishes amyloidosis from other causes of cTn elevation.

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References

  1. Giannitsis, E. & Katus, H. Cardiac troponin level elevations not related to acute coronary syndromes. Nat. Rev. Cardiol. 10, 623–634 (2013).

    Article  CAS  Google Scholar 

  2. Perfetto, F. et al. Cardiac amyloidosis: the heart of the matter. Intern. Emerg. Med. 8, 191–203 (2013).

    Article  Google Scholar 

  3. Palladini, G. et al. The combination of high-sensitivity cardiac troponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis. Blood 116, 3426–3430 (2010).

    Article  CAS  Google Scholar 

  4. Mueller, P. S., Edwards, W. D. & Gertz, M. A. Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis. Am. J. Med. 109, 181–188 (2000).

    Article  CAS  Google Scholar 

  5. Miani, D., Rocco, M., Alberti, E., Spedicato, L. & Fioretti, P. M. Amyloidosis of epicardial and intramural coronary arteries as an unusual cause of myocardial infarction and refractory angina pectoris. Ital. Heart J. 3, 479–482 (2002).

    PubMed  Google Scholar 

  6. Zabernigg, A., Schranzhofer, R., Kreczy, A. & Gattringer, K. Continuously elevated cardiac troponin I in two patients with multiple myeloma and fatal cardiac amyloidosis. Ann. Oncol. 14, 1791 (2003).

    Article  CAS  Google Scholar 

  7. Dispenzieri, A. et al. Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood 104, 1881–1887 (2004).

    Article  CAS  Google Scholar 

  8. Gertz, M. et al. Troponin T level as an exclusion criterion for stem cell transplantation in light-chain amyloidosis. Leuk. Lymphoma 49, 36–41 (2008).

    Article  CAS  Google Scholar 

  9. Cappelli, F. et al. Biohumoral markers as predictor of right ventricular dysfunction in AL amyloidosis. Amyloid (in press).

  10. Capone, R., Amsterdam, E. A., Mason, D. T. & Zelis, R. Systemic amyloidosis, functional coronary insufficiency, and autonomic impairment. Ann. Intern. Med. 76, 599–603 (1972).

    Article  CAS  Google Scholar 

  11. Syed, I. S. et al. Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. JACC Cardiovasc. Imaging 3, 155–164 (2010).

    Article  Google Scholar 

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Authors and Affiliations

  1. Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Largo Giovanni Alessandro Brambilla 3, Florence, 50134, Italy

    Federico Perfetto, Franco Bergesio & Francesco Cappelli

  2. Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi 1, Pisa, 56124, Italy

    Michele Emdin

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  1. Federico Perfetto
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  2. Franco Bergesio
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  4. Francesco Cappelli
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Correspondence to Federico Perfetto.

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Perfetto, F., Bergesio, F., Emdin, M. et al. Troponins in cardiac amyloidosis: multipurpose markers. Nat Rev Cardiol 11, 179 (2014). https://doi.org/10.1038/nrcardio.2013.129-c1

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