Current and Evolving Multimodality Cardiac Imaging in Managing Transthyretin Amyloid Cardiomyopathy - JIMG February 2024-Article: Current and Evolving Multimodality Cardiac Imaging in Managing Transthyretin Amyloid Cardiomyopathy

Article: Current and Evolving Multimodality Cardiac Imaging in Managing Transthyretin Amyloid Cardiomyopathy

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A state-of-the-art review discusses the role of multiple imaging techniques in the diagnosis and management of amyloid transthyretin cardiomyopathy (ATTR-CM), a heart disease caused by protein misfolding. Echocardiography, scintigraphy, and cardiac magnetic resonance (CMR) are important in accurately diagnosing ATTR-CM and providing valuable information on disease progression, prognosis, and treatment response. Echocardiography allows assessment of cardiac function and structure, while scintigraphy visualizes amyloid deposits in the heart. CMR provides a comprehensive evaluation of the heart and can determine tissue characteristics through techniques like late gadolinium enhancement (LGE) and mapping. These imaging modalities have shown predictive value for prognosis and treatment monitoring, with parameters like global longitudinal strain, LGE, and extracellular volume associated with adverse outcomes. The review also highlights the potential use of artificial intelligence (AI) in cardiac imaging for improved diagnostic accuracy and efficiency. AI has shown promise in automating echocardiogram interpretation and identifying patients at risk for wild-type ATTR-CM. However, limitations such as data standardization and interpretability need to be addressed for effective implementation of AI. Overall, multimodality imaging and AI-based analysis have the potential to enhance clinical decision-making and patient management in ATTR-CM. Ongoing research in novel imaging markers and AI advancements will further refine diagnostics, treatment response monitoring, and prognosis prediction in ATTR-CM.

Keywords

amyloid transthyretin cardiomyopathy

ATTR-CM

protein misfolding

echocardiography

scintigraphy

cardiac magnetic resonance

CMR

late gadolinium enhancement

LGE

artificial intelligence