Abstract: 

Cardiac amyloidosis (CA) is an infiltrative disease caused by amyloid fibrils deposition in the myocardium; the two forms that most frequently involve the heart are light chain (AL) and transthyretin (ATTR) amyloidosis. Cardiac troponin (cTn) is the biomarker of choice for the detection of myocardial injury and is frequently found elevated in patients with CA, particularly with high-sensitivity assays (hs-cTn). Multiple mechanisms of myocardial injury in CA have been proposed, including cytotoxic effect of amyloid precursors, interstitial amyloid fibrils infiltration, coronary microvascular dysfunction and amyloid/non-amyloid related coronary artery disease, diastolic dysfunction and heart failure. Regardless of the mechanisms, cTn values have relevant prognostic (and potentially diagnostic) implications in both AL and ATTR amyloidosis. In this review, we will discuss the significant aspects of cTn biology and measurement methods, potential mechanisms of myocardial injury in CA and the clinical application of cTn in the management of both AL and ATTR amyloidosis.

JACC CardioOncology Editor-in-Chief and CME Editor
Bonnie Ky, MD, MSCE, FACC

Author
Maan Malahfji, MD

Important Dates

Date of Release: February 20, 2024
Term of Approval/Date of CME/MOC Expiration: February 19, 2025