Cardiac amyloidosis: heterogenous pathogenic backgrounds.
Cardiac amyloidosis is a fatal disorder which develops on the basis of the different pathologic conditions in systemic amyloidosis: the most common underlying disease is immunoglobulin light chain-derived primary amyloidosis and the next is transthyretin-related hereditary amyloidosis; the latter disorder, typically represented by familial amyloid polyneuropathy, was long regarded as an endemic disease. However, this disorder has now been shown to involve a highly variable clinical picture due to a large number of transthyretin gene mutations, and many patients with diverse ancestors suffer from severe cardiac amyloidosis. Additionally, senile systemic amyloidosis is now noted as a cause of cardiac dysfunction in elderly individuals. Echocardiogram and myocardial technetium-99m-pyrophosphate scintigraphy can provide characteristic findings. Immunohistochemistry on tissue amyloid, biochemical analysis of serum and urine proteins, and DNA sequencing are usually employed to determine the disease-related amyloid fibril protein. Although systemic amyloidosis has become treatable, the prognosis of each patient who received up-to-date and effective, but nevertheless stressful, therapy depends on the severity of cardiac involvement by amyloid deposition.
Ikeda
Shu-ichi
S
Third Department of Medicine, Shinshu University School of Medicine, Matsumoto.
D000686:Amyloidosis / Q000145:classification / Q000175:diagnosis / Q000628:therapy; D028226:Amyloidosis, Familial / Q000175:diagnosis / Q000628:therapy; D009202:Cardiomyopathies / Q000175:diagnosis / Q000628:therapy; D006801:Humans