Thread by @EiranGorodeski

2023 update in the diagnosis & management of cardiac amyloidosis. Welcome our friend and colleague Dr. Justin Grodin @JLGrodin @UTSWNews to #HeartFailure Grand Rounds @HarringtonHVI @UHhospitals twitter.com/i/web/status/1…

Amyloidosis is a protein misfolding disorder. Dr. Grodin @JLGrodin #HeartFailure Grand Rounds @UHhospitals

Myocardium histology and pathology. Thick rubbery myocardium. @JLGrodin

Natural history of cardiac amyloidosis, but by the time most of us will meet them they have advanced symptomatic disease. @JLGrodin

There are many types of cardiac amyloid disease... but 95% of the time the patients we see will have AL or ATTR. @JLGrodin

AL amyloidosis. >3000 new cases/year in the US. AL is more aggressive than ATTR, and early diagnosis is important. @JLGrodin

Origin of the word transthyretin? "TRANSport THYroxine and RETINol" @JLGrodin #HeartFailure Grand Rounds @UHhospitals @HarringtonHVI

Approximately 1.5M African Americans carry the V122I gene. Very long latency phase, goals of research is to identify disease early. @JLGrodin

ATTRwt = "Senile Systemic Amyloidosis." Appears to be a disease of aging with >50% of individuals in their 90s having evidence of deposition. @JLGrodin

Biventricular thickening is *NOT* LVH, this is thickening from amyloid protein. @JLGrodin

Important pearl in cardiac amyloidosis: atria are universally involved and atrial function is poor. CHADS-VASC score doesn't apply, stroke risk is high, must consider anticoagulation. @JLGrodin

LVEF is misleading, a poor marker of cardiac function. @JLGrodin

Fascinating atypical presentation of cardiac amyloidosis: obliteration of coronary arteries by amyloid protein. @JLGrodin

Cardiac amyloidosis: echocardiography, ECG, and cMRI are useful but not amyloid-type specific. @JLGrodin

Amyloid type-specific testing: FLC, tech PYP scanning, and tissue biopsy. @JLGrodin

How do we achieve a "non-biopsy" diagnosis of cardiac amyloidosis? use tech PYP scan in combination with serum free light chain blood work. @JLGrodin

An important contemporary diagnostic algorithm for evaluation of cardiac amyloidosis. @JLGrodin @maz_hanna

Future of cardiac amyloidosis diagnostics: #evuzamitide. Heart Failure Grand Rounds @HarringtonHVI @UHhospitals Dr. Justin Grodin @JLGrodin

TTR silencers: two approaches in treatment of transthyretin cardiac amyloidosis. @JLGrodin

Only FDA approved for hereditary TTR polyneuropathy. Cost is extreme... @JLGrodin

Future silencer? NTLA-2001, a CRISPR-based gene editing therapy. @JLGrodin

A different approach to therapy of cardiac amyloidosis: tetramer stabilizers. @JLGrodin