Eiran Gorodeski, MD, MPH Profile picture
May 17, 2023 22 tweets 14 min read Read on X
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… Image
Amyloidosis is a protein misfolding disorder. Dr. Grodin @JLGrodin #HeartFailure Grand Rounds @UHhospitals Image
Myocardium histology and pathology. Thick rubbery myocardium. @JLGrodin ImageImage
Natural history of cardiac amyloidosis, but by the time most of us will meet them they have advanced symptomatic disease. @JLGrodin Image
There are many types of cardiac amyloid disease... but 95% of the time the patients we see will have AL or ATTR. @JLGrodin Image
AL amyloidosis. >3000 new cases/year in the US. AL is more aggressive than ATTR, and early diagnosis is important. @JLGrodin Image
Origin of the word transthyretin? "TRANSport THYroxine and RETINol" @JLGrodin #HeartFailure Grand Rounds @UHhospitals @HarringtonHVI Image
Approximately 1.5M African Americans carry the V122I gene. Very long latency phase, goals of research is to identify disease early. @JLGrodin ImageImage
ATTRwt = "Senile Systemic Amyloidosis." Appears to be a disease of aging with >50% of individuals in their 90s having evidence of deposition. @JLGrodin Image
Biventricular thickening is *NOT* LVH, this is thickening from amyloid protein. @JLGrodin Image
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 Image
LVEF is misleading, a poor marker of cardiac function. @JLGrodin Image
Fascinating atypical presentation of cardiac amyloidosis: obliteration of coronary arteries by amyloid protein. @JLGrodin Image
Cardiac amyloidosis: echocardiography, ECG, and cMRI are useful but not amyloid-type specific. @JLGrodin Image
Amyloid type-specific testing: FLC, tech PYP scanning, and tissue biopsy. @JLGrodin Image
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 Image
An important contemporary diagnostic algorithm for evaluation of cardiac amyloidosis. @JLGrodin @maz_hanna ImageImage
Future of cardiac amyloidosis diagnostics: #evuzamitide. Heart Failure Grand Rounds @HarringtonHVI @UHhospitals Dr. Justin Grodin @JLGrodin Image
TTR silencers: two approaches in treatment of transthyretin cardiac amyloidosis. @JLGrodin ImageImage
Only FDA approved for hereditary TTR polyneuropathy. Cost is extreme... @JLGrodin Image
Future silencer? NTLA-2001, a CRISPR-based gene editing therapy. @JLGrodin Image
A different approach to therapy of cardiac amyloidosis: tetramer stabilizers. @JLGrodin Image

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More from @EiranGorodeski

Oct 26, 2022
The 'right' way to do a RHC. @RyanTedfordMD Self-described "hemodynamic nerd." Welcome to @UHhospitals!! #HeartFailureGRs @UHhospitals @CWRUSOM Image
The birth of modern-day hemodynamics. @RyanTedfordMD Image
"What the heck do we do with this patient?" Both PH and heart failure? @RyanTedfordMD Image
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