Clinical experience of a systemic algorithm for diagnosis of cardiac amyloidosis

INTRODUCTION. Cardiac amyloidosis is an underdiagnosed disease, and its prevalence is probably higher than previously estimated. We aimed to investigate the effect of introducing a systemic diagnostic algorithm for cardiac amyloidosis in clinical practice. METHODS. A systematic diagnostic algorithm was developed and clinically applied in two hospitals in Eastern Denmark. Elderly patients (males > 60 years, females > 70 years) with left ventricular hypertrophy (≥ 12 mm) and diastolic dysfunction leading to a suspicion of cardiac amyloidosis were referred for standardised workup, including biochemistry and bone scintigraphy. RESULTS. A total of 224 patients (median age 76 years (70-83); 65% males) were included in the analysis. In total, 43 (19%) patients (84% males) were diagnosed with cardiac amyloidosis. Among the 43 diagnosed patients, 38 had transthyretin wild-type amyloidosis, one had the hereditary form and four had monoclonal-immunoglobulin-light-chain amyloidosis. Patients with cardiac amyloidosis were significantly older (81 versus 75 years old, p < 0.001) and more often male (84% versus 61%, p = 0.004) than the overall screened population. CONCLUSIONS. Systematic screening for cardiac amyloidosis in older patients with cardiac hypertrophy and echocardiographic signs of diastolic dysfunction is feasible and shows a diagnostic yield of 19% in the assessed population.