Клиническое наблюдение амилоидоза сердца: значение ультразвукового исследования сердца на пути к диагнозу
https://doi.org/10.24835/1607-0771-077
Abstract
В статье представлен клинический случай тяжелого амилоидоза сердца, подтвержденный прижизненным гистологическим исследованием и данными патологоанатомического вскрытия. Приведены данные клинического, инструментального и полного эхокардиографического обследования пациента. В обсуждении на примере данного клинического случая разобраны этапы алгоритма мультимодальной диагностики амилоидоза: определение критериев, позволяющих заподозрить амилоидоз сердца; подтверждение амилоидоза данными биопсии; определение типа амилоидоза как средства обоснования патогенетической терапии, различной для основных типов амилоидоза AL- и ATTR. Основное внимание уделено на несоответствие между собой ряда клинических проявлений заболевания и данных инструментальных исследований, вызывающих подозрение на амилоидоз сердца. Приведены критерии дифференциальной диагностики с гипертрофической кардиомиопатией и констриктивным перикардитом по данным эхокардиографии, позволяющие выделить амилоидоз среди других нозологических форм с сердечной недостаточностью. Эхокардиография играет решающую роль на первом этапе диагностического поиска и является основным ключом трудной диагностики амилоидоза.
About the Authors
L. O. Glazun
Postgraduate Institute for Public Health Workers
Russian Federation
Russian Federation
Lyudmila O. Glazun – Doct. of Sci. (Med.), Professor, Head of Division of Rаdiology and Functional Diagnostics, Postgraduate Institute for Public Health Workers, Khabarovsk
E. V. Polukhina
Postgraduate Institute for Public Health Workers
Russian Federation
Russian Federation
Elena V. Polukhina – Doct. of Sci. (Med.), Associate Professor, Professor of Division of Rаdiology and Functional Diagnostics, Postgraduate Institute for Public Health Workers, Khabarovsk
E. S. Kanin
Regional Clinical Hospital named after Professor S.I. Sergeev
Russian Federation
Russian Federation
Evgeniy S. Kanin – M.D., Head of the Pathology department, Regional Clinical Hospital named after Professor S.I. Sergeev, Khabarovsk
V. M. Loifman
Regional Clinical Hospital named after Professor S.I. Sergeev
Russian Federation
Russian Federation
Vitaly M. Loifman – M.D., Head of the Сardiology Department, Regional Clinical Hospital named after Professor S.I. Sergeev, Khabarovsk
T. V. Pashkovskaya
Regional Clinical Hospital named after Professor S.I. Sergeev
Russian Federation
Russian Federation
Tatyana V. Pashkovskaya – M.D., Сardiology Department, Regional Clinical Hospital named after Professor S.I. Sergeev, Khabarovsk
References
1. Buxbaum J.N., Dispenzieri A., Eisenberg D.S. et al. Amyloid nomenclature 2022: update, novel proteins, and recommendations by the International Society of Amyloidosis (ISA) Nomenclature Committee. Amyloid. 2022; 29 (4): 213–219. https://doi.org/10.1080/13506129.2022.2147636
2. Strelkova I. E. New era in the treatment of cardiac amyloidosis: review of the Congress of Cardiologists. Attending Doctor. 2021; 12 (24): 90–94. https://doi.org/10.51793/OS.2021.24.12.013 (In Russian)
3. Garcia-Pavia P., Dominguez F., Gonzalez-Lopez E. Transthyretin amyloid cardiomyopathy. Medical Clinic (Barc). 2021; 156 (3): 126–134. https://doi.org/10.1016/j.medcli.2020.06.064
4. Hertz M.A., Dispensieri A. Recognition, prognosis and therapy of systemic amyloidosis: a systematic review. JAMA. 2020; 324 (1): 79–89. https://doi.org/10.1001/jama.2020.5493
5. Tanskanen M., Peuralinna T., Polvikoski T. et al. Senile systemic amyloidosis affects 25% of the very aged and associates with genetic variation in alpha2-macroglobulin and tau: A population-based autopsy study. Ann. Med. 2008; 40 (3): 232–239. https://doi.org/10.1080/07853890701842988
6. Cornwell G.G. 3rd, Murdock V.L., Kyle R.A. et al. Frequency and distribution of senile cardiovascular amyloid: clinicopathological correlation. Am. J. Med. 1983; 75 (4): 618–623. https://doi.org/10.1016/0002-9343(83)90443-6
7. Wechalekar A.D., Fontana M., Quarta C.C., Liedtke M. AL Amyloidosis for Cardiologists: Awareness, Diagnosis, and Future Prospects: JACC: CardioOncology State-of-the-Art Review. JACC: CardioOncol. 2022; 4: 427–441. https://doi.org/10.1016/j.jaccao.2022.08.009
8. Manwani R., Cohen O., Sharpley F. et al. A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib. Blood. 2019; 134 (25): 2271–2280. https://doi.org/10.1182/blood.2019000834
9. Gudkova A.Ya., Lapekin S.V., Bezhanishvili T.G. et al. AL amyloidosis with predominant damage to the heart. Algorithm for non-invasive diagnosis of amyloid cardiomyopathy. Therapeutic Achive. 2021; 93 (4): 87–496. https://doi.org/10.26442/00403660.2021.04.200689 (In Russian)
10. Reznik E.V., Nguyen T.L., Stepanova E.A. et al. Cardiac amyloidosis: the view of a therapist and cardiologist. Archive of Internal Medicine. 2020; 10 (6): 430–457. https://doi.org/10.20514/2226-6704-2020-10-6-430-457 (In Russian)
11. Tereshchenko S.N., Zhirov I.V., Moiseeva O.M. et al. Practical guidelines for the diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM or transthyretin cardiac amyloidosis). Therapeutic Archive. 2022; 94 (4): 584–595. https://doi.org/10.26442/00403660.2022.04.201465 (In Russian)
12. Gudkova A.Ya., Polyakova A.A., Amelin A.V. et al. Val30Met-transthyretin amyloid cardiomyopathy. Literature review and clinical observation. Russian Journal of Cardiology. 2018, 2 (154): 121–128. http://dx.doi.org/10.15829/1560-4071-2018-2-121-128 (In Russian)
13. Cuddy Sarah A.M., Chetrit M., Jankowski M. et al. Practical Points for Echocardiography in Cardiac Amyloidosis. J. Am. Soc. Echocardiogr. 2022; 35 (9): 31А–40А. https://doi.org/10.1016/j.echo.2022.06.006
14. Madeira M., Teixeira R., Costa M. et al. Two-dimensional speckle-tracking cardiac mechanics and constrictive pericarditis: a systematic review. Echocardiography. 2016; 33(10): 1589–1599. https://doi.org/10.1111/echo.13293
15. Garcia-Pavia P., Rapezzi C., Adler Y. et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur. Heart J. 2021; 42 (16): 1554–1568. https://doi.org/10.1093/eurheartj/ehab072
16. Phelan D., Collier P., Thavendiranathan P. et al. Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis. Heart. 2012; 98 (19): 1442–1448. https://doi.org/10.1136/heartjnl-2012-302353
17. Starr N., Ioannou A., Martinez-Naharro A. Monitoring cardiac amyloidosis with multimodality imaging. Rev. Esp. Cardiol. 2024; 77 (1): 79–87. https://doi.org/10.1016/j.rec.2023.06.014
18. Falk R.H., Quarta C.C., Dorbala S. How to image cardiac amyloidosis. Circ. Cardiovasc. Imaging. 2014; 7 (3): 552–562. https://doi.org/10.1161/CIRCIMAGING.113.001396
19. Bokhari S., Shahzad R., Castaño A., Maurer M.S. Nuclear imaging modalities for cardiac amyloidosis. J. Nucl. Cardiol. 2014; 21 (1): 175–184. https://doi.org/10.1007/s12350-013-9803-2
20. Kieninger B., Eriksson M., Kandolf R. et al. Amyloid in endomyocardial biopsies. Virchows Archiv. 2010; 456 (5): 523–532. https://doi.org/10.1007/s00428-010-0909-5
21. Polyakova A.A., Semernin E.N., Sitnikova M.Yu. et al. Transthyretin amyloidosis in a cohort of elderly and long-livers patients with chronic heart failure. Cardiology. 2018; 58(S2): 12–18. https://doi.org/10.18087/cardio.2390 (In Russian)
22. Larsen B.T., Mereuta O.M., Dasari S. et al. Correlation of histomorphological pattern of cardiac amyloid deposition with amyloid type: a histological and proteomic analysis of 108 cases. Histopathology. 2016; 68 (5): 648–656. https://doi.org/10.1111/his. 12793
23. Lousada I., Comenzo R. L., Landau H. et al. Light Chain Amyloidosis: Patient Experience Survey from the Amyloidosis Research Consortium. Adv. Ther. 2015; 32 (10): 920–928. https://doi.org/10.1007/s12325-015-0250-0
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For citations:
Glazun L.O., Polukhina E.V., Kanin E.S., Loifman V.M., Pashkovskaya T.V. . Ultrasound & Functional Diagnostics. 2024;(1):22-34. (In Russ.) https://doi.org/10.24835/1607-0771-077
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