Atualizações sobre amiloidose cardíaca
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Publicado
May 14, 2025
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Resumo
Objetivo: Revisar as principais informações atualizadas quanto à fisiopatologia, diagnóstico e terapia modificadora da doença da amiloidose cardíaca. Métodos: Revisão de literatura do tipo integrativa publicada no período de 2019 a 2024, contemplando estudos disponíveis nas línguas inglesa e portuguesa. Resultados: Foram identificados, nas bases de dados, 5.880 artigos relacionados ao tema, dos quais, desses, 32 foram selecionados para a extração de dados e a discussão dos resultados obtidos. Considerações finais: Muitos avanços recentes têm sido alcançados no diagnóstico e na terapia modificadora da doença da amiloidose cardíaca. Por exemplo, a cintilografia óssea emergiu como uma ferramenta crucial para o diagnóstico precoce e não invasivo dessa condição médica. Além disso, tratamentos moduladores da doença, como Tafamidis e Bortezomibe, têm alterado de forma significativa a perspectiva para os pacientes com amiloidose cardíaca, o que pode proporcionar uma melhor qualidade de vida, além de uma maior expectativa de vida para esses indivíduos.
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Como Citar
OliveiraL. G. de, SousaR. de, BritoM. V. H., PereiraJ. V. D., SilvaW. R. Q. da, OliveiraA. K. B. de, & LimaA. B. de. (2025). Atualizações sobre amiloidose cardíaca. Revista Eletrônica Acervo Saúde, 25(5), e19615. https://doi.org/10.25248/reas.e19615.2025
Seção
Revisão Bibliográfica
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Referências
1. ALSOMALI D, et al. Treatment of Amyloid Light Chain Cardiac Amyloidosis: Systematic Review and Future Directions. Clin Adv Hematol Oncol. 2022; 20(10): 609–18.
2. ARGON A, et al. Cardiac Amyloidosis: Clinical Features, Pathogenesis, Diagnosis, and Treatment. Turk Patoloji Derg. 2024; 40(1): 1–9.
3. BAGGIANO A, et al. Noncontrast Magnetic Resonance for the Diagnosis of Cardiac Amyloidosis. JACC Cardiovasc Imaging. 2020; 13(1): 69–80.
4. BARRETT CD, et al. Outcomes in Patients With Cardiac Amyloidosis Undergoing Heart Transplantation. JACC Hear Fail. 2020; 8(6): 461–8.
5. CHAMLING B, et al. Therapeutic value of tafamidis in patients with wild-type transthyretin amyloidosis (ATTRwt) with cardiomyopathy based on cardiovascular magnetic resonance (CMR) imaging. Clin Res Cardiol [Internet]. 2023; 112(3): 353–62.
6. CHATZANTONIS G, et al. Diagnostic value of cardiovascular magnetic resonance in comparison to endomyocardial biopsy in cardiac amyloidosis: a multi-centre study. Clin Res Cardiol [Internet]. 2021; 110(4): 555–68.
7. DASGUPTA NR, et al. Inotersen therapy of transthyretin amyloid cardiomyopathy. Amyloid. 2020; 27(1): 52–8.
8. DEUX JF, et al. Diagnostic value of extracellular volume quantification and myocardial perfusion analysis at CT in cardiac amyloidosis. Radiology. 2021; 300(2): 326–35.
9. FERNANDES F, et al. Posicionamento sobre Diagnóstico e Tratamento da Amiloidose Cardíaca – 2021. Arq Bras Cardiol. 2021; 117(3): 561–98.
10. GRIFFIN JM, ROSENBLUM H, et al. Pathophysiology and Therapeutic Approaches to Cardiac Amyloidosis. Circ Res. 2021; 128(10): 1554–75.
11. HASEGAWA K, et al. Abdominal Fat Pad Fine-Needle Aspiration for Diagnosis of Cardiac Amyloidosis in Patients with Non-Ischemic Cardiomyopathy Evidence from a Cohort of 77 Cardiac Biopsy Cases. Int Heart J. 2022; 63(1): 49–55.
12. ITZHAKI BZO e KORNOWSKI R. Cardiac care of patients with cardiac amyloidosis. Acta Haematol. 2020; 143(4): 343–51.
13. JUDGE DP, et al. Transthyretin Stabilization by AG10 in Symptomatic Transthyretin Amyloid Cardiomyopathy. J Am Coll Cardiol. 2019; 74(3): 285–95.
14. KESSLER L, et al. Quantitative 99mTc-DPD-SPECT/CT assessment of cardiac amyloidosis. J Nucl Cardiol. 2023; 30(1): 101–11.
15. KIM SH, et al. Diagnostic performance of PET for detection of cardiac amyloidosis: A systematic review and meta-analysis. J Cardiol [Internet]. 2020; 76(6): 618–25.
16. MARQUES N, et al. Specific therapy for transthyretin cardiac amyloidosis: A systematic literature review and evidence-based recommendations. J Am Heart Assoc. 2020; 9(19).
17. MESQUITA ET, et al. Amiloidose cardíaca e seu novo fenótipo clínico: Insuficiência cardíaca com fração de ejeção preservada. Arq Bras Cardiol. 2017; 109(1): 71–80.
18. MOREIRA RR, et al. Amiloidose cardíaca. Brazilian J Heal Rev. 2022; 5(5): 18451–9.
19. OCHI Y, et al. Integrated diagnostic approach to wild-type transthyretin cardiac amyloidosis with the use of high-sensitivity cardiac troponin T measurement and 99mTc-pyrophosphate scintigraphy. J Cardiol. 2020; 75(1): 12–9.
20. OUZZANI M, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev [Internet]. 2016; 5(1): 1–10.
21. POLO JM, et al. Echocardiographic markers of cardiac amyloidosis in patients with heart failure and left ventricular hypertrophy. Cardiol J. 2023; 30(2): 266–75.
22. RAPEZZI C, et al. Efficacy of Tafamidis in Patients With Hereditary and Wild-Type Transthyretin Amyloid Cardiomyopathy: Further Analyses From ATTR-ACT. JACC Hear Fail. 2021; 9(2): 115–23.
23. RAVAL M, et al. A review of recent advances in the diagnosis of cardiac amyloidosis, treatment of its cardiac complications, and disease-modifying therapies. F1000Research. 2023; 12:1–11.
24. RAZVI Y, et al. Cardiac transplantation in transthyretin amyloid cardiomyopathy: Outcomes from three decades of tertiary center experience. Front Cardiovasc Med. 2023; 9.
25. SHAH SJ, et al. Effect of Tafamidis on Cardiac Function in Patients with Transthyretin Amyloid Cardiomyopathy: A Post Hoc Analysis of the ATTR-ACT Randomized Clinical Trial. JAMA Cardiol. 2024; 9(1): 25–34.
26. SINGH BM, et al. A Systematic Review of Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy. Cureus. 2021; 9.
27. STELMACH-GOŁDYŚ A, et al. Physiology, Diagnosis and Treatment of Cardiac Light Chain Amyloidosis. J Clin Med. 2022; 11(4).
28. SUKAINA M, et al. Efficacy of tafamidis in transthyretin amyloid cardiomyopathy: a systematic review and meta-analysis. Ann Med Surg. 2024; 86(1): 433–8.
29. TSAI CH, et al. Cardiomyopathy Efficacy of Tafamidis in Patients with Ala97Ser Hereditary Transthyretin Cardiac Amyloidosis: A Six-Month Follow-Up Study. Acta Cardiol Sin. 2023; 39(4): 619–27.
30. VELAGA J, et al. Multimodality Imaging in the Diagnosis and Assessment of Cardiac Amyloidosis. Front Cardiovasc Med. 2022; 9.
31. VERGARO G, et al. N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T hold diagnostic value in cardiac amyloidosis. Eur J Heart Fail. 2023; 25(3): 335–46.
32. WANG J, et al. Tafamidis treatment in patients with transthyretin amyloid cardiomyopathy: a systematic review and meta-analysis. eClinicalMedicine [Internet]. 2023; 63(37): 102172.
33. WISNIOWSKI B e WECHALEKAR A. Confirming the diagnosis of amyloidosis. Acta Haematol. 2020; 143(4): 312–21.
34. WU Z, YU C. Diagnostic performance of CMR, SPECT, and PET imaging for the detection of cardiac amyloidosis: a meta-analysis. BMC Cardiovasc Disord [Internet]. 2021; 21(1): 1–12.
35. ZHANG Y e CHAOLU H. Papel Diagnóstico do NT-proBNP em Pacientes com Comprometimento por Amiloidose Cardíaca: Uma Metanálise. 2022; 119(85): 212–22.
36. ZHAO H, et al. Performance of bone tracer for diagnosis and differentiation of transthyretin cardiac amyloidosis: a systematic review and meta-analysis. Diagnostic Interv Radiol. 2021; 27(6): 802–10.
2. ARGON A, et al. Cardiac Amyloidosis: Clinical Features, Pathogenesis, Diagnosis, and Treatment. Turk Patoloji Derg. 2024; 40(1): 1–9.
3. BAGGIANO A, et al. Noncontrast Magnetic Resonance for the Diagnosis of Cardiac Amyloidosis. JACC Cardiovasc Imaging. 2020; 13(1): 69–80.
4. BARRETT CD, et al. Outcomes in Patients With Cardiac Amyloidosis Undergoing Heart Transplantation. JACC Hear Fail. 2020; 8(6): 461–8.
5. CHAMLING B, et al. Therapeutic value of tafamidis in patients with wild-type transthyretin amyloidosis (ATTRwt) with cardiomyopathy based on cardiovascular magnetic resonance (CMR) imaging. Clin Res Cardiol [Internet]. 2023; 112(3): 353–62.
6. CHATZANTONIS G, et al. Diagnostic value of cardiovascular magnetic resonance in comparison to endomyocardial biopsy in cardiac amyloidosis: a multi-centre study. Clin Res Cardiol [Internet]. 2021; 110(4): 555–68.
7. DASGUPTA NR, et al. Inotersen therapy of transthyretin amyloid cardiomyopathy. Amyloid. 2020; 27(1): 52–8.
8. DEUX JF, et al. Diagnostic value of extracellular volume quantification and myocardial perfusion analysis at CT in cardiac amyloidosis. Radiology. 2021; 300(2): 326–35.
9. FERNANDES F, et al. Posicionamento sobre Diagnóstico e Tratamento da Amiloidose Cardíaca – 2021. Arq Bras Cardiol. 2021; 117(3): 561–98.
10. GRIFFIN JM, ROSENBLUM H, et al. Pathophysiology and Therapeutic Approaches to Cardiac Amyloidosis. Circ Res. 2021; 128(10): 1554–75.
11. HASEGAWA K, et al. Abdominal Fat Pad Fine-Needle Aspiration for Diagnosis of Cardiac Amyloidosis in Patients with Non-Ischemic Cardiomyopathy Evidence from a Cohort of 77 Cardiac Biopsy Cases. Int Heart J. 2022; 63(1): 49–55.
12. ITZHAKI BZO e KORNOWSKI R. Cardiac care of patients with cardiac amyloidosis. Acta Haematol. 2020; 143(4): 343–51.
13. JUDGE DP, et al. Transthyretin Stabilization by AG10 in Symptomatic Transthyretin Amyloid Cardiomyopathy. J Am Coll Cardiol. 2019; 74(3): 285–95.
14. KESSLER L, et al. Quantitative 99mTc-DPD-SPECT/CT assessment of cardiac amyloidosis. J Nucl Cardiol. 2023; 30(1): 101–11.
15. KIM SH, et al. Diagnostic performance of PET for detection of cardiac amyloidosis: A systematic review and meta-analysis. J Cardiol [Internet]. 2020; 76(6): 618–25.
16. MARQUES N, et al. Specific therapy for transthyretin cardiac amyloidosis: A systematic literature review and evidence-based recommendations. J Am Heart Assoc. 2020; 9(19).
17. MESQUITA ET, et al. Amiloidose cardíaca e seu novo fenótipo clínico: Insuficiência cardíaca com fração de ejeção preservada. Arq Bras Cardiol. 2017; 109(1): 71–80.
18. MOREIRA RR, et al. Amiloidose cardíaca. Brazilian J Heal Rev. 2022; 5(5): 18451–9.
19. OCHI Y, et al. Integrated diagnostic approach to wild-type transthyretin cardiac amyloidosis with the use of high-sensitivity cardiac troponin T measurement and 99mTc-pyrophosphate scintigraphy. J Cardiol. 2020; 75(1): 12–9.
20. OUZZANI M, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev [Internet]. 2016; 5(1): 1–10.
21. POLO JM, et al. Echocardiographic markers of cardiac amyloidosis in patients with heart failure and left ventricular hypertrophy. Cardiol J. 2023; 30(2): 266–75.
22. RAPEZZI C, et al. Efficacy of Tafamidis in Patients With Hereditary and Wild-Type Transthyretin Amyloid Cardiomyopathy: Further Analyses From ATTR-ACT. JACC Hear Fail. 2021; 9(2): 115–23.
23. RAVAL M, et al. A review of recent advances in the diagnosis of cardiac amyloidosis, treatment of its cardiac complications, and disease-modifying therapies. F1000Research. 2023; 12:1–11.
24. RAZVI Y, et al. Cardiac transplantation in transthyretin amyloid cardiomyopathy: Outcomes from three decades of tertiary center experience. Front Cardiovasc Med. 2023; 9.
25. SHAH SJ, et al. Effect of Tafamidis on Cardiac Function in Patients with Transthyretin Amyloid Cardiomyopathy: A Post Hoc Analysis of the ATTR-ACT Randomized Clinical Trial. JAMA Cardiol. 2024; 9(1): 25–34.
26. SINGH BM, et al. A Systematic Review of Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy. Cureus. 2021; 9.
27. STELMACH-GOŁDYŚ A, et al. Physiology, Diagnosis and Treatment of Cardiac Light Chain Amyloidosis. J Clin Med. 2022; 11(4).
28. SUKAINA M, et al. Efficacy of tafamidis in transthyretin amyloid cardiomyopathy: a systematic review and meta-analysis. Ann Med Surg. 2024; 86(1): 433–8.
29. TSAI CH, et al. Cardiomyopathy Efficacy of Tafamidis in Patients with Ala97Ser Hereditary Transthyretin Cardiac Amyloidosis: A Six-Month Follow-Up Study. Acta Cardiol Sin. 2023; 39(4): 619–27.
30. VELAGA J, et al. Multimodality Imaging in the Diagnosis and Assessment of Cardiac Amyloidosis. Front Cardiovasc Med. 2022; 9.
31. VERGARO G, et al. N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T hold diagnostic value in cardiac amyloidosis. Eur J Heart Fail. 2023; 25(3): 335–46.
32. WANG J, et al. Tafamidis treatment in patients with transthyretin amyloid cardiomyopathy: a systematic review and meta-analysis. eClinicalMedicine [Internet]. 2023; 63(37): 102172.
33. WISNIOWSKI B e WECHALEKAR A. Confirming the diagnosis of amyloidosis. Acta Haematol. 2020; 143(4): 312–21.
34. WU Z, YU C. Diagnostic performance of CMR, SPECT, and PET imaging for the detection of cardiac amyloidosis: a meta-analysis. BMC Cardiovasc Disord [Internet]. 2021; 21(1): 1–12.
35. ZHANG Y e CHAOLU H. Papel Diagnóstico do NT-proBNP em Pacientes com Comprometimento por Amiloidose Cardíaca: Uma Metanálise. 2022; 119(85): 212–22.
36. ZHAO H, et al. Performance of bone tracer for diagnosis and differentiation of transthyretin cardiac amyloidosis: a systematic review and meta-analysis. Diagnostic Interv Radiol. 2021; 27(6): 802–10.