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Standard Poster Abstracts for the 17th Asia Pacific Heart Rhythm Society (APHRS) Scientific Sessions

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Cardiac Amyloidosis Treatment.

Cardiac amyloidosis (CA) is a restrictive cardiomyopathy with a traditionally poor prognosis. Until recently, CA treatment options were limited and consisted predominantly of managing symptoms and disease-related complications. However, the last decade has seen significant advances in disease-modifying therapies, increased awareness of CA, and improved diagnostic methods resulting in earlier diagnoses. In this review, we provide an overview of current and experimental treatments for the predominant types of CA: transthyretin cardiac amyloidosis (ATTR-CA) and immunoglobulin light chain (AL)-med

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… The benefit of atrial appendage occluder device placement in this population has also not been evaluated but can be considered for appropriate patients. … No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis. JACC Clin Electrophysiol. 2019. Dec;5(12):1473-1474. doi: 10.1016/j.jacep.2019.10.013 82. Feng D, Edwards WD, Oh JK, et al. …

Abstract

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… EcoTE on August 29 confirmed a 44 x 38 mm thrombotic formation occluding the left atrial appendage, accompanied by a 1.9 cm floating fragment, localized only in the atrial septum. Progressive reduction of the thrombus to echocardiographic follow-up. … The examination highlights: atrial appendage free from thrombotic formations, right ventricle dilated but normokinetic (Fraction of variation of areas FAC > 0,40), right atrium dilated (volume > 20 cm2), absence of pericardial effusion. …

Current Therapies and Future Horizons in Cardiac Amyloidosis Treatment.

Purpose of reviewCardiac amyloidosis (CA) is a condition characterized by misfolding and extracellular deposition of proteins, leading to organ dysfunction. While numerous forms of CA exist, two subtypes dominate clinical prevalence: Transthyretin amyloid (ATTR) and immunoglobulin light chain amyloid.Recent findingsThe current scientific landscape reflects the urgency to advance therapeutic interventions with over 100 ongoing clinical trials. Heart failure treatment is affected by CA phenotype with poor tolerance of otherwise frequently used medications. Treating comorbidities including atrial

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… A retrospective study with 100 ATTR-amyloidosis patients showed that 30 patients developed a thrombus in the left atrial appendage (LAA), 26 of them were on systemic anticoagulation (87%), indicating that the recommendation for anticoagulation based on CHA2DS2-VASc-Score may not be applicable for CA … No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis. JACC Clin Electrophysiol. 2019;5:1473–4. 10.1016/j.jacep.2019.10.013. 10.1016/j.jacep.2019.10.013 32. Napolitano A, de Michieli L, Sinigiani G, Berno T, Cipriani A, Spiezia L. …

Progress and challenges in the treatment of cardiac amyloidosis: a review of the literature.

Cardiac amyloidosis is a restrictive cardiomyopathy determined by the accumulation of amyloid, which is represented by misfolded protein fragments in the cardiac extracellular space. The main classification of systemic amyloidosis is determined by the amyloid precursor proteins causing a very heterogeneous disease spectrum, but the main types of amyloidosis involving the heart are light chain (AL) and transthyretin amyloidosis (ATTR). AL, in which the amyloid precursor is represented by misfolded immunoglobulin light chains, can involve almost any system carrying the worst prognosis among amyl

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… appendage thrombus on transesophageal echocardiogram. … No association between CHADS‐VASc score and left atrial appendage thrombus in patients with transthyretin amyloidosis. JACC Clin Electrophysiol 2019; 5: 1473–1474. 38. Giancaterino S, Urey MA, Darden D, Hsu JC. Management of arrhythmias in cardiac amyloidosis. …

Cardiac amyloidosis responding to bortezomib: case report and review of literature.

We report a case of a 53-year old patient with symptoms of congestive heart failure in whom a restrictive cardiomyopathy and a kappa-chain monoclonal gammopahty were diagnosed. Treatment with eight cycles of Bortezomib, a proteasome inhibitor, resulted in a significant regression of myocardial amyloid deposition and a notable clinical and hemodynamic improvement. Over the last few years, the management of cardiac amyloidosis has taken advantage of many of the advances of the chemotherapeutic regimens, as well as the wider availability of stem cell transplantation. The management of cardiac amy

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… This may be demonstrated on echocardiography (transthoracic and transesophageal) by the presence of a small transmitral A wave (< 20 cm/s) with a markedly decreased atrial appendage Doppler velocities (< 40 cm/s) [ 20 ]. …

A Comprehensive Review of the Management of Light-Chain (AL) and Transthyretin (ATTR) Cardiac Amyloidosis.

Cardiac amyloidosis, once considered a rare and untreatable disorder, is now increasingly recognized as a significant cause of heart failure, particularly in older adults. The two most clinically relevant subtypes of cardiac amyloidosis-immunoglobulin light-chain amyloidosis (AL) and transthyretin-related amyloidosis (ATTR)-differ in pathogenesis, natural history, and management strategies, thereby necessitating a tailored approach to diagnosis and therapy. Advances in multimodality cardiac imaging, including echocardiography, cardiac magnetic resonance, and nuclear scintigraphy, have enabled

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… A study by Donnellan et al . [ 88 ] on a population of patients with ATTR cardiac amyloidosis demonstrated an incidence of 30% of left atrial appendage (LAA) thrombus, 26% of those who had LAA thrombus were already on systemic anticoagulation prior to diagnosis. … No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis. JACC. Clinical Electrophysiology . 2019;5:1473–1474. doi: 10.1016/j.jacep.2019.10.013. [89] Alexander KM, Witteles RM. Management of Cardiac Amyloidosis: Do’s and Don’ts. …

Extracorporeal membrane oxygenation as bridge-to-decision in acute heart failure due to systemic light-chain amyloidosis.

PatientFemale, 58.Final diagnosisAcute hear failure.SymptomsDispnoea • edema • fatigue.Medication—Clinical procedureBone marrow biopsy • endomyocardial biopsy • abdominal subcutaneous fat biopsy under ECMO support.SpecialtyCardiology.ObjectiveRare disease.BackgroundCardiac amyloidosis results from the amyloid deposition in heart tissue, either in the context of a systemic disease or as a localized form. Several pro-amyloid proteins can produce amyloid deposits in the heart. Each of these amyloidoses has characteristic clinical (cardiac and extracardiac) features, and a specific diagnosis and t

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… On the left atrial appendage, a highly mobile thrombus was visible. At this point the clinical and echocardiographic data strongly indicated restrictive cardiomyopathy due to an infiltrative process; amyloidosis is the most common cause of this condition [ 3 – 5 ]. …

Current Data and Future Perspectives on Patients with Atrial Fibrillation and Cancer

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… Procedural and Short-Term Outcomes of Percutaneous Left Atrial Appendage Closure in Patients with Cancer. Am. J. Cardiol. 2021;141:154–157. doi: 10.1016/j.amjcard.2020.12.003. 67. Peixoto de Miranda É.J.F., Takahashi T., Iwamoto F., Yamashiro S., Samano E., Macedo A.V.S., Ramacciotti E. …

Association between advanced lung cancer inflammation index levels and ischemic stroke in patients with atrial fibrillation: a propensity score-matching analysis.

IntroductionInflammation is closely associated with atrial fibrillation (AF) complicated by stroke. The Advanced Lung Cancer Index (ALI) is a comprehensive indicator of inflammation; however, its relationship with AF-related stroke is unclear. Therefore, this retrospective study was conducted to explore the correlation between ALI and ischemic stroke in patients with AF.MethodsPatients were divided into two groups according to the optimal cutoff value of ALI: low ALI and high ALI groups. The primary outcome was ischemic stroke in patients with AF. To ensure robustness of the findings, propensi

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… C-reactive protein and left atrial appendage velocity are independent determinants of the risk of thrombogenesis in patients with atrial fibrillation. Int J Cardiol. (2010) 142:22–8. doi: 10.1016/j.ijcard.2008.12.052, 40. Li Q, Ma X, Shao Q, Yang Z, Wang Y, Gao F, et al. …

Cardiac Amyloidosis: Tribulations and New Frontiers.

This review article aims to provide an overview of the pathophysiology, diagnosis, and contemporary management of cardiac amyloidosis (CA) as well as identify the knowledge gaps and areas of potential research. CA can be divided into two main groups: transthyretin cardiac amyloidosis (ATTR-CA) and light chain cardiac amyloidosis (AL-CA). The former further separates into wild-type transthyretin (ATTRwt) and hereditary transthyretin (ATTRv). African Americans, males, and people older than 75 are the most common demographics affected by this disease. Thanks to an increased understanding of this

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… In that cohort of patients, 30% had a left atrial appendage (LAA) thrombus identified [ 109 ]. The researchers found that “the incidence of LAA thrombus did not demonstrate a proportional increase in relation to CHA 2 DS 2 VASC score” [ 109 ]. … No Association Between CHADS-VASc Score and Left Atrial Appendage Thrombus in Patients With Transthyretin Amyloidosis. J. Am. Coll. Cardiol. EP. 2019;5:1473–1474. doi: 10.1016/j.jacep.2019.10.013. 110. Kristen A.V., Dengler T.J., Hegenbart U., Schonland S.O., Goldschmidt H., Sack F. …

The Roles of EDA2R in Ageing and Disease.

Ageing is a complex biological process driven, in part, by inflammaging. Recent research identifies the ectodysplasin A2 receptor (EDA2R) as a key regulator of inflammaging and a novel biomarker of ageing, with its expression increasing with age across diverse tissues in humans and animal models. Elevated EDA2R gene expression is associated with accelerated ageing, cellular senescence, frailty, obesity, acne, radiation response and increased levels of inflammatory, renal, cardiac and vascular biomarkers. Similarly, elevated EDA2R protein levels, a critical component of the proteomic ageing clo

Arrhythmias, conduction disorders and sudden cardiac death in cancer patients and survivors: expert opinion of the working groups on cardio-oncology and on electrophysiology of the hellenic cardiac society.

Advances in cancer therapeutics have significantly improved patient survival; however, cardiotoxic effects-including arrhythmias-have emerged as a growing clinical concern. This expert opinion, developed by the Working Groups on Cardio-Oncology and Electrophysiology of the Hellenic Cardiological Society, aims to raise awareness of the increasing burden of arrhythmias in cancer patients and survivors. This document explores the multifactorial etiology of arrhythmias in this population, including patient-related factors, the direct effects of malignancy, and the arrhythmogenic potential of thera

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… In these patients, if the thrombotic risk is high and their life expectancy is more than one year, percutaneous left atrial appendage occlusion may be considered as an alternative option. …

What Cardiologists Should Know About Amyloidosis.

Background: Cardiac amyloidosis (CA) is an increasingly recognized but historically underdiagnosed cause of restrictive cardiomyopathy and heart failure with preserved ejection fraction (HFpEF). It results from the extracellular deposition of misfolded protein fibrils, most commonly transthyretin (ATTR) or immunoglobulin light chains (AL), leading to progressive myocardial dysfunction and multi-organ involvement. Objective: This review provides a comprehensive, cardiology-centered overview of cardiac amyloidosis, with an emphasis on early recognition, diagnostic strategies, subtype differentia

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… Other possible findings on echocardiography include normal to small LV cavity size, biatrial enlargement and dysfunction, left atrial appendage stasis and/or thrombi, thickening of valves, right ventricular thickening, pericardial and pleural effusions, and a restrictive transmitral doppler filling pattern …

Diagnosis and treatment of cardiac amyloidosis: an interdisciplinary consensus statement.

The prevalence and significance of cardiac amyloidosis have been considerably underestimated in the past; however, the number of patients diagnosed with cardiac amyloidosis has increased significantly recently due to growing awareness of the disease, improved diagnostic capabilities and demographic trends. Specific therapies that improve patient prognosis have become available for certain types of cardiac amyloidosis. Thus, the earliest possible referral of patients with suspicion of cardiac amyloidosis to an experienced center is crucial to ensure rapid diagnosis, early initiation of treatmen

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… Even patients with sinus rhythm might develop thrombi of the left atrial appendage based on increased filling pressures, atrial dysfunction, and electromechanical dissociation. …

Cardiac amyloidosis: From diagnosis to therapeutics breakthroughs.

Cardiac amyloidosis (CA) is a progressive infiltrative cardiomyopathy resulting from the deposition of misfolded amyloid fibrils in the myocardium and heart valves, with the main forms being amyloid light-chain (AL), transthyretin-related (ATTR) (wild-type or hereditary), and amyloid A amyloidosis. Although historically underdiagnosed, recent advances in non-invasive imaging techniques such as cardiac magnetic resonance imaging and bone scintigraphy have significantly improved its recognition. This review outlines the current diagnostic approaches and therapeutic advancements in CA, emphasizin

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… Amyloid deposition disrupts the atrial endocardium, promoting clot formation, and severe atrial stiffness impairs both left atrial appendage and body contraction. …

Резюме ESPR 2013Европейское общество педиатрической радиологии 50th Ежегодное совещание и 36th Курсы для аспирантов. Июнь 3–7 2013. Будапешт, Венгрия.

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Best of JACC: Case Reports From ACC.23.

This dedicated issue of JACC: Case Reports highlights the top ranked Complex Clinical Cases from the ACC 2023 Scientific Sessions. These cases were reviewed and selected by a committee of peers in the months leading up to the annual meeting. These reviewers were ACC members with no affiliation to the JACC: Case Reports Editorial Board. While the cases were presented at the meeting and included in the formal Abstract Book from ACC, they have not been published elsewhere. These cases illustrate how the ACC can be a place for cardiovascular professionals to come together to learn, grow, and share

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… Both patients underwent septal myectomy, debridement of MAC, AVR with #25 CE valve and left atrial appendage closure. In addition Patient A underwent chordal sparing MVR with # 29 Biocor valve and ascending aortic aneurysm replacement. …

Amyloidosis with Cardiac Involvement: Identification, Characterization, and Management.

Purpose of reviewAmyloidosis is a protein deposition disease whereby a variety of precursor proteins form insoluble fibrils that deposit in tissues, causing organ dysfunction and, many times, death. Accurate characterization of the disease based on the nature of the precursor protein, organ involvement, and extent of disease is paramount to guide management. Cardiac amyloidosis is critical to understand because of its impact on prognosis and new treatment options available.Recent findingsNew imaging methods have proven to be considerably valuable in the identification of cardiac amyloid infilt

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… Atrial function is also impaired, and thrombus in the left atrium and left atrial appendage may occur in normal sinus rhythm, thus raising the risk of embolic stroke. Reduction of atrial contractility results in a restrictive mitral inflow pattern with a diminutive “a” wave on diastology. …

What the Intensivists Need to Know About Critically Ill Myeloma Patients

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… Factors associated with increased risk of intracardiac thrombosis include atrial fibrillation, poor left ventricular diastolic function (grade 3 or 4), lower left atrial appendage emptying velocity (≤15 cm/s), increased RV wall thickness, low systolic blood pressure, and increased heart rate. …