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Cardiac transthyretin amyloidosis
  1. Jason N Dungu1,2,
  2. Lisa J Anderson1,
  3. Carol J Whelan2,
  4. Philip N Hawkins2
  1. 1Cardivascular Sciences, St George's University of London, London, UK
  2. 2National Amyloidosis Centre, Centre for Amyloidosis & Acute Phase Proteins, Division of Medicine, UCL Medical School, Royal Free Campus, London, UK
  1. Correspondence to Dr Jason Dungu, Clinical Research Fellow, St George's University of London, Cranmer Terrace, London SW17 0RE, UK; jdungu{at}


Cardiac amyloidosis of transthyretin fibril protein (ATTR) type is an infiltrative cardiomyopathy characterised by ventricular wall thickening and diastolic heart failure. Increased access to cardiovascular magnetic resonance imaging has led to a marked increase in referrals to our centre of Caucasian patients with wild-type ATTR (senile systemic) amyloidosis and Afro-Caribbean patients with the hereditary ATTR V122I type. Both subtypes present predominantly as isolated cardiomyopathy. The differential diagnosis includes cardiac amyloid light-chain (AL) amyloidosis, which has a poorer prognosis and can be amenable to chemotherapy. We review here the clinical features of cardiac ATTR amyloidosis and describe the diagnostic tests to determine ATTR type. Correct diagnosis is ever more crucial given that several novel therapies for ATTR amyloidosis are on the near horizon.

  • Cardiac amyloidosis
  • cardiovascular MRI
  • cardiomyopathy
  • valvular disease
  • cardiac function
  • cardiac remodelling
  • interventional cardiology
  • non-coronary intervention
  • percutaneous valve therapy
  • heart failure
  • systolic heart failure
  • diastolic dysfunction
  • myocardial disease
  • cardiomyopathy restrictive

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  • Funding JD is supported by a British Heart Foundation Clinical Research Training Fellowship grant no. FS/09/063/28026.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.