Navigating Therapeutic Pathways and Transforming Care in ATTR-CM - Episode 4
Advancements in Screening and Diagnostic Techniques in ATTR-CM
The panel discusses how advances in imaging and biomarkers have transformed the diagnostic approach to ATTR-CM. Historically, diagnosis required invasive endomyocardial biopsy, but cardiac radionuclide scintigraphy with bone-avid tracers now enables noninvasive identification in many patients. This imaging modality is widely accessible and interpretable for cardiologists, making earlier diagnosis more feasible. However, the group emphasizes the critical importance of ruling out monoclonal protein before relying on radionuclide uptake, as AL amyloidosis can produce misleading results and requires urgent, different treatment. The conversation also highlights the evolving role of biomarkers, including high-sensitivity troponin, NT-proBNP, and prealbumin (TTR) levels, both for staging and potentially monitoring disease or therapeutic response, though standardized guidance is still developing. Additionally, the panel notes that interpretation of imaging requires nuance, particularly with borderline or focal uptake patterns. Collectively, these diagnostic advancements support earlier detection, but clinical context, careful interpretation, and structured testing pathways remain essential.
The panel discusses how advances in imaging and biomarkers have transformed the diagnostic approach to ATTR-CM. Historically, diagnosis required invasive endomyocardial biopsy, but cardiac radionuclide scintigraphy with bone-avid tracers now enables noninvasive identification in many patients. This imaging modality is widely accessible and interpretable for cardiologists, making earlier diagnosis more feasible. However, the group emphasizes the critical importance of ruling out monoclonal protein before relying on radionuclide uptake, as AL amyloidosis can produce misleading results and requires urgent, different treatment.
The conversation also highlights the evolving role of biomarkers, including high-sensitivity troponin, NT-proBNP, and prealbumin (TTR) levels, both for staging and potentially monitoring disease or therapeutic response, though standardized guidance is still developing. Additionally, the panel notes that interpretation of imaging requires nuance, particularly with borderline or focal uptake patterns. Collectively, these diagnostic advancements support earlier detection, but clinical context, careful interpretation, and structured testing pathways remain essential.
