Cardiac Amyloidosis Determines the Prognosis of Systemic Amyloidosis; Roles and Responsibilities of Cardiologist

Cardiac amyloidosis is a prognostically critical condition, since it is a frequent cause of death in patients with systemic amyloidosis. Lee et al. reported, for the first time, describing systemic amyloidosis in Korea from the perspective of cardiologists. In this paper, the authors enrolled 129 systemic amyloidosis patients retrospectively from 1999 to 2011. They showed that cardiac involve was the major prognostic factor, and old age, elevation of cardiac troponin I (cTNI), left ventricular (LV) systolic dysfunction and diastolic dysfunction were independent prognostic factors in survival. All cardiac amyloidosis were confirmed to have cardiac involvement by well-established and uncontroversial criteria including mean left ventricular thickness over 12 mm and low voltage in electrocardiogram or pathologically-confirmed amyloid deposit in endomyocardial biopsy. These diagnostic criteria were closely related to poor outcome in systemic amyloidosis. The diagnosis and prognosis of cardiac amyloidosis still remains to be clarified, despite the development of more sensitive tools, such as delayed gadolinium enhancement (DGE) in cardiac magnetic resonance imaging (MRI) and cardiac biomarkers. In previous studies, when cardiac MRI was performed in all AL amyloidosis patients, DGE was found in 47% of the patients with normal LV wall thickness in echocardiography. Moreover, the level of NT-proBNP proved to Editorial