September 9, 2019 — The American Society of Nuclear Cardiology (ASNC) published a new expert consensus document along with eight other societies on recommendations for multimodality imaging in cardiac amyloidosis in the Journal of Nuclear Cardiology. ASNC assembled a writing team of 26 experts in cardiovascular imaging and amyloidosis representing these nine societies: the American College of Cardiology (ACC), the American Heart Association (AHA), the American Society of Echocardiography (ASE), the European Association of Nuclear Medicine (EANM), the Heart Failure Society of America (HFSA), the International Society of Amyloidosis (ISA), the Society of Cardiovascular Magnetic Resonance (SCMR), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). Emerging imaging methods have facilitated earlier diagnosis of cardiac amyloidosis and improved prognostication and management with new treatment options. The diagnostic criteria for cardiac amyloidosis, required updating to include these novel imaging tools.
Cardiac amyloidosis is emerging as an underdiagnosed cause of heart failure and mortality characterized by the deposition of amyloid fibrils (misfolded protein deposits) into myocardial tissue. An ideal non-invasive diagnostic method would identify cardiac involvement in amyloidosis and would also confirm the etiologic subtype. No existing diagnostic tools can provide this information individually, necessitating a multimodality cardiac imaging approach.
The purpose of the new consensus document is to:
- Achieve multisocietal consensus on standardized imaging methods, image acquisition, interpretation and reporting;
- Develop multisocietal consensus criteria for the diagnosis of cardiac amyloidosis combining histopathology, laboratory and imaging features; and
- Define appropriate use of imaging in cardiac amyloidosis.
The writing group reviewed and summarized available literature for imaging in cardiac amyloidosis, and provided comprehensive expert recommendations regarding the role of imaging in cardiac amyloidosis based on evidence combined with expert opinion.
The joint expert consensus document on imaging cardiac amyloidosis is divided into two parts:
- Part 1 - Evidence base and standardized methods of imaging
- Part 2 - Diagnostic criteria and appropriate utilization
"For the first time, imaging experts conferred with heart failure experts and amyloidosis experts to provide guidance on standardized imaging techniques, diagnostic criteria and appropriate utilization of echocardiography, cardiac magnetic resonance imaging and radionuclide imaging in cardiac amyloidosis. We anticipate that these expert multisocietal consensus recommendations on multimodality imaging in cardiac amyloidosis will standardize the diagnosis and improve the management of this highly morbid and underdiagnosed disease." stated writing chairs, Sharmila Dorbala, M.D., MPH, FASNC, director of nuclear cardiology, Brigham and Women's Hospital; and Jamieson Bourque, M.D., MHS, FASNC, director of nuclear cardiology at the University of Virginia.
The experts in the writing group envision the use of these consensus recommendations will improve the clinical care and outcomes of individuals affected by cardiac amyloidosis, particularly with newly approved treatments now available. The literature gaps identified could spur relevant research to broaden the understanding of this complex disease and support future development of imaging guidelines for cardiac amyloidosis.
For more information: www.asnc.org/jnc
1. Dorbala S., Ando Y., Bokhari S., et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 2 of 2-Diagnostic Criteria and Appropriate Utilization. Journal of Nuclear Cardiology, published online Aug. 29, 2019. https://doi.org/10.1007/s12350-019-01760-6
2. Dorbala S., Ando Y., Bokhari S., et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 2 of 2—Diagnostic criteria and appropriate utilization. Journal of Nuclear Cardiology, published online Aug. 29, 2019. https://doi.org/10.1007/s12350-019-01761-5