Optimal non-invasive diagnostic approaches and disease-modifying therapeutic strategies in cardiac amyloidosis (literature review)

Abstract

Cardiac amyloidosis is an infiltrative cardiomyopathy caused by extracellular deposition of amyloid fibrils in the myocardium, leading to progressive restrictive dysfunction. The main clinical challenge is delayed diagnosis and differentiation between transthyretin amyloidosis and immunoglobulin light-chain amyloidosis, as treatment approaches and prognosis differ substantially. The purpose of this review is to systematize optimal noninvasive diagnostic approaches and to summarize disease-modifying therapeutic strategies according to amyloid type. Current clinical guidelines and recent studies were analyzed. Diagnostic algorithms using scintigraphy with technetium-99m–labeled bone-avid radiotracers and cardiac magnetic resonance imaging with T1 relaxation time mapping and quantitative assessment of extracellular volume are reviewed, as they improve the accuracy of amyloid type identification and disease staging and support timely initiation of therapy.