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Vol 9, No 3 (2018)
Review paper
Published online: 2018-10-17

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Light-chain cardiac amyloidosis from the cardiologists’ point of view

Jacek Grzybowski1, Justyna Anna Szczygieł1, Monika Gawor1, Piotr Michałek2, Agnieszka Sioma1, Natalia Ojrzyńska1, Łukasz Mazurkiewicz13, Marta Legatowicz-Koprowska4, Ewa Walczak4, Maria Franaszczyk5, Magdalena Marczak3
DOI: 10.5603/Hem.2018.0029
Hematologia 2018;9(3):222-238.

Abstract

Light-chain amyloidosis (amyloidosis AL) is diagnosed in approx. 70% of patients with cardiac amyloidosis. This type of amyloidosis has the worst prognosis, especially if the diagnosis is made in advanced stages. The majority of patients are referred to a cardiologist, but unfortunately only every fifth of them has the proper diagnosis. Therefore, strategies promoting early diagnosis are important. One of them is the measurement of serum free light chains concentration in every patient with heart failure with preserved ejection fraction. The acknowledgement of free light chains (FLCs) cardiotoxicity rendered the picture of AL amyloidosis from infiltrative cardiomyopathy into a toxic one. Best improvement in regard to heart failure is achieved upon hematological treatment resulting in decrease of FLCs concentration. Therefore, cardiological treatment is rather a supportive therapy. The role of cardiologist is the rapid diagnosis of the disease and referral of the patient to the hematologist. The standard heart failure treatment encompassing use of beta-blockers and angiotensin converting enzyme inhibitors aggravates orthostatic hypotension and congestion. Instead, up-to-date hematological treatment improves the prognosis of AL amyloidosis markedly, as long as early diagnosis is made.

Keywords: light-chain amyloidosisamyloidosis ALcardiac amyloidosisheart failure with preserved ejection fraction

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