emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2024.8.2.2328emcardio-3Research ArticleКлинический случайSTEP-BY-STEP диагностика амилоидоза сердца: от подозрения до верификации диагнозSTEP-BY-STEP diagnosis of cardiac amyloidosis: from suspicion to verificationБондареваА. А.BondarevaA. A.

 Минск 

 Minsk 

БалышЕ. М.BalyshE. M.

 Минск 

 Minsk 

СтаткевичТ. В.StatkevichT. V.

 Минск 

 Minsk  Minsk 

ПетроваЕ. Б.PetrovaE. B.

 Минск 

 Minsk 

ШабуневичО. М.ShabunevichO. M.

 Минск 

 Minsk 

МоисеенкоД. С.MoiseenkoD. S.

 Минск 

 Minsk 

КонончукН. Б.KononchukN. B.

 Минск 

 Minsk 

УЗ «Городская клиническая больница скорой медицинской помощи»City Clinical Hospital of Emergency Medical CareУО «Белорусский государственный медицинский университет»Belarusian State Medical University202418062025822328–2336Copyright © Бондарева А.А., Балыш Е.М., Статкевич Т.В., Петрова Е.Б., Шабуневич О.М., Моисеенко Д.С., Конончук Н.Б., 20252025Бондарева А.А., Балыш Е.М., Статкевич Т.В., Петрова Е.Б., Шабуневич О.М., Моисеенко Д.С., Конончук Н.Б.Bondareva A.A., Balysh E.M., Statkevich T.V., Petrova E.B., Shabunevich O.M., Moiseenko D.S., Kononchuk N.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/3

В статье проанализирован современный взгляд на алгоритм диагностики амилоидной кардиомиопатии и место кардиоваскулярной магнитно-резонансной томографии (МРТ) в нем. На примере клинического случая представлена пошаговая диагностика AA-амилоидоза сердца. Течение заболевания характеризовалось нарастанием симптомов сердечной недостаточности в сочетании с персистирующим повышением уровня тропонина, псевдоинфарктным паттерном на электрокардиограмме, необъяснимой гипертрофией миокарда по данным эхокардиографии. В рамках уточнения характера поражения миокарда выполнена кардиоваскулярная МРТ, по результатам которой выявлены признаки болезни накопления. С целью подтверждения амилоидоза выполнено гистологической исследование биоптата слизистой оболочки ротовой полости.

The article analyzes the modern view on the algorithm for the diagnosis of amyloid cardiomyopathy and the role of cardiovascular magnetic resonance imaging in it. A step-by-step diagnosis of AA amyloidosis of the heart is presented using a clinical case as an example. The course of the disease was characterized by worsening of the symptoms of heart failure in combination with persistent increase in troponin levels, pseudo-infarction pattern on the electrocardiogram, and unexplained myocardial hypertrophy according to echocardiography. In order to clarify the nature of the myocardial damage, a cardiovascular MRI was performed, the results of which revealed signs of storage disease. In order to confirm amyloidosis, a histological examination of a biopsy of the oral mucosa was performed.

амилоидоз сердцаинфильтративная кардиомиопатиямагнитно-резонансная томографияcardiac amyloidosisinfiltrative cardiomyopathymagnetic resonance imagingReferencesArbelo E., Protonotarios A., Gimeno J. R. уt al. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J, 2023, vol. 44(37), pp. 3503–3626. doi: 10.1093/eurheartj/ehad194.Arbelo E., Protonotarios A., Gimeno J. R. уt al. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J, 2023, vol. 44(37), pp. 3503–3626. doi: 10.1093/eurheartj/ehad194.Garcia-Pavia P., Rapezzi Cl., Adler Y. et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J, 2021, vol. 42(16), pp. 1554-1568. doi: 10.1093/eurheartj/ehab072.Garcia-Pavia P., Rapezzi Cl., Adler Y. et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J, 2021, vol. 42(16), pp. 1554-1568. doi: 10.1093/eurheartj/ehab072.Quock T. P., Yan T., Chang E. et al. Epidemiology of AL amyloidosis: a real-world study using US claims data. Blood Adv, 2018, vol. 2(10), pp. 1046-1053. doi: 10.1093/eurheartj/ehab072.Quock T. P., Yan T., Chang E. et al. Epidemiology of AL amyloidosis: a real-world study using US claims data. Blood Adv, 2018, vol. 2(10), pp. 1046-1053. doi: 10.1093/eurheartj/ehab072.Rameev V.V., Moiseev S.V., Kozlovskaya L.V. AA-amyloidosis in autoinflammatory diseases. Clinical pharmacology and therapy, 2021, vol. 30(4), pp. 52-61. (in Russian).Rameev V.V., Moiseev S.V., Kozlovskaya L.V. AA-amyloidosis in autoinflammatory diseases. Clinical pharmacology and therapy, 2021, vol. 30(4), pp. 52-61. (in Russian).Brunger A.F., Nienhuis H.L.A., Bijzet J., Hazenberg B.P.C. Causes of AA amyloidosis: a systematic review. Amyloid, 2020, vol. 27(1), pp. 1-12. doi: 10.1080/13506129.2019.1693359.Brunger A.F., Nienhuis H.L.A., Bijzet J., Hazenberg B.P.C. Causes of AA amyloidosis: a systematic review. Amyloid, 2020, vol. 27(1), pp. 1-12. doi: 10.1080/13506129.2019.1693359.Merlini G, Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med, 2003, vol. 349(6), pp. 583-596. doi: 10.1056/NEJMra023144.Merlini G, Bellotti V. Molecular mechanisms of amyloidosis. N Engl J Med, 2003, vol. 349(6), pp. 583-596. doi: 10.1056/NEJMra023144.Reznik E.V., Nguyen T.L., Stepanova E.A., Ustyuzhanin D.V., Nikitin I.G. Cardiac amyloidosis: internist and cardiologist insight. Archive of internal medicine, 2020, vol. 10(6), pp. 430-456. doi: 10.20514/2226-6704-2020-10-6-430-457. (in Russian).Reznik E.V., Nguyen T.L., Stepanova E.A., Ustyuzhanin D.V., Nikitin I.G. Cardiac amyloidosis: internist and cardiologist insight. Archive of internal medicine, 2020, vol. 10(6), pp. 430-456. doi: 10.20514/2226-6704-2020-10-6-430-457. (in Russian).Mohtya D., Damyc T., Cosnay P. et al. Cardiac amyloidosis: Updates in diagnosis and management. Arch Cardiovasc Dis, 2013, vol. 106(10), pp. 528-540. doi: 10.1016/j.acvd.2013.06.051.Mohtya D., Damyc T., Cosnay P. et al. Cardiac amyloidosis: Updates in diagnosis and management. Arch Cardiovasc Dis, 2013, vol. 106(10), pp. 528-540. doi: 10.1016/j.acvd.2013.06.051.Kittleson M.M., Maurer M.S., Ambardekar A.V. et al. Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association. Circulation, 2020, vol. 142(1), pp. e7-e22. doi: 10.1161/CIR.0000000000000792.Kittleson M.M., Maurer M.S., Ambardekar A.V. et al. Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement From the American Heart Association. Circulation, 2020, vol. 142(1), pp. e7-e22. doi: 10.1161/CIR.0000000000000792.Fitzgerald B.T., Scalia G.M., Cain P.A. et al. Left atrial size-Another Differentiator for Cardiac Amyloidosis. Heart Lung Circ, 2011, vol. 20(9), pp. 574-578. doi: 10.1016/j.hlc.2011.06.002.Fitzgerald B.T., Scalia G.M., Cain P.A. et al. Left atrial size-Another Differentiator for Cardiac Amyloidosis. Heart Lung Circ, 2011, vol. 20(9), pp. 574-578. doi: 10.1016/j.hlc.2011.06.002.Oda S., Kidoh M., Nagayam Y. et al. Trends in Diagnostic Imaging of Cardiac Amyloidosis: Emerging Knowledge and Concepts. Radiographics, 2020, vol. 40(4), pp. 961-981. doi: 10.1148/rg.2020190069.Oda S., Kidoh M., Nagayam Y. et al. Trends in Diagnostic Imaging of Cardiac Amyloidosis: Emerging Knowledge and Concepts. Radiographics, 2020, vol. 40(4), pp. 961-981. doi: 10.1148/rg.2020190069.Vogelsberg H., Mahrholdt Н., Deluigi C. et al. Cardiovascular Magnetic Resonance in Clinically Suspected Cardiac Amyloidosis: Noninvasive Imaging Compared to Endomyocardial Biopsy. J Am Coll Cardiol, 2008, vol. 51(10), pp. 1022-1030. doi: 10.1016/j.jacc.2007.10.049.Vogelsberg H., Mahrholdt Н., Deluigi C. et al. Cardiovascular Magnetic Resonance in Clinically Suspected Cardiac Amyloidosis: Noninvasive Imaging Compared to Endomyocardial Biopsy. J Am Coll Cardiol, 2008, vol. 51(10), pp. 1022-1030. doi: 10.1016/j.jacc.2007.10.049.Mohammed S.F., Mirzoyev S.A., Edwards W.D. et al. Left ventricular amyloid deposition in patients with heart failure and preserved ejection fraction. JACC Heart Fail, 2014, vol. 2(2), pp. 113-22. doi: 10.1016/j.jchf.2013.11.004.Mohammed S.F., Mirzoyev S.A., Edwards W.D. et al. Left ventricular amyloid deposition in patients with heart failure and preserved ejection fraction. JACC Heart Fail, 2014, vol. 2(2), pp. 113-22. doi: 10.1016/j.jchf.2013.11.004.Mircsof D. Diagnosis of Amyloidosis: A Survey of Current Awareness and Clinical Challenges Among Cardiologists in Switzerland. Cardiol Ther, 2020, vol. 9(1), pp. 127-138. doi: 10.1007/s40119-019-00160-8Mircsof D. Diagnosis of Amyloidosis: A Survey of Current Awareness and Clinical Challenges Among Cardiologists in Switzerland. Cardiol Ther, 2020, vol. 9(1), pp. 127-138. doi: 10.1007/s40119-019-00160-8

The authors declare that there are no conflicts of interest present.