ACC CardiaCast 2025 ACC Concise Clinical Guidance on Evaluation and Management of ATTR-CM
16 snips
Feb 27, 2026 
Jan Griffin, amyloid expert and clinician-scientist from MUSC, discusses spotting transthyretin cardiac amyloidosis. She covers cardiac clues like ECG and strain, extracardiac signs such as carpal tunnel and neuropathy, and the diagnostic algorithm including pitfalls. Treatment topics include stabilizers versus silencers, monitoring strategies, heart failure management nuances, and promising future therapies like gene editing and amyloid depletors.
AI Snips
Chapters
Transcript
Episode notes
Biopsy And Typing When Monoclonal Protein Is Present
- If monoclonal protein is present, pursue tissue biopsy and mass spectrometry typing rather than relying on nuclear scans.
- Be aware fat pad and marrow biopsies have low sensitivity for wild‑type ATTR; cardiac tissue may be needed.
Know The Limitations Of Nuclear Imaging
- Nuclear scans can yield false positives and false negatives depending on timing, blood pool, prior MI, fractures, drugs, or ATTR variant.
- Confirm planar uptake with delayed SPECT/SPECT‑CT at ~2–3 hours to avoid blood pool artifacts.
How To Monitor Asymptomatic Carriers And Tissue‑Positive Patients
- For patients with extracardiac ATTR deposits or TTR variant carriers, screen with history, ECG, biomarkers, and echocardiogram with strain.
- Begin surveillance ~10 years before proband onset and repeat every 3–5 years if asymptomatic.