Cardiac Troponin in Patients With Light Chain and Transthyretin Cardiac Amyloidosis: JACC: CardioOncology State-of-the-Art Review

Laura De Michieli; Alberto Cipriani; Sabino Iliceto; Angela Dispenzieri; Allan S Jaffe

doi:10.1016/j.jaccao.2023.12.006

Cardiac Troponin in Patients With Light Chain and Transthyretin Cardiac Amyloidosis: JACC: CardioOncology State-of-the-Art Review

JACC CardioOncol. 2024 Feb 20;6(1):1-15. doi: 10.1016/j.jaccao.2023.12.006. eCollection 2024 Feb.

Authors

Laura De Michieli^{1

2}, Alberto Cipriani^{1

3}, Sabino Iliceto^{1

3}, Angela Dispenzieri⁴, Allan S Jaffe^{2

5}

Affiliations

¹ Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy.
² Cardiovascular Department, Mayo Clinic and Medical School, Rochester, Minnesota, USA.
³ Cardiology Unit, University Hospital of Padua, Padua, Italy.
⁴ Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Department of Laboratory Medicine and Pathology, Mayo Clinic and Medical School, Rochester, Minnesota, USA.

Abstract

Cardiac amyloidosis (CA) is an infiltrative disease caused by amyloid fibril deposition in the myocardium; the 2 forms that most frequently involve the heart are amyloid light chain (AL) and amyloid transthyretin (ATTR) amyloidosis. Cardiac troponin (cTn) is the biomarker of choice for the detection of myocardial injury and is frequently found to be elevated in patients with CA, particularly with high-sensitivity assays. Multiple mechanisms of myocardial injury in CA have been proposed, including cytotoxic effect of amyloid precursors, interstitial amyloid fibril infiltration, coronary microvascular dysfunction, amyloid- and non-amyloid-related coronary artery disease, diastolic dysfunction, and heart failure. Regardless of the mechanisms, cTn values have relevant prognostic (and potentially diagnostic) implications in both AL and ATTR amyloidosis. In this review, the authors discuss the significant aspects of cTn biology and measurement methods, potential mechanisms of myocardial injury in CA, and the clinical application of cTn in the management of both AL and ATTR amyloidosis.

Keywords: amyloidosis; diagnosis; myocardial injury; prognosis; troponin.

Publication types

Review