Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

The heart of the matter

John P. Veinot
CMAJ September 02, 2003 169 (5) 392-393;
John P. Veinot
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Sandeep Arora and associates1 recommend extracardiac biopsy and other diagnostic modalities instead of heart biopsy for diagnosis of cardiac amyloidosis. However, endomyocardial biopsy remains an excellent method of demonstrating this problem, and false-negative results are uncommon in patients with heart failure.2

Immunohistochemical typing of the amyloid may be prognostic. Primary (amyloid light-chain [AL]) amyloidosis with resultant heart failure is associated with a poor prognosis, and up to 40% of such patients die of heart disease.3 In contrast, senile amyloidosis, which is common, is often uncomplicated, and treatment with cytotoxic agents may not be required.4,5

Algorithms have been proposed to diagnose amyloidosis.5,6 Depending on the amyloid type, the results of extracardiac staining may not accurately indicate the presence of cardiac amyloid.3 Furthermore, in a study of patients with AL-type amyloidosis who had positive results on endomyocardial biopsy, the extracardiac biopsy results were not always positive.3

In patients with severe heart failure, biopsy-proven extracardiac amyloid site, characteristic electrocardiographic findings and characteristic echocardiographic changes, most clinicians feel confident in attributing cardiac dysfunction to amyloidosis.3 However, doing so may underestimate or overestimate cardiac involvement, depending on the patient population. Endomyocardial biopsy may be the only way to diagnose amyloidosis if it is confined to the heart. Immunotyping of the biopsy specimen may add prognostic information. Heart biopsy is also useful in distinguishing restrictive myocardial abnormalities from constrictive pericardial disease.

John P. Veinot Pathology and Laboratory Medicine University of Ottawa Ottawa, Ont.

References

  1. 1.↵
    Arora S, Arora A, Makkar RPS, Monga A. Stiff heart syndrome. CMAJ 2003;168(13):1690-1.
    OpenUrlFREE Full Text
  2. 2.↵
    Frenzel H, Schwartzkopff B, Kuhn H, Losse B, Thormann J, Hort W, et al. Cardiac amyloid deposits in endomyocardial biopsies: light microscopic, ultrastructural, and immunohistochemical studies. Am J Clin Pathol 1986;85:674-80.
    OpenUrlPubMed
  3. 3.↵
    Pellikka PA, Holmes DR Jr, Edwards WD, Nishimura RA, Tajik AJ, Kyle RA. Endomyocardial biopsy in 30 patients with primary amyloidosis and suspected cardiac involvement. Arch Intern Med 1988;148:662-6.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Kyle RA, Spittell PC, Gertz MA, Li CY, Edwards WD, Olson LJ, et al. The premortem recognition of systematic senile amyloidosis with cardiac involvement. Am J Med 1996;171:395-400.
    OpenUrl
  5. 5.↵
    Gertz MA, Kyle RA, Edwards WD. Recognition of congestive heart failure due to senile cardiac amyloidosis. Biomed Pharmacother 1989;43:101-6.
    OpenUrlCrossRefPubMed
  6. 6.↵
    Elias JM. Histochemical and immunohistochemical analysis of amyloid. In: Elias JM, editor. Immunohistopathology. A practical approach to diagnosis. Chicago: ASCP [American Society for Clinical Pathology] Press; 1990. p. 441-88.
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 169 (5)
CMAJ
Vol. 169, Issue 5
2 Sep 2003
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The heart of the matter
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The heart of the matter
John P. Veinot
CMAJ Sep 2003, 169 (5) 392-393;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
The heart of the matter
John P. Veinot
CMAJ Sep 2003, 169 (5) 392-393;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Hospital-at-home programs in Canada: challenges and pitfalls
  • Author response to “Pitfalls of analyzing perinatal outcomes by health care provider”
  • Pitfalls of analyzing perinatal outcomes by health care provider
Show more Letters

Similar Articles

Collections

  • Topics
    • Cardiovascular medicine

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire