Using Biomarkers to Monitor ATTR-CM

Summary for Physicians: Long-Term Monitoring in ATTR-CM and Biomarkers Used

Long-term monitoring in patients with ATTR-CM (transthyretin amyloid cardiomyopathy) involves regular clinical assessments, imaging studies, and biomarker evaluations to track disease progression and manage complications. Key aspects of monitoring include:

1. Clinical Monitoring:
   1. Regular assessment of cardiac symptoms such as heart failure, arrhythmias, and functional status
   2. Monitoring for signs of organ involvement beyond the heart, as ATTR-CM can affect other organs, such as the liver and nervous system
2. Imaging:
   1. Echocardiography to assess left ventricular function and wall thickness
   2. Cardiac MRI to evaluate myocardial involvement and amyloid deposits
   3. Nuclear imaging (eg, bone scintigraphy) to detect amyloid deposition in the heart
3. Biomarkers:
   1. N-terminal pro B-type natriuretic peptide (NT-proBNP): A marker for heart failure, often elevated in ATTR-CM
   2. Troponin: Can indicate myocardial injury or stress, which may be elevated in patients with ATTR-CM
   3. Serum free light chains: Helpful in distinguishing ATTR-CM from other forms of amyloidosis, such as light chain amyloidosis
   4. C-reactive protein: Can be elevated in systemic inflammation associated with amyloidosis
   5. TTR genetic testing and serum TTR concentration may help to confirm the diagnosis and assess familial risk.
4. Functional Assessments:
   1. Regular evaluation of the patient’s functional status, including exercise tolerance and quality of life (using tools such as the 6-minute walk test and patient-reported outcome measures).

Monitoring these biomarkers, alongside clinical and imaging evaluations, helps physicians track the progression of ATTR-CM, adjust therapies, and intervene early in cases of disease progression or complications. Regular follow-up is essential for optimizing management and improving patient outcomes.