Abstract
Background: Pericardial effusion is associated with amyloidosis, specifically amyloid light chain (AL) and transthyretin (ATTR) subtypes. However, the patients might present with different clinical symptoms.
Objective: To determine the characteristics and associations of patients with pericardial effusion owing to either AL or ATTR amyloidosis.
Methods: This study reviewed 26 studies from databases such as PubMed, MEDLINE, Web of Science, Google Scholar and CINAHL databases after protocol registration. The data were analyzed in IBM SPSS 21. Many statistical tests, such as Student t- and the Mann-Whitney U tests, were used. Multivariate logistic regression analysis was also performed. A p-value< 0.05 was considered significant.
Results: A total of 531 patients with pericardial effusion secondary to amyloidosis were included. The mean age was 58.4±24.5 years. Most of the patients were male (72.9%). Common co-morbid conditions included hypertension (16.8%) and active smoking (12.9%). The most common time from symptom onset to the clinical presentation was less than 1 week (45%). ATTR amyloidosis was more common in older patients (p<0.05). Abdominal and chest discomfort were commonly associated with AL and ATTR amyloidosis, respectively (p<0.05). Patients with AL amyloidosis had a higher association with interventricular septal thickening and increased posterior wall thickness (p<0.05). First-degree atrioventricular block, left bundle branch block (LBBB), and atrial fibrillation (AF) were more associated with ATTR amyloidosis (p<0.05).
Conclusion: Pericardial effusion in patients with AL amyloidosis was associated with hypertrophic remodeling, while conduction abnormalities were associated with ATTR amyloidosis.
[1]
Bustamante JG, Zaidi SRH. Amyloidosis.In: StatPearls. Treasure Island, FL: StatPearls Publishing 2023.
[2]
Kumar N, Zhang NJ, Cherepanov D, Romanus D, Hughes M, Faller DV. Global epidemiology of amyloid light-chain amyloidosis. Orphanet J Rare Dis 2022; 17(1): 278.
[http://dx.doi.org/10.1186/s13023-022-02414-6] [PMID: 35854312]
[http://dx.doi.org/10.1186/s13023-022-02414-6] [PMID: 35854312]
[3]
Orphanet. Wild type ATTR amyloidosis Available from: https://www.orpha.net/consor/cgibin/ OC_Exp.php?lng=EN&Expert=330001#:~:text=The%20preval ence%20of%20wild%20type
[4]
Martinez-Naharro A, Hawkins PN, Fontana M. Cardiac amyloidosis. Clin Med 2018; 18 (Suppl. 2): s30-5.
[http://dx.doi.org/10.7861/clinmedicine.18-2-s30] [PMID: 29700090]
[http://dx.doi.org/10.7861/clinmedicine.18-2-s30] [PMID: 29700090]
[5]
Magdi M, Mostafa MR, Abusnina W, et al. A systematic review and meta-analysis of the prevalence of transthyretin amyloidosis in heart failure with preserved ejection fraction. Am J Cardiovasc Dis 2022; 12(3): 102-11.
[PMID: 35873185]
[PMID: 35873185]
[6]
Binder C, Duca F, Binder T, et al. Prognostic implications of pericardial and pleural effusion in patients with cardiac amyloidosis. Clin Res Cardiol 2021; 110(4): 532-43.
[http://dx.doi.org/10.1007/s00392-020-01698-7] [PMID: 32914241]
[http://dx.doi.org/10.1007/s00392-020-01698-7] [PMID: 32914241]
[7]
Porcari A, Falco L, Lio V, et al. Cardiac amyloidosis: Do not forget to look for it. Eur Heart J Suppl 2020; 22 (Suppl. E): E142-7.
[http://dx.doi.org/10.1093/eurheartj/suaa080] [PMID: 32523459]
[http://dx.doi.org/10.1093/eurheartj/suaa080] [PMID: 32523459]
[8]
Grogan M, Scott CG, Kyle RA, et al. Natural history of wild-type transthyretin cardiac amyloidosis and risk stratification using a novel staging system. J Am Coll Cardiol 2016; 68(10): 1014-20.
[http://dx.doi.org/10.1016/j.jacc.2016.06.033] [PMID: 27585505]
[http://dx.doi.org/10.1016/j.jacc.2016.06.033] [PMID: 27585505]
[9]
Shams P, Ahmed I. Cardiac amyloidosis.In: StatPearls. Treasure Island, FL: StatPearls Publishing 2023.
[10]
Kotecha T, Martinez-Naharro A, Treibel TA, et al. Myocardial edema and prognosis in amyloidosis. J Am Coll Cardiol 2018; 71(25): 2919-31.
[http://dx.doi.org/10.1016/j.jacc.2018.03.536] [PMID: 29929616]
[http://dx.doi.org/10.1016/j.jacc.2018.03.536] [PMID: 29929616]
[11]
Willner DA, Goyal A, Grigorova Y, Kiel J. Pericardial effusion.In: StatPearls. Treasure Island, FL: StatPearls Publishing 2023.
[12]
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018; 23(2): 60-3.
[http://dx.doi.org/10.1136/bmjebm-2017-110853] [PMID: 29420178]
[http://dx.doi.org/10.1136/bmjebm-2017-110853] [PMID: 29420178]
[13]
Bethesda MD. National heart, lung and blood institute. A study quality assessment tools. Bethesda, MD 2021. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessmenttools
[14]
Itagaki H, Yamamoto T, Uto K, et al. Recurrent pericardial effusion with pericardial amyloid deposition: A case report and literature review. Cardiovasc Pathol 2020; 46: 107191.
[http://dx.doi.org/10.1016/j.carpath.2019.107191] [PMID: 31927216]
[http://dx.doi.org/10.1016/j.carpath.2019.107191] [PMID: 31927216]
[15]
Yuda S, Hayashi T, Yasui K, et al. Pericardial effusion and multiple organ involvement are independent predictors of mortality in patients with systemic light chain amyloidosis. Intern Med 2015; 54(15): 1833-40.
[http://dx.doi.org/10.2169/internalmedicine.54.3500] [PMID: 26234222]
[http://dx.doi.org/10.2169/internalmedicine.54.3500] [PMID: 26234222]
[16]
John KJ, Mishra AK, Iyyadurai R. A case report of cardiac amyloidosis presenting with chronic pericardial effusion and conduction block. Eur Heart J Case Rep 2019; 3(4): 1-7.
[http://dx.doi.org/10.1093/ehjcr/ytz162] [PMID: 31911988]
[http://dx.doi.org/10.1093/ehjcr/ytz162] [PMID: 31911988]
[17]
Matute-Blanco L, Casanova-Sandoval J, Rivera K, Fernández-Rodríguez D. Recurrent severe pericardial effusion and senile cardiac amyloidosis: Usefulness of balloon pericardiotomy. Rev Esp Geriatr Gerontol 2021; 56(5): 320-2.
[http://dx.doi.org/10.1016/j.regg.2021.02.009]
[http://dx.doi.org/10.1016/j.regg.2021.02.009]
[18]
Damy T, Jaccard A, Guellich A, et al. Identification of prognostic markers in transthyretin and AL cardiac amyloidosis. Amyloid 2016; 23(3): 194-202.
[http://dx.doi.org/10.1080/13506129.2016.1221815] [PMID: 27647161]
[http://dx.doi.org/10.1080/13506129.2016.1221815] [PMID: 27647161]
[19]
Toyama K, Oka H, Obata K, Ogawa H. Primary systemic amyloidosis with bloody pericardial effusion. Intern Med 2009; 48(10): 821-6.
[http://dx.doi.org/10.2169/internalmedicine.48.1846] [PMID: 19443978]
[http://dx.doi.org/10.2169/internalmedicine.48.1846] [PMID: 19443978]
[20]
Wang J, Kong X, Xu H, et al. Noninvasive diagnosis of cardiac amyloidosis by MRI and echochardiography. J Huazhong Univ Sci Technolog Med Sci 2010; 30(4): 536-40.
[http://dx.doi.org/10.1007/s11596-010-0464-y] [PMID: 20714885]
[http://dx.doi.org/10.1007/s11596-010-0464-y] [PMID: 20714885]
[21]
Scafi M, Valleix S, Benyamine A, et al. Lysozyme amyloidosis. Rev With Internal 2019; 40(5): 323-9.
[http://dx.doi.org/10.1016/j.revmed.2018.08.008]
[http://dx.doi.org/10.1016/j.revmed.2018.08.008]
[22]
Georgin-Lavialle S, Guellich A, Deux JF, Buob D, Damy T. Isolated pericardial infiltration without myocardial involvement in light-chain–related amyloidosis. Ann Thorac Surg 2017; 103(3): e255-7.
[http://dx.doi.org/10.1016/j.athoracsur.2016.08.108] [PMID: 28219562]
[http://dx.doi.org/10.1016/j.athoracsur.2016.08.108] [PMID: 28219562]
[23]
Barros-Gomes S, Naksuk N, Jevremovic D, Villarraga HR. A rash with a heavy heart. Echo Res Pract 2017; 4(3): K11-5.
[http://dx.doi.org/10.1530/ERP-17-0021] [PMID: 28687586]
[http://dx.doi.org/10.1530/ERP-17-0021] [PMID: 28687586]
[24]
Abdelazeem B, Manasrah N, Yousaf A, Gjeka R, Kunadi A. Light chain (AL) cardiac amyloidosis: A diagnostic dilemma. Cureus 2021; 13(11): e19278.
[http://dx.doi.org/10.7759/cureus.19278] [PMID: 34881130]
[http://dx.doi.org/10.7759/cureus.19278] [PMID: 34881130]
[25]
Baca M, Newberry M. Amyloid cardiomyopathy in the emergency department. J Emerg Med 2019; 56(2): 205-9.
[http://dx.doi.org/10.1016/j.jemermed.2018.10.023] [PMID: 30553561]
[http://dx.doi.org/10.1016/j.jemermed.2018.10.023] [PMID: 30553561]
[26]
Kuprian M, Mount G. Acute cardiac tamponade in light-chain amyloidosis. BMJ Case Rep 2014; 2014(apr02 1): bcr2013200248.
[http://dx.doi.org/10.1136/bcr-2013-200248] [PMID: 24695654]
[http://dx.doi.org/10.1136/bcr-2013-200248] [PMID: 24695654]
[27]
Hirata Y, Kusunose K, Miki H, Yamada H. Improvement of global longitudinal strain following high-dose chemotherapy and autologous peripheral blood stem cell transplantation in patients with amyloid light-chain cardiac amyloidosis: A case report. Eur Heart J Case Rep 2019; 3(4): 1-6.
[http://dx.doi.org/10.1093/ehjcr/ytz225] [PMID: 31911987]
[http://dx.doi.org/10.1093/ehjcr/ytz225] [PMID: 31911987]
[28]
Yamamoto H, Hashimoto T, Kawamura S, et al. Hereditary cardiac amyloidosis associated with Pro24Ser transthyretin mutation: A case report. J Med Case Reports 2018; 12(1): 370.
[http://dx.doi.org/10.1186/s13256-018-1931-5] [PMID: 30553273]
[http://dx.doi.org/10.1186/s13256-018-1931-5] [PMID: 30553273]
[29]
Medvedovsky AT, Pollak A, Shuvy M, Gotsman I. Prognostic significance of the frontal QRS-T angle in patients with AL cardiac amyloidosis. J Electrocardiol 2020; 59: 122-5.
[http://dx.doi.org/10.1016/j.jelectrocard.2020.02.001] [PMID: 32062381]
[http://dx.doi.org/10.1016/j.jelectrocard.2020.02.001] [PMID: 32062381]
[30]
Hsu HC, Liao MF, Hsu JL, et al. Phenotypic expressions of hereditary transthyretin Ala97Ser related amyloidosis (ATTR) in taiwanese. BMC Neurol 2017; 17(1): 178.
[http://dx.doi.org/10.1186/s12883-017-0957-4] [PMID: 28882124]
[http://dx.doi.org/10.1186/s12883-017-0957-4] [PMID: 28882124]
[31]
Mekinian A, Lions C, Leleu X, et al. Prognosis assessment of cardiac involvement in systemic AL amyloidosis by magnetic resonance imaging. Am J Med 2010; 123(9): 864-8.
[http://dx.doi.org/10.1016/j.amjmed.2010.03.022] [PMID: 20800158]
[http://dx.doi.org/10.1016/j.amjmed.2010.03.022] [PMID: 20800158]
[32]
Domingues K, Saraiva M, Marta L, Monteiro I, Leal M. Light chain cardiac amyloidosis - A rare cause of heart failure in a young adult. Rev Assoc Med Bras 2019; 64(9): 787-90.
[33]
Huang Y, Zhan J, Wei X, et al. Clinical characteristics of 42 patients with cardiac amyloidosis. Z Honghua NE IK EZ AZ Hi 2014; 53(7): 546-9.
[PMID: 25264010]
[PMID: 25264010]
[34]
Cheng ASH, Banning AP, Mitchell ARJ, Neubauer S, Selvanayagam JB. Cardiac changes in systemic amyloidosis: Visualisation by magnetic resonance imaging. Int J Cardiol 2006; 113(1): E21-3.
[http://dx.doi.org/10.1016/j.ijcard.2006.07.107] [PMID: 17049635]
[http://dx.doi.org/10.1016/j.ijcard.2006.07.107] [PMID: 17049635]
[35]
Sekiya T, Foster CJ, Isherwood I, Lucas SB, Kahn MK, Miller JP. Computed tomographic appearances of cardiac amyloidosis. Heart 1984; 51(5): 519-22.
[http://dx.doi.org/10.1136/hrt.51.5.519] [PMID: 6721947]
[http://dx.doi.org/10.1136/hrt.51.5.519] [PMID: 6721947]
[36]
Qian G, Wu C, Zhang Y, Chen YD, Dong W, Ren YH. Prognostic value of high-sensitivity cardiac troponin T in patients with endomyocardial-biopsy proven cardiac amyloidosis. J Geriatr Cardiol 2014; 11(2): 136-40.
[http://dx.doi.org/10.3969/j.issn.1671-5411.2014.02.011] [PMID: 25009564]
[http://dx.doi.org/10.3969/j.issn.1671-5411.2014.02.011] [PMID: 25009564]
[37]
Lavine E, Siadecki SD, Lewiss RE, Frasure SE, Saul T. Cardiac amyloidosis evaluation by bedside ultrasound in the emergency department. A case report. Med Ultrason 2014; 16(1): 63-6.
[http://dx.doi.org/10.11152/mu.2014.2066.161.el1sds2] [PMID: 24567927]
[http://dx.doi.org/10.11152/mu.2014.2066.161.el1sds2] [PMID: 24567927]
[38]
Navarro JF, Rivera M, Ortuño J. Cardiac tamponade as presentation of systemic amyloidosis. Int J Cardiol 1992; 36(1): 107-8.
[http://dx.doi.org/10.1016/0167-5273(92)90115-J] [PMID: 1428240]
[http://dx.doi.org/10.1016/0167-5273(92)90115-J] [PMID: 1428240]
[39]
Muchtar E, Dispenzieri A, Magen H, et al. Systemic amyloidosis from A (AA) to T (ATTR): A review. J Intern Med 2021; 289(3): 268-92.
[http://dx.doi.org/10.1111/joim.13169] [PMID: 32929754]
[http://dx.doi.org/10.1111/joim.13169] [PMID: 32929754]
[40]
Cuscaden C, Ramsay SC, Prasad S, Goodwin B, Smith J. Estimation of prevalence of transthyretin (ATTR) cardiac amyloidosis in an Australian subpopulation using bone scans with echocardiography and clinical correlation. J Nucl Cardiol 2021; 28(6): 2845-56.
[http://dx.doi.org/10.1007/s12350-020-02152-x] [PMID: 32385832]
[http://dx.doi.org/10.1007/s12350-020-02152-x] [PMID: 32385832]
[41]
Mohamed-Salem L, Santos-Mateo JJ, Sanchez-Serna J, et al. Prevalence of wild type ATTR assessed as myocardial uptake in bone scan in the elderly population. Int J Cardiol 2018; 270: 192-6.
[http://dx.doi.org/10.1016/j.ijcard.2018.06.006] [PMID: 29903517]
[http://dx.doi.org/10.1016/j.ijcard.2018.06.006] [PMID: 29903517]
[42]
Longhi S, Guidalotti PL, Quarta CC, et al. Identification of TTR-related subclinical amyloidosis with 99mTc-DPD scintigraphy. JACC Cardiovasc Imaging 2014; 7(5): 531-2.
[http://dx.doi.org/10.1016/j.jcmg.2014.03.004] [PMID: 24831216]
[http://dx.doi.org/10.1016/j.jcmg.2014.03.004] [PMID: 24831216]
[43]
Bhupathy P, Haines CD, Leinwand LA. Influence of sex hormones and phytoestrogens on heart disease in men and women. Womens Health 2010; 6(1): 77-95.
[http://dx.doi.org/10.2217/WHE.09.80] [PMID: 20088732]
[http://dx.doi.org/10.2217/WHE.09.80] [PMID: 20088732]
[44]
Bruno M, Castaño A, Burton A, Grodin JL. Transthyretin amyloid cardiomyopathy in women: Frequency, characteristics, and diagnostic challenges. Heart Fail Rev 2021; 26(1): 35-45.
[http://dx.doi.org/10.1007/s10741-020-10010-8] [PMID: 32794090]
[http://dx.doi.org/10.1007/s10741-020-10010-8] [PMID: 32794090]
[45]
Quack TP, Yan JT, Chang E, Guthrie SD, Broder MS. Real-world burden of comorbidities in US patients with AL amyloidosis. Blood 2017; 130 (Suppl. 1): 5595.
[http://dx.doi.org/10.1182/blood.V130.Suppl_1.5595.5595]
[http://dx.doi.org/10.1182/blood.V130.Suppl_1.5595.5595]
[46]
Merlini G, Seldin DC, Gertz MA. Amyloidosis: Pathogenesis and new therapeutic options. J Clin Oncol 2011; 29(14): 1924-33.
[http://dx.doi.org/10.1200/JCO.2010.32.2271] [PMID: 21483018]
[http://dx.doi.org/10.1200/JCO.2010.32.2271] [PMID: 21483018]
[47]
Alkhawam H, Patel D, Nguyen J, et al. Cardiac amyloidosis: Pathogenesis, clinical context, diagnosis and management options. Acta Cardiol 2017; 72(4): 380-9.
[http://dx.doi.org/10.1080/00015385.2017.1335034] [PMID: 28705053]
[http://dx.doi.org/10.1080/00015385.2017.1335034] [PMID: 28705053]
[48]
Palladini G, Lavatelli F, Russo P, et al. Circulating amyloidogenic free light chains and serum N-terminal natriuretic peptide type B decrease simultaneously in association with improvement of survival in AL. Blood 2006; 107(10): 3854-8.
[http://dx.doi.org/10.1182/blood-2005-11-4385] [PMID: 16434487]
[http://dx.doi.org/10.1182/blood-2005-11-4385] [PMID: 16434487]
[49]
Palladini G, Barassi A, Klersy C, et al. The combination of high-sensitivity cardiac troponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis. Blood 2010; 116(18): 3426-30.
[http://dx.doi.org/10.1182/blood-2010-05-286567] [PMID: 20644111]
[http://dx.doi.org/10.1182/blood-2010-05-286567] [PMID: 20644111]
[50]
Schulman A, Connors LH, Weinberg J, et al. Patient outcomes in light chain (AL) amyloidosis: The clock is ticking from symptoms to diagnosis. Eur J Haematol 2020; 105(4): 495-501.
[http://dx.doi.org/10.1111/ejh.13472] [PMID: 32564450]
[http://dx.doi.org/10.1111/ejh.13472] [PMID: 32564450]
[51]
Yen T, Chen FW, Witteles RM, Liedtke M, Nguyen LA. Clinical implications of gastrointestinal symptoms in systemic amyloidosis. Neurogastroenterol Motil 2018; 30(4): e13229.
[http://dx.doi.org/10.1111/nmo.13229] [PMID: 29024324]
[http://dx.doi.org/10.1111/nmo.13229] [PMID: 29024324]
[52]
Boldrini M, Cappelli F, Chacko L, et al. Multiparametric echocardiography scores for the diagnosis of cardiac amyloidosis. JACC Cardiovasc Imaging 2020; 13(4): 909-20.
[http://dx.doi.org/10.1016/j.jcmg.2019.10.011] [PMID: 31864973]
[http://dx.doi.org/10.1016/j.jcmg.2019.10.011] [PMID: 31864973]
[53]
Falk RH. Diagnosis and management of the cardiac amyloidoses. Circulation 2005; 112(13): 2047-60.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.104.489187] [PMID: 16186440]
[http://dx.doi.org/10.1161/CIRCULATIONAHA.104.489187] [PMID: 16186440]
[54]
Maestro-Benedicto A, Vela P, de Frutos F, et al. Frequency of hereditary transthyretin amyloidosis among elderly patients with transthyretin cardiomyopathy. Eur J Heart Fail 2022; 24(12): 2367-73.
[http://dx.doi.org/10.1002/ejhf.2658] [PMID: 35999650]
[http://dx.doi.org/10.1002/ejhf.2658] [PMID: 35999650]
[55]
Donnellan E, Wazni OM, Hanna M, et al. Atrial fibrillation in transthyretin cardiac amyloidosis. JACC Clin Electrophysiol 2020; 6(9): 1118-27.
[http://dx.doi.org/10.1016/j.jacep.2020.04.019] [PMID: 32972546]
[http://dx.doi.org/10.1016/j.jacep.2020.04.019] [PMID: 32972546]
[56]
Papathanasiou M, Jakstaite AM, Oubari S, et al. Clinical features and predictors of atrial fibrillation in patients with light‐chain or transthyretin cardiac amyloidosis. ESC Heart Fail 2022; 9(3): 1740-8.
[http://dx.doi.org/10.1002/ehf2.13851] [PMID: 35178887]
[http://dx.doi.org/10.1002/ehf2.13851] [PMID: 35178887]
[57]
Siddiqi OK, Ruberg FL. Cardiac amyloidosis: An update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med 2018; 28(1): 10-21.
[http://dx.doi.org/10.1016/j.tcm.2017.07.004] [PMID: 28739313]
[http://dx.doi.org/10.1016/j.tcm.2017.07.004] [PMID: 28739313]
[58]
Porcari A, Fontana M, Gillmore JD. Transthyretin cardiac amyloidosis. Cardiovasc Res 2023; 118(18): 3517-35.
[http://dx.doi.org/10.1093/cvr/cvac119] [PMID: 35929637]
[http://dx.doi.org/10.1093/cvr/cvac119] [PMID: 35929637]
[59]
Ferreiro L, Pou C, Suárez-Antelo J, et al. Characteristics of pleural effusion due to amyloidosis. Ann Thorac Med 2023; 18(2): 53-60.
[http://dx.doi.org/10.4103/atm.atm_433_22] [PMID: 37323369]
[http://dx.doi.org/10.4103/atm.atm_433_22] [PMID: 37323369]
