Amyloidosis guideline published

Published 04/09/2023

The British Society of Echocardiography (BSE) is delighted to announce the publication of a new cardiac amyloidosis guideline.

This 2023 guideline forms an update of the 2013 BSE protocol for the assessment of restrictive cardiomyopathy. Since then, there has been an exponential rise in the diagnosis of cardiac amyloidosis fuelled by increased clinician awareness and improvements in cardiovascular imaging. The guideline is aimed at improving our ability to suspect and diagnose cardiac amyloidosis early. This is incredibly important as we are entering a new era with the tantalizing prospect of targeted therapies being able to halt progression or even reverse pathology in this disease.

The current guideline seeks to highlight the important role of echo as a first-line imaging modality when assessing patients with possible cardiac amyloidosis while acknowledging its potential limitations in terms of diagnostic specificity and as always, the need to interpret imaging findings within the clinical context. While there are European and US guidelines already published on recommendations for multimodality imaging in cardiac amyloidosis, to-date the major focus has not been on echocardiography. The current guideline provides a focused review of the literature on echocardiography in cardiac amyloidosis highlighting its important role in the diagnosis, prognosis and screening of at-risk individuals, before concluding with a suggested minimum data set, for use as an aide memoire when reporting. It is highlighted echo. This document explains where echo sits within the diagnostic algorithm for cardiac amyloidosis and will help standardise the reporting of echocardiography studies for patients that are referred with a suspicion of cardiac amyloidosis. It will also influence practice in specialties outside of cardiology because amyloidosis is a multi-systemic disease that requires input from multiple other specialties not limited to haematology, neurology, genetics and gastroenterology.

This guideline will be published in the BSE’s official journal, Echo Research and Practice. Dr Will Moody, Consultant Cardiologist at University Hospitals Birmingham NHS Foundation Trust and lead author said, "The need to suspect and diagnose cardiac amyloidosis promptly has never been more important with the promise of numerous disease targeted therapies coming on line very soon. With echo inevitably being requested as the first line imaging test for patients with amyloidosis who will typically present with signs of heart failure, echocardiographers will have an increasingly important role to play in helping to raise suspicion early in this disease."

Read the guideline