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CME: ASNC Presents: Cardiac Amyloidosis: Practice Essentials for Diagnosis & Management

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ASNC

ASNC Presents: Cardiac Amyloidosis: Practice Essentials for Diagnosis & Management

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ASNC Presents: Cardiac Amyloidosis: Practice Essentials for Diagnosis & Management
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What recent advances can we put into practice to improve outcomes for our patients with ATTR-CM?

Available credits: 0.50

Time to complete: 30 Minutes

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  • Overview

    This online activity is a concise review of the diagnosis and management of cardiac amyloidosis. Panelists will discuss the biological basis of cardiac amyloidosis, address the challenges of disease presentation, the role of various imaging modalities in the diagnosis, including a detailed discussion of technetium-99m pyrophosphate imaging and provide an overview of current and emerging treatments for transthyretin cardiac amyloidosis.

  • Statement of Need

    Transthyretin cardiomyopathy (ATTR-CM), a type of cardiac amyloidosis (CA) caused by the accumulation of misfolded transthyretin amyloid fibrils in the heart, leads to dysrhythmias and heart failure.[Ruberg 2012a]  Diagnosis often occurs late in the disease and prognosis is poor.[Ruberg 2012a; Ruberg 2012b] Transthyretin CA (ATTR-CA) has two main subtypes, hereditary/mutant ATTR, caused by a hereditary amino acid mutation in the transthyretin molecule, and senile or wild-type ATTR, seen mostly in patients with advancing age.[Falk 2011] Deposition of amyloid in the heart, irrespective of the type, can lead to diastolic dysfunction and congestive heart failure. ATTR-CM is an increasingly recognized etiology of heart failure with preserved ejection fraction (HFpEF).[Vranian 2015]  Traditional therapies for heart failure provide systematic treatment but do not address the underlying disease, and in some instances, may even be detrimental. Hence, early and accurate diagnosis is of critical importance.

    Lack of awareness and suspicion of CA, and the fact that the clinical presentation often overlaps with other more common cardiovascular diseases, including hypertrophic cardiomyopathy, hypertensive heart disease, and aortic stenosis, leads to missed and/or delayed diagnosis.[White 2016] The limited specificity of echocardiography and the traditional requirement for histologic confirmation, preceding the use of Tc-99m PYP to make a confirmed diagnosis, also delays accurate diagnosis.

    Non-invasive imaging and new therapies in development have the potential to improve the long-term prognosis of patients with ATTR-CM. Clinicians need to distinguish the signs and symptoms of CA from other cardiovascular diseases, provide early and accurate diagnosis differentiating the subtype, and understand both current and emerging treatments to optimize patient care and limit organ damage. Early diagnosis and treatment of CA are essential to treat the disease before irreversible organ damage occurs and to improve long-term patient outcomes.[Ruberg 2012a, Maurer 2017]

    Sources
    Ruberg FL, et al. Circulation. 2012a;126:1286-1300.
    Ruberg FL, et al. Am Heart J. 2012b;164:222-228.
    Falk RH. Circulation. 2011;124:1079–1085.
    Vranian MN, et al. Curr Cardiol Rep. 2015;17:100.
    White JA, et al. Curr Cardiol Rep. 2016;18:77.
    Maurer M, et al. Circulation. 2017;135:1357-1377.

  • Overall Purpose

    The goal of this initiative is to improve diagnosis, treatment, and management of ATTR-CM in clinical practice. This initiative will help clinicians make a timely diagnosis and referral to amyloid experts and increase awareness and knowledge of emerging treatment options with the goal of improving outcomes of patients with ATTR-CM in their practice.

  • Learning Objectives

    • Describe amyloidosis, including specific types, cardiac features, and disease burden
    • Identify challenges to patient identification and early diagnosis
    • Summarize the diagnostic evaluation for CA, including the differential diagnosis using Tc-99m PYP imaging
    • Provide details of Tc-99m PYP imaging, including imaging protocol, semi-quantitative and quantitative scoring, interpretation and components of an appropriate report
    • Demonstrate understanding of current and emerging treatments for patients with ATTR-CM
  • Target Audience

    This educational activity will be targeted to general cardiologists, nuclear cardiologists, heart failure specialists, nuclear medicine physicians, radiologists, and nuclear imaging technologists.

  • Accreditation and Credit Designation Statements

    The American Society of Nuclear Cardiology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    The American Society of Nuclear Cardiology designates this internet enduring educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

  • Planners & Reviewers

    Prem Soman, MD, PhD, MASNC (Chair)
    Linda Giering, PhD (ASNC Staff)

    Reviewers
    Jamieson Bourque, MD (Education Committee Reviewer)

     

  • Presenters

    Prem Soman, MD, PhD, MASNC (Chair)
    Sharmila Dorbala, MD, MPH, FASNC
    Mathew S. Maurer, MD
    Frederick L. Ruberg, MD

  • Disclosure of Conflicts of Interest

    As an accredited provider of the Accreditation Council for Continuing Medical Education (ACCME), The American Society of Nuclear Cardiology (ASNC) adheres to the ACCME’s Standards for Commercial Support. In compliance with these standards, it is ASNC’s policy to ensure balance, independence, objectivity, and scientific merit in all of its educational activities through the disclosure of relevant financial relationship with commercial companies and resolution of conflicts of interest. The financial interest or relationships requiring disclosure are outlined in ASNC’s CME Conflict of Interest Policy. All planners, reviewers, and presenters involved with this activity were required to disclose any relevant financial relationships.

    The American Society of Nuclear Cardiology has reviewed this activity’s faculty disclosures and resolved or managed all identified conflicts of interest. 

    The following planners, presenters, peer reviewers, and staff reported no financial relationships:
    Linda Giering, PhD (ASNC staff)

    The following planners, presenters, peer reviewers, staff reported financial relationships:
    Prem Soman, MD, PhD, MASNC: Research Grant: Astellas, Pfizer; Advisory Board: Alnylam, Ionis, Pfizer, Talaria Therapeutics
    Sharmila Dorbala, MD, MPH, FASNC: Consultant: Advanced Accelerator Applications, GE Health Care, Pfizer, Proclara; Research Grant: American Heart Association, Amyloidosis Foundation, ASNC Foundation, NIH, Pfizer
    Mathew S. Maurer, MD: Research Grant: Eidos Therapeutics, National Heart, Lung, and Blood Institute (NHLBI), Pfizer; Advisory Board: Akcea, Alnylam, Eidos, GSK, Pfizer
    Frederick L. Ruberg, MD: Consultant: Glaxo SmithKline, Pfizer; Research Grant: Eidos Therapeutics
    Jamieson Bourque, MD (Reviewer): Consultant: Pfizer; Research Grant: Astellas

  • Provider

    This activity is provided by the American Society of Nuclear Cardiology.

    American Society of Nuclear Cardiology
    9302 Lee Highway, Suite 1210
    Fairfax, Virginia 22031
    Phone: 703-459-2555
    info@asnc.org

  • Acknowledgement of Commercial Support

    This activity is supported by an educational grant from Pfizer.

  • Off Label Use

    Presentations may include discussion of drugs or devices, or uses of drugs or devices, that have not been approved by the U.S. Food & Drug Administration (FDA) or have been approved by the FDA for specific uses only. The FDA has stated it is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice. ASNC is committed to the free exchange of medical education. Inclusion of any discussion in this program, including discussion on off-label uses, does not imply an endorsement by ASNC of the uses, products, or techniques presented. Presenters are required to disclose to the learners, if there is any off-label usage within the presentation.

  • Method of Participation and CME Certificates

    This product offers up to 0.5 CME credits, based on the number of hours watching the presentation and taking the CME pre- and post-test questions. 

    To receive CME credit for this product, learners must:
    1. Read the CME front matter. 
    2. Take the CME pre-test.
    3. View the session.
    4. Click the CME Test button.
    5. Complete the post-test. 
    6. Complete the evaluation and download or save your certificate to your computer.i

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