AUTHOR=Çavuşoğlu Yüksel , Başarıcı İbrahim , Tüfekçioğlu Omaç , Özpelit Ebru , Özdemir Elif , Sivrikoz İlknur Ak , Altay Hakan , Değertekin Muzaffer , Dinçer İrem , İkitimur Barış , Kahveci Gökhan , Bozkurt Murat Fani , Erkılıç Metin , Kaya Gamze Çapa , Beksaç Meral , Salihoğlu Ayşe , Tokgözoğlu Lale 

TITLE=Current barriers and recommendations on the diagnosis of transthyretin amyloid cardiomyopathy: a Delphi study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1299261

DOI=10.3389/fcvm.2024.1299261

ISSN=2297-055X

ABSTRACT=This study has been conducted to investigate the non-invasive diagnostic journey of aTTR-CM patients in Turkiye, identify the challenges and uncertainties on the path to diagnosis from expert physicians' perspectives, and develop recommendations that can be applied in such cases.This three round modified Delphi-method study included 10 cardiologists and 5 nuclear medicine specialists. Two hematologists also shared their expert opinions on the survey results related to hematological tests during a final face-to-face discussion. It was considered a consensus when 80% or more of the panel members marked the "agree/strongly agree" or "disagree/strongly disagree" option.All panelists agreed that aTTR-CM diagnosis could be established by scintigraphy (using either 99mTc-PYP, 99mTc-DPD or 99mTc-HMPD) in a patient with suspected CA without a further investigation if AL amyloidosis is ruled out (by sFLC, SPIE and UPIE) and scintigraphy imaging performed by SPECT or SPECT-CT showed Grade ≥2 myocardial uptake with H/CL ratio of ≥1.5. Cardiology panelists positioned CMR and detailed echocardiographic scoring as last resorts before planning an endomyocardial biopsy in patients with suspected CA whose scintigraphy results were discordant/inconclusive or negative but still carried a high clinical suspicion of aTTR-CM.The diagnostic approach in aTTR-CM should be customized based on the availability of diagnostic tools/methods in each expert clinic to achieve a timely and definitive diagnosis.