Diagnostic practice points of multimodality imaging in cardiac amyloidosis: a summary of diagnostic perspective

Cardiac amyloidosis (CA) is an emerging iceberg among the cardiomyopathies with significant morbidity and mortality. The overlapping signs and symptoms with other cardiac pathologies warrant prompt identification of the clinical red flags and imaging red flags (iRF) for early detection and treatment of CA. Unluckily data suggests that these patients visit 4-5 physicians before being diagnosed with CA; this is mainly due to perception of rarity, overlapping symptomatology with other common cardiac conditions (hypertension, chronic renal failure, aortic stenosis, and hypertrophic cardiomyopathy), and inability of identification of clinical and iRF of CA by the practicing physicians in the routine outpatient department (OPD) working. Recently published multiregional expert consensus on multimodality correlative cardiac imaging by international societies has emphasized on specific clinical and imaging red flags (iRF) using ECG, echocardiogram, 99m Tc-based scintigraphy, and cardiac MR for robust diagnosis of CA. However, reading all these tedious guidelines and retaining their diagnostic practice points (DPPs) appears difficult in daily practice for practicing physicians and residents. Therefore, the current draft has condensed and highlighted the DPPs of recent 5 years of published data in the form of concise, printable tables and flow charts, enabling a physician in the OPD to flick through, teach, and direct the suspected patients for prompt and timely diagnostic testing to rule out CA.