{
  "abstract": "Introduction Amyloidosis is a collection of disorders caused by the deposition of insoluble proteins within the extracellular space and is characterised by a restrictive cardiomyopathy. Early diagnosis and treatment of amyloidosis is key to favourable clinical outcomes. The British Society of Echocardiography recently published a guideline for the assessment of cardiac amyloidosis, including a statement on when to suspect amyloidosis based on clinical and imaging findings, and how these should be reported. The guideline emphasises the role of a skilled echocardiographic assessment in early diagnosis and treatment initiation with the potential to improve quality and length of life for patients.The guideline states that any patient with a left ventricular wall thickness of ≥12mm plus any single clinical feature should be classified as ‘suspicious’ for amyloidosis. These include, atrial fibrillation, a pacemaker and heart failure with a preserved ejection fraction. According to the guideline patients identified as suspicious for amyloidosis should further be reported as ‘not suggestive’, ‘equivocal’ or ‘suggestive’ based on the imaging findings.It is hypothesised that a significant number of patients referred for echocardiography would meet the criteria for ‘suspicious - equivocal’ or ‘suspicious - suggestive’ thus necessitating further tests, including haematological blood tests and cardiac scintigraphy.Method We examined all echocardiograms performed at our multi-site tertiary centre over a 1-week period and applied the guideline. Our aim was to assess how many patients would be classified as suspicious, and of those, how many should be reported as ‘equivocal’ or ‘suggestive’ for amyloidosis.Results Over a 1-week period, 741 echocardiograms were performed across all sites. Of these, 157 had a wall thickness ≥12mm, 75 were classified as suspicious, 73 as ‘equivocal’ and 2 ‘suggestive’ of amyloidosis.Most patients were classified as suspicious based on a history of AV conduction disease, atrial fibrillation or elevated NT-proBNP and mild increase in Troponin.During a one-year period, 69 cardiac scintigraphy scans were performed at our tertiary centre. 27 were reported as Perugini grade 2 or 3, classified as ‘suspicious-equivocal’. 42 were reported as Perugini grade 0 or 1, 40 of which classified as ‘suspicious-equivocal’. Thus 67 of the 69 were classified as ‘suspicious-equivocal.’Conclusion In conclusion, if we were to apply the BSE Amyloidosis Guideline across our multi-site tertiary centre, this would classify one-in-ten patients attending for routine echocardiography as suspicious of amyloidosis. This equates to 73 patients per week classified as ‘suspicious’ and ‘equivocal’ for cardiac amyloidosis, or nearly 4,000 per year requiring further assessment with cardiac scintigraphy.The British Society of Echocardiography guidelines for the assessment of amyloidosis, are not adequately discriminatory and specific clinical algorithms are in urgent need.",
  "authors": [
    {
      "affiliations": [
        "Manchester Foundation Trust, Manchester, UK"
      ],
      "name": "Mi Suan Yau"
    },
    {
      "affiliations": [
        "Manchester Foundation Trust, Manchester, UK"
      ],
      "name": "Christopher Orsborne"
    }
  ],
  "title": "6-025 British society of echocardiography amyloidosis guidelines: are they specific enough? A single tertiary centre study",
  "uid": "7d79e4bb-41af-51d2-a0ad-0f696679af8f"
}