Clinical Practice Guidelines for diagnosis of organic involvement of amyloidosis: Part 2/3.Year 2020
CPG organic damage in amyloidosis
DOI:
https://doi.org/10.31053/1853.0605.v79.n1.30897Keywords:
amyloidosis, diagnosis, amyloidosis inmunoglobulin light-chain amyloidosis, amyloidosis, familialAbstract
Method: Use the PICO format to generate a series of questions, focusing on the specificity and sensitivity of the amyloidosis diagnostic test. PubMed searches were conducted in English and Spanish from July to August 2019. The level of evidence and recommendation are based on the GRADE system (http://www.gradeworkinggroup.org/index.htm). The recommendations are graded according to their direction (for or against) and strength (strong and weak). Finally, it is recommended to use GLIA tools to evaluate the obstacles and facilitators in implementation.
Suggested explanation: A strong suggestion indicates a high degree of trust in support or opposition to the intervention. When defining a strong recommendation, this guide uses the "recommended" language. The weaker recommendations indicate that the outcome of the intervention (favorable or unfavorable) is doubtful. In this case, if a weak recommendation is defined, the "recommendation" language is used.
How to use these guidelines: Recommendations must be explained within the scope of special care in validated diagnostic studies conducted by specially trained doctors. It is not assumed to change the coexistence conditions of the disease process. Presumably, the attending physician has a high degree of suspicion of amyloidosis. It assumes that diagnostic research is conducted by well-trained doctors using a validated standardized method. This guide is intended for health care professionals and those involved in health care policies to help ensure that the necessary agreements have been reached to provide appropriate care.
Summary of recommendations
For patients with suspected amyloidosis, it is recommended:
● Electrocardiogram be used as a preliminary assessment for all patients with amyloidosis.- Doppler echocardiography conventional be used as the initial image of the first choice for cardiac amyloidosis in patients diagnosed with suspected heart involvement due to amyloidosis.
- Echocardiographic strain diagnosis for patients with amyloidosis prompted by conventional echocardiography or uncertain.
- Cardiac magnetic resonance imaging (MRI) be used for the diagnosis of cardiac amyloidosis in patients with previous studies suggesting or uncertain amyloidosis.
- T1 mapping technology for cardiac MRI to diagnose myocardial amyloidosis as an alternative to MRI, for patients with kidney failure or contraindication to other studies
- Cardiac MRI examination with T1 localization technique for patients who have previously studied amyloidosis, and measure the extracellular volume and quantify the degree of cardiac involvement in order to diagnose and measure the cardiac involvement caused by amyloidosis.
It is suggested:
- Cardiac MRI with T1 mapping technique and extracellular volume measurement for the early diagnosis of amyloidosis in patients with previous studies suggestive of amyloidosis.
- Measurement of type B-type natriuretic peptide measurement be used for screening and diagnosis of cardiac amyloidosis.
- Pyrophosphate scintigraphy to make a preliminary diagnosis of patients with suspected cardiac amyloidosis, so as to distinguish ATTR (positive) from other patients.
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