Familial occurrences of cardiac wild-type transthyretin amyloidosis: a case series

Oscar M Westin*, Tor S Clemmensen, Anne Tybjærg Hansen, Finn Gustafsson, Steen Hvitfeldt Poulsen

*Corresponding author af dette arbejde

Abstract

BACKGROUND: Cardiomyopathy caused by aggregation and deposition of transthyretin amyloid fibrils in the heart (ATTR-CM) is divided into a hereditary (ATTRv) and a wild-type (ATTRwt) forms. While ATTR-CM has been considered a rare disease, recent studies suggest that it is severely underdiagnosed and an important cause of heart failure in elderly patients. Familial occurrence is implicit in ATTRv, but it is not expected in ATTRwt.

CASE SUMMARY: We report a case series of two unrelated families each with two brothers diagnosed with ATTRwt. Genetic testing did not reveal mutations in the transthyretin gene. Family screening with electrocardiogram, echocardiography, and genetic testing did not raise any suspicion of ATTR in first-line family members.

DISCUSSION: Familial occurrence of a rare, non-hereditary disease is statistically unlikely. Two siblings in two different families diagnosed with ATTRwt highlight that the aetiology of ATTRwt is poorly understood, and that genetic factors distinct from mutations in the transthyretin gene, as well as environmental factors, might contribute to the pathogenesis. Identifying such factors might reveal new therapeutic targets. To investigate this further, clinicians need to be aware of the possibility of familial occurrence of ATTRwt.

OriginalsprogEngelsk
Artikelnummerytae199
TidsskriftEuropean Heart Journal - Case Reports
Vol/bind8
Udgave nummer5
ISSN2514-2119
DOI
StatusUdgivet - maj 2024

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