RESUMO
RESUMEN La amiloidosis es un desorden sistémico producido por el depósito de fibrillas de proteínas insolubles que se pliegan y depositan en el miocardio. Los pacientes con amiloidosis y compromiso cardíaco tienen mayor mortalidad respecto a pacientes sin compromiso cardíaco. Las dos formas de amiloidosis más prevalentes que se asocian con compromiso cardíaco son la amiloidosis AL, por el depósito de las cadenas livianas de las inmunoglobulinas, y la amiloidosis ATTR, por el depósito de la proteína transtiretina (TTR) en forma mutada o senil. Este artículo tiene el objetivo de revisar las diferentes modalidades de imágenes cardíacas (ecocardiografía, resonancia magnética cardiaca, medicina nuclear y tomografía) que permiten determinar la severidad del compromiso cardíaco en pacientes con amiloidosis, el tipo de amiloidosis y su pronóstico. Finalmente, se sugiere un algoritmo diagnóstico para determinar el compromiso cardíaco en la amiloidosis adaptado a las herramientas diagnósticas disponibles localmente, con un enfoque práctico y clínico.
ABSTRACT Cardiac amyloidosis is a systemic disorder caused by the extracellular deposition of fibrils of insoluble proteins that misfold and deposit in the myocardium. Patients with amyloidosis and cardiac involvement have higher mortality rate than those without cardiac involvement. The two most prevalent types are amyloidosis with cardiac involvement are light-chain amyloidosis (AL) due to immunoglobulin light chain deposition and transthyretin amyloidosis (ATTR) due to deposition of mutated or senile forms of the transthyretin (TTR) protein. The aim of this paper is to review the different modalities of cardiac imaging tests (echocardiography, cardiac magnetic resonance imaging, nuclear medicine images and computed tomography scan) that can determine the severity of cardiac involvement in patients with amyloidosis, the type of amyloidosis and its prognosis. Finally, a diagnostic algorithm is proposed to determine cardiac involvement in amyloidosis, tailored to the diagnostic tools locally available with a practical and clinical approach.
RESUMO
Abstract The coronary artery calcium score plays an Important role In cardiovascular risk stratification, showing a significant association with the medium- or long-term occurrence of major cardiovascular events. Here, we discuss the following: protocols for the acquisition and quantification of the coronary artery calcium score by multidetector computed tomography; the role of the coronary artery calcium score in coronary risk stratification and its comparison with other clinical scores; its indications, interpretation, and prognosis in asymptomatic patients; and its use in patients who are symptomatic or have diabetes.
Resumo O escore de cálcio coronariano tem papel relevante na estratificação de risco cardiovascular, apresentando significativa associação com a ocorrência de eventos cardiovasculares maiores no acompanhamento de médio e longo prazo. São discutidos: os protocolos de aquisição e quantificação por meio da tomografia computadorizada multidetectores; seu papel na estratificação de risco coronariano e relação com os demais escores clínicos; suas indicações, interpretação e prognóstico em pacientes assintomáticos; sua utilização em pacientes sintomáticos e em diabéticos.
