Cardiac amyloidosis: An underdiagnosed/underappreciated disease.

Cardiac amyloidosis or amyloid cardiomyopathy (ACM), commonly resulting from extracellular deposition of amyloid fibrils consisted of misfolded immunoglobulin light chain (AL) or transthyretin (TTR) protein, is an underestimated cause of heart failure and cardiac arrhythmias. Among the three types of cardiac amyloidosis (wild-type or familial TTR and light-chain), the wild-type (Wt) TTR-related amyloidosis (ATTR) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF), and amyloidosis should be considered in the differential diagnosis of this heart failure group of patients. Recent advances in the diagnosis and drug treatment of ACM have ushered in a new era in early disease detection and better management of these patients. Certain clues in cardiac and extracardiac manifestations of ACM may heighten clinical suspicion and guide further confirmatory testing. Newer noninvasive imaging methods (strain echocardiography, cardiac magnetic resonance and bone scintigraphy) may obviate the need for endomyocardial biopsy in ATTR patients, while newer targeted therapies may alter the adverse prognosis in these patients. Early recognition of ACM is crucial in halting the disease process before irreversible organ damage occurs. Chemotherapy and stem-cell transplantation combined with immunomodulatory therapy may also favorably affect the course and prognosis of light chain ACM. Finally, in select patients with end-stage disease, heart transplantation may render results comparable to non-ACM patients. All these issues are herein reviewed.

Influence of Diabetes Mellitus on the Biomechanical Properties of the Human Skin as Measured Using the Cutometer: A Case-Control Study

OBJECTIVE: Longstanding diabetes mellitus has been suggested to cause several skin problems associated with biomechanical skin properties. However, the association between impaired skin properties and diabetic peripheral neuropathy (DPN) has not been clarified. This study aimed to investigate the biomechanical properties of the diabetic human skin and their relationship with DPNs. METHODS: This case-control study included 39 chronic diabetic patients and 41 matched healthy controls. The diabetic group was divided into subgroups according to the presence of diabetic sensorimotor polyneuropathy (DSPN) and peripheral autonomic neuropathy (PAN) as determined by the results of nerve conduction study and sympathetic skin response test, respectively. Different skin regions were measured using the non-invasive Cutometer instrument (Courage and Khazaka Electronic GmbH, Cologne, Germany). The following skin parameters were compared between the groups: distensibility (Uf), elasticity (Ua/Uf and Ur/Uf), and viscoelasticity (Uv/Ue). The impact of DPNs, participant age, and diabetes duration on the investigated skin properties was analyzed. RESULTS: The diabetic group showed higher Uf values, and lower Ua/Uf, Ur/Uf, and Uv/Ue values, compared to the control group. However, no significant differences in biomechanical skin properties were noted between diabetic patients with PAN and without PAN. There were also no differences in the investigated skin properties between diabetic patients with DSPN and without DSPN. Diabetes duration and participant age of both groups had a significant impact on the skin properties. CONCLUSION: A long-term hyperglycemic state could induce inferior biomechanical skin properties in the peripheral limbs; however, this phenomenon seems unrelated to DPNs.