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Unlike AL amyloidosis, there are no specific circulating biomarkers of ATTR-CM, though the endogenous TTR ligand RBP4 has shown promise.
Echocardiographic analyses of cardiac deformation, specifically reduced longitudinal systolic strain, is useful in ATTR-CM.
There is a distinctive pattern of “apical sparing” in which the left ventricular apical region shows more normal strain compared to progressively worse values at the mid and basal regions.
Quantification of abnormal ratios of apical to basal strain, or apical to basal plus midventricular strain, have good diagnostic accuracy for differentiating amyloid heart disease from other etiologies.