What is an echocardiogram for ATTR-CM?
Fact-checked by An echocardiogram is a type of heart imaging test that often plays a role in diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM).
In ATTR-CM, clumps of misfolded transthyretin (TTR) protein accumulate in the heart, causing problems with its structure and function. Because the condition’s symptoms overlap with those of other heart diseases, ATTR-CM can be difficult to diagnose.
An echocardiogram for ATTR-CM can help identify abnormalities in the heart, raising red flags that may point toward the condition. This is often an early step in the diagnostic process, with additional tests usually being required to confirm the diagnosis.
For people with unexplained heart-related symptoms, regular echocardiograms may help detect changes associated with ATTR-CM earlier, supporting timely diagnosis and treatment.
What is an echocardiogram?
An echocardiogram, sometimes called an echo, is a heart ultrasound. It’s used to create moving pictures of the heart, capturing the shape, size, and pumping activity of its chambers and valves. It specifically works by using a device that emits high-frequency sound waves, measuring how these waves bounce off heart structures.
The most common type of echo is a transthoracic echo, which uses a device that’s held outside the chest to capture images of the heart. A transesophageal echo, meanwhile, uses a probe that’s inserted down the throat, allowing it to be closer to the heart and producing higher-quality images. That procedure, however, is more disruptive and requires sedation.
Echo tests for ATTR-CM offer several advantages in regular clinical practice. The technology is widely available, and can be used to identify problems in both the structure and function of the heart. This is important because a combination of structural and functional problems may point to ATTR-CM.
What an echocardiogram may show in ATTR-CM
Potential problems an echocardiogram can show in ATTR-CM include:
- left or right ventricular hypertrophy: thickening of the wall of the left or right ventricle, the heart’s lower chambers that pump blood to the lungs and to the rest of the body
- small left ventricular cavity: a left ventricle that’s smaller than average
- abnormalities in longitudinal strain: subtle changes in heart muscle movement that can help predict more serious problems in the future
- diastolic dysfunction: problems with how well the ventricles relax and fill up with blood during the initial phase of a heartbeat
- biatrial dilation: enlargement of the atria, the heart’s upper chambers
- small pericardial effusion: minor buildup of fluid in the sac around the heart
- granular sparkling appearance of myocardium: a speckled, abnormal appearance of the heart’s muscle (myocardium), which may indicate abnormal protein buildup associated with ATTR-CM
- aortic stenosis: narrowing or blockage of the heart’s aortic valve
These problems may indicate increased stress on the heart and a reduced capacity to pump blood effectively to the body. However, it’s important to remember that not all of these issues are present in every case, and that these problems can also occur in other conditions.
How an echocardiogram differs from a PYP scan
Although ATTR-CM echocardiogram results can raise red flags, they can’t confirm the diagnosis. To achieve that, doctors need to identify TTR amyloid deposits — the abnormal protein clumps that cause ATTR-CM — in the heart, which an echo can’t do.
Technetium-99m pyrophosphate scans, also called PYP scans, are another type of ATTR-CM diagnostic test that can help determine if TTR amyloid deposits are present in the heart. For a PYP test, patients receive a dose of a radioactive tracer molecule that moves through the body and binds to TTR amyloid deposits. Accumulation of the tracer in the heart indicates the presence of TTR amyloid deposits, which can confirm an ATTR-CM diagnosis if other conditions are ruled out.
What happens during the test
For a transthoracic echocardiogram:
- the patient lies comfortably on an exam table
- the clinician puts gel on the patient’s chest and on a handheld, wand-like device that sends sound waves to the heart to help get a clearer picture
- the wand-like device is pressed firmly against the chest, with the clinician moving it around as needed to capture heart images
- the provider may ask the patient to move or breathe in certain ways to improve image quality
A transesophageal echocardiogram is similar, but before the images are captured, the patient gargles a numbing solution and receives sedation. The ultrasound device is then inserted down the throat to the area behind the heart.
Questions to ask your doctor about your results
A doctor should always review and help interpret echocardiogram findings. After receiving these results, patients may want to ask:
- if echocardiogram findings are consistent with a diagnosis of ATTR-CM or other health conditions
- what are the next steps to confirm or rule out an ATTR-CM diagnosis
- if other known, coexisting conditions might have affected the echocardiogram results
After diagnosis, people with ATTR-CM may also have regular echocardiograms for monitoring purposes. Patients undergoing repeated scans may want to ask about how their results have changed and what that might mean for their treatment.
Open dialogue between patients and doctors may help streamline diagnosis and treatment.
Amyloidosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
