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Natriuretic Peptides and Cardiac Troponins: Markers of Disease Progression and Risk in Light Chain Cardiac Amyloidosis

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Abstract

Purpose of Review

Light chain (AL) amyloidosis can cause an infiltrative cardiomyopathy that can result in symptomatic heart failure. The vague, nonspecific onset of signs and symptoms may lead to a delay in diagnosis and treatment leading to poor outcomes. Cardiac biomarkers, such as troponins and natriuretic peptides, play a pivotal role in diagnosis, determining prognosis, and assessing treatment response in patients with AL amyloidosis. Because of the evolving landscape for both diagnosis and treatment of AL cardiac amyloidosis, we review the critical role these and other biomarkers play in the clinical management of this disease.

Recent Findings

A number of conventional cardiac and noncardiac serum biomarkers are commonly used in AL cardiac amyloidosis and may be surrogates for cardiac involvement and inform prognosis. These include typical heart failure biomarkers such as levels of circulating natriuretic peptides as well as cardiac troponins. Other noncardiac biomarkers frequently measured in AL cardiac amyloidosis included difference between the involved and uninvolved free light chains (dFLC) and markers of endothelial cell activation and damage such as von Willebrand factor antigen and matrix metalloproteinases.

Summary

AL amyloidosis can lead to cardiac involvement which has been associated with poor outcomes, especially if not identified and treated early. Natriuretic peptides and cardiac troponins are cornerstones for the diagnosis and management of AL cardiac amyloidosis. Their levels may represent cardiac stress, injury, and possibly degree of cardiac involvement, and they play a key role in AL amyloidosis disease staging.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Isabel Wees

  2. Parkland Health and Hospital System, Dallas, TX, USA

    Isabel Wees, Nicholas S. Hendren & Justin L. Grodin

  3. Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Nicholas S. Hendren, Lori R. Roth & Justin L. Grodin

  4. Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA

    Gurbakhash Kaur

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Correspondence to Justin L. Grodin.

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Conflict of Interest

JLG: consulting: Pfizer, Eidos/BridgeBio, Alnlyam, Intellia, Sarepta, and AstraZeneca; grant support: Pfizer 67656485, Eidos/BridgeBio, Texas Health Resources Clinical Scholarship, and NHLBI R01 HL160892-01A1. GK: consulting/honoraria: BMS, Janssen, Sanofi, Arcellx, Kedrion, Pfizer; research funding: BMS, Janssen, and Abbvie.

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Wees, I., Hendren, N.S., Kaur, G. et al. Natriuretic Peptides and Cardiac Troponins: Markers of Disease Progression and Risk in Light Chain Cardiac Amyloidosis. Curr Heart Fail Rep 20, 350–357 (2023). https://doi.org/10.1007/s11897-023-00616-y

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