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Foreword: touchREVIEWS in Endocrinology 22.2

Welcome to the latest edition of touchREVIEWS in Endocrinology, which features a diverse selection of editorials, reviews and original research articles exploring current developments in endocrine and metabolic care, from evolving diagnostic approaches to advances in treatment and the challenges of translating evidence into clinical practice. We begin with an editorial from Matos and colleagues, […]

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Overview

Cardiac amyloidosis

Explore expert insights on distinguishing cardiac amyloid light-chain amyloidosis (AL) from transthyretin amyloidosis (ATTR).

Learning Objectives Skip to Activities

These activities are funded by:

An independent educational grant from Alexion Pharma GmbH.

Jointly provided by Partners for Advancing Clinical Education and touchIME.

touchIME is an EBAC® accredited provider.

Latest Activities

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Activities
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Activity 2

Cardiac amyloidosis in the MDT era: Getting the AL vs. ATTR diagnosis right3

Learning Objectives
Launched Oct 22, 26
41 mins
3 Modules

Cardiac amyloidosis in the MDT era: Getting the AL vs. ATTR diagnosis right

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Multidisciplinary discussion on achieving an accurate diagnosis of AL vs. ATTR in cardiac amyloidosis.

Activity Modules

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Building a shared AL vs. ATTR diagnostic pathway

Duration: 13:09

Integrating emerging AL therapies into real‑world MDT decisions

Duration: 13:13

Operationalizing the cardiac amyloidosis MDT

Duration: 14:27
Activity 1

Beyond ATTR in Japan: Accurate diagnosis of cardiac AL in the TTR stabilizer era3

Learning Objectives
Launched Jul 30, 26
9 mins
Module 1 1 Module

Recognizing cardiac AL beyond ATTR patterns

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Expert insights on recognizing clinical and imaging red flags for cardiac AL and distinguishing these from overlapping ATTR presentations in Japanese patients with heart failure (recorded in Japanese, with an English-dubbed version and English slides available).

Activity Modules

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Introduction

How does cardiac amyloidosis present in Japanese heart failure populations?

Which clinical red flags should raise your suspicion towards a diagnosis of cardiac AL vs. ATTR?

What imaging clues should prompt reconsideration of a presumed ATTR diagnosis?

What is the JCS diagnostic algorithm and how does it support confidently ruling out cardiac AL?

What examples have you seen in your clinic where poor recognition of these features has impacted the diagnosis of AL?

7 mins
Module 2

Applying the JCS algorithm before TTR stabilizers

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Practical guidance on applying the JCS diagnostic algorithm, including monoclonal protein testing, biopsy and amyloid typing, to exclude AL before starting TTR stabilizers (recorded in Japanese, with an English-dubbed version and English slides available).

Activity Modules

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Introduction

Duration: 0:17

How should the JCS algorithm be applied to achieve a diagnosis of cardiac AL?

Duration: 2:34

At which point in the diagnosis of cardiac amyloidosis should cardiac AL vs. ATTR be distinguished?

Duration: 1:44

What are some of the frequent pitfalls that Japanese clinicians encounter when identifying cardiac amyloidosis?

Duration: 1:01

What are some clear triggers for urgent referral to hematology and/or MDT discussion?

Duration: 2:21
9 mins
Module 3

Avoiding misdiagnosis in the TTR stabilizer era

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Expert perspectives on navigating diagnostic pitfalls, including coexisting MGUS and ATTR, and recognizing when urgent hematology referral and multidisciplinary review are needed (recorded in Japanese, with an English-dubbed version and English slides available).

Activity Modules

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Introduction

Duration: 0:17

How has the expanding use of TTR stabilizers impacted the diagnosis of cardiac AL?

Duration: 2:14

What are some common clinical scenarios where misdiagnosis can frequently occur?

Duration: 2:03

What are your tips and tricks to enable clinicians to minimize diagnostic errors to prevent misuse of TTR stabilizers?

Duration: 2:21

How can closer collaboration between cardiology and hematology improve outcomes for patients with cardiac AL?

Duration: 2:47
Activity 1

Beyond ATTR in Japan: Accurate diagnosis of cardiac AL in the TTR stabilizer era

Launched Jul 30, 26

Japanese Downloads

Downloads Slides: Japanese

File Type: PDF
File Size: 0.57 MB
Download

English Downloads

Downloads Slides: English

File Type: PDF
File Size: 0.46 MB
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Expert Faculty5

Learn directly from experts in the field of Kidney Disorders

Dr. Toru Kubo

Kochi Medical School, Kochi University, Japan
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Dr. Toru Kubo

Kochi Medical School, Kochi University, Japan

Biography

Dr. Toru Kubo is an associate professor in the Department of Cardiology and Geriatrics at Kochi Medical School, Kochi University. He is also director of the Department of Clinical Genetics and the Heart Failure Center at Kochi Medical School Hospital.

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Dr. Kubo specializes in cardiovascular medicine, with a particular focus on the diagnosis and treatment of heart failure and cardiomyopathy, and the genetic analysis of cardiovascular disease.

Dr. Kubo is a registered physician of the Japanese Society of Internal Medicine and a certified specialist of the Japanese Society of Internal Medicine, the Japanese Circulation Society, the Japan Society of Human Genetics, and the Japanese Geriatrics Society.

Dr. Toru Kubo discloses: Speakers’ bureau fees from Alexion Pharmaceuticals, Alnylam Japan, Bristol Myers Squibb, and Pfizer Japan.

Ms. Christine Chiti

Dr. Christian Nitsche

Dr. Christian Nitsche

Medical University of Vienna, Vienna, Austria
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Dr. Christian Nitsche

Medical University of Vienna, Vienna, Austria

Biography

Dr. Christian Nitsche is a consultant cardiologist in the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.

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Dr. Nitsche’s clinical and research interests include cardiac amyloidosis, valvular heart disease, and multimodality cardiovascular imaging. His work focuses on improving risk stratification and outcome prediction through non-invasive myocardial tissue characterization using cardiovascular magnetic resonance, advanced echocardiography, multidetector computed tomography, and cardiac nuclear imaging. He also has expertise in transcatheter therapies for valvular heart disease.

Dr. Christian Nitsche discloses: Advisory board/panel fees from Prothena (relationship terminated). Grants/research support from AstraZeneca, Bayer, and Pfizer. Speaker bureau fees from Alnylam, Bayer, Meril Life Sciences, and Pfizer.

Dr. Toru Kubo

Dr. Yawara Kawano

Dr. Yawara Kawano

Kumamoto University Hospital, Kumamoto City, Japan
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Dr. Yawara Kawano

Kumamoto University Hospital, Kumamoto City, Japan

Biography

Dr. Yawara Kawano is a hematologist and physician-scientist at Kumamoto University Hospital, Japan, specializing in multiple myeloma and systemic amyloid light-chain amyloidosis (AL).

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Dr. Kawano graduated from Kumamoto University School of Medicine in 2006 and subsequently received his PhD from Kumamoto University. From 2013 to 2015, he was a postdoctoral research fellow at the Dana-Farber Cancer Institute, Boston, USA, where he investigated multiple myeloma biology and the bone marrow microenvironment. He is currently an assistant professor in the Department of Hematology and associate director of the Amyloidosis Center at Kumamoto University Hospital. He also serves as a councilor of the Japanese Society of Hematology and as a member of the delegation of the Japanese Society of Myeloma.

Dr. Kawano’s research integrates plasma-cell biology, clinical hematology, and multidisciplinary care to improve the understanding and management of plasma-cell disorders. His work in multiple myeloma has focused on tumor metabolism and interactions between myeloma cells and the bone marrow microenvironment. He has been actively involved in international clinical trials evaluating novel therapies, including isatuximab, teclistamab, and talquetamab for multiple myeloma, as well as anselamimab and etentamig for systemic AL. His clinical research in AL includes the significance of t(11;14), sensitive detection of monoclonal proteins, and real-world outcomes of daratumumab-based therapy. He has also contributed to multidisciplinary cardiac amyloidosis research using multimodality assessment—including cardiovascular magnetic resonance, computed tomography, extracellular-volume and T1 mapping, and cardiac strain analysis—to support risk stratification and treatment-response assessment.

Dr. Yawara Kawano discloses: Advisory board/panel fees from Bristol Myers Squibb and Johnson & Johnson. Speaker bureau fees from Alexion Pharmaceuticals, Bristol Myers Squibb, Johnson & Johnson, Ono Pharmaceutical, Pfizer, Sanofi, and Sebia.

Dr. Christian Nitsche

Dr. Paolo Milani

Dr. Paolo Milani

University of Pavia, Pavia, Italy
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Dr. Paolo Milani

University of Pavia, Pavia, Italy

Biography

Dr. Paolo Milani is a consultant at the Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, and an associate professor of clinical chemistry and clinical molecular biology at the University of Pavia. He specializes in systemic amyloidoses, monoclonal gammopathies, and precision diagnostic and therapeutic approaches for amyloid light-chain (AL) and transthyretin amyloidosis.

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Dr. Milani completed his medical, internal-medicine, and PhD training at the University of Pavia and undertook a hematology research fellowship at Mayo Clinic, Rochester, Minnesota, USA. His research spans the clinical, laboratory, and translational aspects of amyloidosis, including mass-spectrometry–based monoclonal-protein assessment, biomarker development, outcome prediction, and clinical trials of novel therapies for AL and transthyretin amyloidosis.

His research focuses particularly on renal amyloidosis and rarer forms of monoclonal gammopathy of renal significance. He supports this field through his role as secretary of the International Kidney and Monoclonal Gammopathy Research Group. Dr. Milani has served as principal investigator or sub-investigator in national and international amyloidosis studies and contributes to multidisciplinary care for patients with cardiac and renal involvement.

Dr. Paolo Milani discloses: Advisory board/panel fees from Bayer. Grants/research support from Pfizer.

Dr. Yawara Kawano

Ms. Christine Chiti

Ms. Christine Chiti

Royal Free London NHS Foundation Trust, London, UK
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Ms. Christine Chiti

Royal Free London NHS Foundation Trust, London, UK

Biography

Ms. Christine Chiti is a renal and transthyretin amyloidosis (ATTR) specialist nurse at the National Amyloidosis Centre (NAC), Royal Free London NHS Foundation Trust.

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With almost 24 years of nursing experience, Ms. Chiti has worked across a range of specialties, including pediatrics, pediatric critical care, trauma, neurology, nephrology, and dialysis. Throughout her career, she has held clinical roles at Kitwe Central Hospital in Zambia, the Royal National Orthopaedic Hospital, Fresenius Dialysis Centres, Barts Health NHS Trust, and the Royal Free London NHS Foundation Trust, gaining extensive experience in the management of complex and long-term conditions.

In her current role, she provides specialist care and support to patients with ATTR amyloidosis, with particular interests in patient education; long-term condition management; and holistic, patient-centered care. Ms. Chiti holds a diploma in nursing from Kitwe Central Hospital, Zambia, and has undertaken further studies in health and social care and genomics, supporting her interest in precision medicine, genetic medicine, and the management of hereditary ATTR amyloidosis. She is passionate about empowering patients through education and delivering high-quality multidisciplinary care that improves patient outcomes and quality of life. 

Ms. Christine Chiti discloses: Advisory board/panel fees from Bayer and Pfizer. Consultancy fees from Alnylam and AstraZeneca.

Dr. Paolo Milani

Dr. Toru Kubo

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These activities are funded by:

An independent educational grant from Alexion Pharma GmbH.

Jointly provided by Partners for Advancing Clinical Education and touchIME.

touchIME is an EBAC® accredited provider.

Disclosure of Unlabelled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

EBAC® Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

This content is intended for healthcare professionals outside of the UK.

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What You'll Learn

After completing this Program, you'll be better able to:
Select Activity...
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Activity 1
Activity 2
Activity 1

Beyond ATTR in Japan: Accurate diagnosis of cardiac AL in the TTR stabilizer era

Learning Objective 1

Recognize clinical and imaging features that should raise suspicion for cardiac AL (vs. ATTR) in Japanese patients with heart failure, particularly in older individuals with overlapping phenotypes

Start Now
Learning Objective 2

Apply the JCS‑recommended diagnostic algorithm in routine practice, including monoclonal protein testing, biopsy strategies, and definitive amyloid typing before starting TTR stabilizer therapy

Start Now
Learning Objective 3

Interpret common diagnostic pitfalls in the Japanese setting (such as coexistence of monoclonal gammopathy of undetermined significance and ATTR or rapidly progressive cardiac disease) to determine when urgent hematology referral and MDT discussion are warranted

Start Now
Activity 2

Cardiac amyloidosis in the MDT era: Getting the AL vs. ATTR diagnosis right

Learning Objective 1

Describe a practical, stepwise approach to distinguishing AL from ATTR in patients with suspected cardiac amyloidosis, including when to “rule out AL first” before starting TTR‑targeted therapy

Start Now
Learning Objective 2

Identify the key roles and responsibilities of cardiology, hematology, nephrology, and imaging within an MDT pathway for cardiac amyloidosis, including protocols for monoclonal testing, biopsy, and amyloid typing

Start Now
Learning Objective 3

Explain how emerging AL‑specific mechanisms of action (such as fibril‑directed agents) fit alongside plasma‑cell–directed therapy within real‑world MDT decision‑making

Start Now
Activity 1

Beyond ATTR in Japan: Accurate diagnosis of cardiac AL in the TTR stabilizer era

Learning Objective 1

Recognize clinical and imaging features that should raise suspicion for cardiac AL (vs. ATTR) in Japanese patients with heart failure, particularly in older individuals with overlapping phenotypes

Start Now
Learning Objective 2

Apply the JCS‑recommended diagnostic algorithm in routine practice, including monoclonal protein testing, biopsy strategies, and definitive amyloid typing before starting TTR stabilizer therapy

Start Now
Learning Objective 3

Interpret common diagnostic pitfalls in the Japanese setting (such as coexistence of monoclonal gammopathy of undetermined significance and ATTR or rapidly progressive cardiac disease) to determine when urgent hematology referral and MDT discussion are warranted

Start Now
Activity 2

Cardiac amyloidosis in the MDT era: Getting the AL vs. ATTR diagnosis right

Learning Objective 1

Describe a practical, stepwise approach to distinguishing AL from ATTR in patients with suspected cardiac amyloidosis, including when to “rule out AL first” before starting TTR‑targeted therapy

Start Now
Learning Objective 2

Identify the key roles and responsibilities of cardiology, hematology, nephrology, and imaging within an MDT pathway for cardiac amyloidosis, including protocols for monoclonal testing, biopsy, and amyloid typing

Start Now
Learning Objective 3

Explain how emerging AL‑specific mechanisms of action (such as fibril‑directed agents) fit alongside plasma‑cell–directed therapy within real‑world MDT decision‑making

Start Now