Table 1.
Comparison of the clinical manifestations of ATTR and COVID-19
| ATTR | COVID-19 | References | |
|---|---|---|---|
| Cardiovascular | HF, rhythm disturbances, conduction block, dyspnea, syncope, palpitations, elevated biomarkers, thromboembolism | HF, myocardial injury, myocarditis, acute coronary syndromes, palpitations, dyspnea, elevated biomarkers, thromboembolism | [11, 14, 17, 26, 30, 63, 64, 66] |
| Gastrointestinal | Diarrhea, constipation, loss of appetite, nausea | Diarrhea, loss of appetite, nausea/vomiting, gastroenteritis | [6, 9, 26, 29, 91, 92] |
| Hematologic and Immunologic | Increased pro-inflammatory cytokines, increased propensity to left atrial thrombosis | Cytokine storm, venous thrombosis, lymphopenia, venous/arterial thromboembolism, coagulopathy, microangiopathy | [15, 16, 20–22, 40, 56] |
| Musculoskeletal | CTS, spinal stenosis, trigger finger, shoulder, knee and hip surgery | Arthralgia, myalgias | [11, 31, 81, 103, 104] |
| Renal | Proteinuria, renal failure | AKI, ATN | [26, 30, 40, 48, 93, 94] |
| Neurologic | CNS: headache, ataxia, seizures, stroke-like episodes | Headache, dizziness, seizures, mental status changes, muscle pain, stroke, neuropathy (eg, AIDP), myopathy, myelitis, anosmia, hypogeusia, dysgeusia | [12, 26, 30, 32, 34, 70–72, 75–77, 105, 106] |
| Peripheral neuropathy: numbness/tingling in hands and feet, neuropathic pain, walking disability, loss of balance | |||
| Autonomic neuropathy: urinary retention and incontinence; erectile dysfunction; orthostatic hypotension; gastrointestinal manifestations | |||
| Pulmonary | Impairment from alveolar-septal amyloidosis | Cough, shortness of breath, pneumonia, ARDS | [1, 4, 5, 44, 45, 47, 48] |
| Pulmonary hypertension due to left-sided heart disease | |||
| Other/Constitutional | Unintentional weight loss | Fever, fatigue | [5, 7, 26] |
Bold text indicates overlapping manifestations or symptoms when comparing ATTR and COVID-19. Cardiac and musculoskeletal manifestations are most predominant in patients with ATTRwt amyloidosis; clinical manifestations in peripheral and autonomic nerves, along with the kidney, and eye are rarer. AIDP Acute Inflammatory Demyelinating Polyneuropathy, AKI Acute kidney injury, ARDS Acute respiratory distress syndrome, ATN Acute tubular necrosis, ATTR Amyloid transthyretin, CNS Central nervous system, COVID-19 Coronavirus disease 2019, CTS Carpal tunnel syndrome, HF Heart failure