. 2022 Nov 21;74(6):441–449. doi: 10.1016/j.ihj.2022.11.006

Table 1.

Red flags of ATTR-CM.

Cardiac	Extracardiac
• Hypotensive or normotensive if previously hypertensive • Atrial fibrillation together with conduction system disorders • Increased LV wall thickness • Arrythmias and conduction defects with HFpEF • Infiltration of the atrioventricular and sinoatrial nodes • Cardiac conduction abnormalities • Low-flow and low-gradient aortic stenosis • Cardiogenic shock due to diffuse ischemia (although rare) • Pseudo infarct pattern with low/decreased QRS voltage on ECG • Disproportionally elevated NT-proBNP to degree of HF • Persistently elevated troponin levels • Increased valve thickness • Subendocardial LGE • Abnormal gadolinium kinetics • Increased extracellular volume	• Soft tissue infiltrations - purpura (advanced disease), bilateral carpal tunnel syndrome/weakness or paresthesia of hands, atraumatic biceps tendon rupture, lumbar spinal stenosis • Nervous system - peripheral neuropathy and dysautonomia • Gastrointestinal tract - diarrhea and/or constipation, nausea and vomiting, and early satiety, leading to weight loss • Ophthalmological - glaucoma, intravitreal deposition and scalloped pupils • Liver and kidney - hepatomegaly (advanced disease) and renal disease (rare)

Cardiac

Extracardiac

•
Hypotensive or normotensive if previously hypertensive
•
Atrial fibrillation together with conduction system disorders
•
Increased LV wall thickness
•
Arrythmias and conduction defects with HFpEF
•
Infiltration of the atrioventricular and sinoatrial nodes
•
Cardiac conduction abnormalities
•
Low-flow and low-gradient aortic stenosis
•
Cardiogenic shock due to diffuse ischemia (although rare)
•
Pseudo infarct pattern with low/decreased QRS voltage on ECG
•
Disproportionally elevated NT-proBNP to degree of HF
•
Persistently elevated troponin levels
•
Increased valve thickness
•
Subendocardial LGE
•
Abnormal gadolinium kinetics
•
Increased extracellular volume

•
Soft tissue infiltrations - purpura (advanced disease), bilateral carpal tunnel syndrome/weakness or paresthesia of hands, atraumatic biceps tendon rupture, lumbar spinal stenosis
•
Nervous system - peripheral neuropathy and dysautonomia
•
Gastrointestinal tract - diarrhea and/or constipation, nausea and vomiting, and early satiety, leading to weight loss
•
Ophthalmological - glaucoma, intravitreal deposition and scalloped pupils
•
Liver and kidney - hepatomegaly (advanced disease) and renal disease (rare)

ECG, electrocardiogram; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; LGE, late gadolinium enhancement; LV, left ventricular; NT-proBNP, N-terminal pro b-type natriuretic peptide.