Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.
Jinghua Wang, Department of Hematology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China

Main Body of the Abstract
Background: Light chain deposition disease (LCDD) is a systemic disease characterized by abnormal production of monoclonal immunoglobulin light chains (LCs) deposited in multiple organs. The kidney is the principal involved organ, and the examination of renal biopsy specimens using immunofluorescence (IF) or immunoelectron microscopy (IEM) has proven to be a practical and sensitive method for the diagnosis of LCDD. We report here two clinical cases of LCDD, which exhibited identical electron microscope characteristics in the kidneys and labial salivary glands (LSG).
Case Report: Patient 1 was a 71-year-old woman presented with both lower extremities edema. Laboratory investigations showed decreased hemoglobin level of 80 g/L, increased 24-hr urinary protein level of 2102 mg. NT-proBNP and hs-cTnT levels increased to 630.3 pg/mL and 25.9 pg/mL, respectively; interventricular septum (IVS) thickness increased to 13.8mm on echocardiography. Immunofixation electrophoresis (IFE) of serum and urine were both positive for monoclonal λ LC. Serum free λ LC was elevated at 2308.08mg/L with κ/λ ratio of 0.01. Bone marrow examination showed 4% plasma cells with λ LC restriction. We then performed LSG biopsy for this patient suspected of amyloidosis. Electron-dense, granular, nonfibrillar, amorphous deposits along acinar basement membrane and capillary basement membrane were seen under IEM, and fine-grained substances aggregation were seen in some acinar cavities. The λ chain was positive but κ chain was negative for deposits. Further renal biopsy was performed and IEM confirmed electron dense deposits in the mesangial area, along the glomerular basement membrane (GBM) and tubular basement membrane (TBM), with λ chain-restricted staining. Patient 2 was a 54-year-old woman presented with chest distress and lower extremities edema. Laboratory results revealed very high level of 24-hr urinary protein (7310 mg), and raised NT-proBNP (765.5 pg/mL) and hs-cTnT (28.2 pg/mL) levels. Echocardiography showed thickened IVS of 13mm. IFE of serum and urine both revealed monoclonal IgG-κ. Serum free LC results were κ 2717.00 mg/L and κ/λ 186.86. Bone marrow examination revealed 6% monoclonal plasma cell infiltration. IEM examination of LSG showed electron dense deposits along capillary basement membrane, among focal interstitium, with κ chain-restricted staining. Further workup of renal biopsy demonstrated only κ chain staining in mesangial area, GBM and TBM by IF, and electron dense deposits by electron microscopy. Congo red staining for the biopsies of the two patients were all 

Unsuspected light chain deposition disease diagnosed by labial salivary gland biopsy PC9 (#47)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Daniel Davies. Mayo Clinic, Rochester, MN, U.S.A.

**Main Body of the Abstract**
Background: A simple, six-variable score was developed to identify patients with heart failure with preserved ejection fraction (LVEF ≥ 40%) at increased risk of transthyretin amyloid cardiomyopathy (ATTR-CM). We sought to determine the score's performance in patients with reduced ejection fraction (HFrEF, LVEF < 40%).
Methods: The ATTR-CM score was applied to patients with LVEF <40% undergoing 99mtechnetium-pyrophosphate scintigraphy (PYP) for suspicion of ATTR-CM at Mayo Clinic (2013-2023). The score, based on clinical and echocardiographic variables (age [+2 if 60-69 y.o., +3 if 70-79 y.o., and +4 if ≥80 y.o.], male sex [+2], EF < 60% [+1], posterior wall thickness of ≥ 12mm [+1], relative wall thickness > 0.57 [+2], and hypertension history [-1]) was calculated using an additive point system. A score ≥ 6 indicated "high risk" for ATTR-CM. Standard ROC methods were used to assess performance.
Results: A LVEF <40% was present in 204 of 2239 patients (median age 73, 84% male, 43% ATTR-CM prevalence), of whom 64% had a "high risk" score. The ATTR-CM patients were older, less likely hypertensive, and had thicker left ventricles (see table). The score exhibited strong discrimination (AUC 0.83), sensitivity 90%, specificity 55%, and excellent calibration (Hosmer-Lemeshow p=0.25). Precision recall curves indicated clinically useful classification (positive predictive value > 60% at score cutoff ≥ 6).
Conclusions: The ATTR-CM score showed strong predictive performance in HFrEF patients undergoing PYP for suspicion of ATTR-CM. This highlights the utility of the ATTR-CM score irrespective of ejection fraction, aiding in identifying candidates for definitive diagnostic testing.



Prediction of Transthyretin Amyloid Cardiomyopathy in Heart Failure with Reduced Ejection Fraction Using the ATTR-CM Score PB110 (#274)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Saurabh Zanwar, Mayo Clinic, Rochester, MN

**Main Body of the Abstract**
Background: Daratumumab, bortezomib, cyclophosphamide and dexamethasone (D-VCd) represents the current standard of care for most patients with previously untreated diagnosed AL amyloidosis. However, data guiding subsequent treatment following D-VCd are limited.
Methods: Patients initiated on frontline D-VCd between 01/2018 and 12/2022 and switched to a subsequent treatment for progression/rising serum free light chains (sFLC), suboptimal response [≤partial response], or toxicity,  were included. Patients with a planned autologous stem cell transplant (ASCT) after a very good partial response or better with D-VCd induction were excluded. Hematologic response was assessed from start of subsequent treatment and organ response was calculated from frontline treatment initiation using consensus definitions. Event-free survival (EFS) and overall survival (OS) were calculated from start of subsequent treatment to stopping treatment due to progression, suboptimal response or toxicity.
Results: Out of 119 patients treated with D-VCd, 28 patients received subsequent treatment and were included in the study cohort (Table). The median follow-up time from subsequent treatment was 17.9 months (95% CI: 16.3-26.4). Indications for initiating subsequent treatment were suboptimal response in 21 (75%) patients (mostly hematologic PR), progression/rising sFLC in 6 (21%) patients, and toxicity in 1 (4%) patient. Treatments utilized were heterogeneous (Table) with daratumumab-based combinations being the most common subsequent regimen (n=12; 43%) followed by ASCT ( n=7, 25%); 82% (23/29) demonstrated a deepening response. Median EFS was 14.3 months (95% CI: 10.3-NR), and 18-month OS rate was 89 %.
Conclusion: Treatments utilized post D-VCd are heterogeneous and demonstrate a deepening of response in majority of patients.



Treatment Patterns for AL Amyloidosis after Frontline Daratumumab, Bortezomib, Cyclophosphamide and Dexamethasone Treatment Failures PA151 (#184)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Aina Gayà-Barroso 1,2, Juan González-Moreno 1,2, Adrián Rodríguez 1,2, Tomás Ripoll-Vera 2,3, Inés Losada López 1,2, Milena Paneque 4,5,6, and Eugenia Cisneros-Barroso 1,2,
1. Internal Medicine Department. Son Llàtzer University Hospital. Palma de Mallorca. Spain.
2. Health Research Institute of the Balearic Islands (IdISBa), Son Llàtzer University Hospital, Palma de Mallorca, Spain.
3. Cardiology Department. Son Llàtzer University Hospital. Palma de Mallorca. Spain.
4. Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.
5. Center for Predictive and Preventive Genetics, Institute for Molecular and Cell Biology (CGPP-IBMC), Porto, Portugal.
6. Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.

**Main Body of the Abstract**
Background:
Variant transthyretin amyloidosis (ATTRv) is a rare genetic disease that affects patients' quality of life by affecting various organs and tissues. Despite a wealth of research on medical and psychosocial interventions, the impact of occupational therapy on patients with ATTRv is not well understood. This research focuses on the assessment of activities of daily living and occupations as a fundamental tool in the management of patients after diagnosis.
Objective:
The aim of this study was to develop an occupational therapy programme for the improvement of daily functioning and quality of life in patients with ATTRv.
Methods:
After an initial semi-structured interview, fourteen patients with ATTRv were enrolled in the study. The occupational therapist worked with the patient to develop short and medium term occupational goals, based on the Model of Human Occupation. During the six-month intervention period, weekly or ten-day sessions were held to monitor and adjust the guidelines. Outcomes were measured using scores for activities of daily living and psychological well-being.
Results:
The results showed that twelve patients stayed the same in their activities of daily living, two got worse and eight improved their psychological scores and the occupational situation. The study highlights the importance of early intervention and further research into the effectiveness of occupational therapy  interventions for patients with ATTRv. It also notes that patients who received occupational therapy intervention reported that six months was not enough and emphasises the fundamental role of the therapist in providing motivation, facilitating meaningful activities, improving daily living and routines.



Daily life in patients with hereditary transthyretin amyloidosis: a qualitative study. PC29 (#1)

Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.
Joon Young Hur, Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Republic of Korea

Main Body of the Abstract
Introduction
In amyloid light chain (AL) amyloidosis, bortezomib-based therapy can grant satisfactory (hematologic complete remission and/or organ response) and durable response in some patients who may then not proceed to autologous stem cell transplantation (ASCT). We retrospectively compare the outcomes of the patients who deferred ASCT with the patients who conducted ASCT after induction treatment.
Methods
We reviewed the outcomes of newly diagnosed ASCT-eligible AL amyloidosis patients who received bortezomib-based chemotherapy at a referral center between 2013 and 2020. Patients with biopsy-proven, systemic, AL amyloidosis, aged between 18-70 years, N-terminal pro-brain natriuretic peptide (NT-proBNP) <5,000 pg/mL, troponin-T (TNT) <0.06 ng/mL, high sensitivity TNT (hsTNT) <0.075 ng/mL, and ejection fraction (EF) > 40% were included. Major exclusion criteria was concurrent multiple myeloma defined.
Results
Of total 27 patients who were eligible for ASCT, 24 patients who had induction chemotherapy were enrolled in this study. The best hematologic response rate after induction treatment was 66.6% (n=16) complete remission (CR) and 33.3% (n=8) very good partial remissions (VGPR). There was no specific difference of progression free survival (PFS) according to ASCT (P=0.22). Median PFS did not differ with the presence of organ response (p=0.86). However, patients who achieve hematologic CR after induction chemotherapy had favorable PFS compared with patients who achieve hematologic VGPR (P=0.043). Swimmer's plot of each patients was shown in Figure.
Conclusions
In this study, we documented a high hematologic response rate with bortezomib based induction chemotherapy. We investigated if patients receiving bortezomib based chemotherapy could defer ASCT.

The role of deferred autologous stem cell transplantation in patients with AL amyloidosis who had VGPR or CR after bortezomib-based induction therapy  PA140 (#90)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Nicolas Hugo Quiroz; Maria Victoria Anconetani; Marcelina Carretero; Delfina Cirelli; Erika Bárbara Brulc; María Adela Aguirre; Gabriela Alejandra Blugerman; Elsa Mercedes Nucifora; Marcelo Raul Risk; María Lourdes Posadas Martínez.
Submitting Author: Delfina Cirelli. Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires. Argentina.

**Main Body of the Abstract**
Background: Early detection of systemic amyloidosis is crucial for prognosis and quality of life. Artificial intelligence (AI) predictive models offer the potential for timely identification. Studies using medical records for diagnostic algorithms are lacking.
Objective: To develop an AI-driven predictive model for systemic amyloidosis identification.
Materials & methods: Dynamic retrospective cohort study. All adult patients affiliated to the Medical Care Program at the Hospital Italiano de Buenos Aires were included. For each case of amyloidosis, up to four controls without amyloidosis of the same age, gender, and affiliation period were matched. A retrospective collection of all available information was conducted for each case and their respective controls spanned from six months before diagnosis. The collected data included demographic, clinical, laboratory, and imaging information. Seven machine-learning models, employing resampling techniques, were applied to training and testing cohorts with internal validation through cross-validation.
Results: Among 961 patients, 218 cases and 743 controls met the selection criteria. The mean age was 65 years, with 63% male. The predictive variables that best identify amyloidosis included carpal tunnel syndrome history, arrhythmia, abnormalities in free light chains, and imaging. When assessing performance details, the random forest and decision tree models exhibited the best AUC (over 90%) consistently in both cohorts.
Summary & conclusion: Medical record features demonstrated strong performance in early amyloidosis identification using the developed AI-driven model, particularly with the random forest and decision tree algorithms.



Artificial intelligence for the detection of systemic amyloidosis PA3 (#105)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
María Lourdes Posadas Martínez; Delfina Cirelli; Florencia De Florio; María Adela Aguirre; María Soledad Saez; Patricia Beatriz Sorroche; Erika Barbara Brulc; Elsa Mercedes Nucifora; Valeria Aliperti; Jimena Vicens; Marcelina Carretero.
Submitting Author: Delfina Cirelli. Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires. Argentina.

**Main Body of the Abstract**
Background: Data on the epidemiology of amyloidosis are scarce worldwide, making it difficult to understand its true incidence and mortality.
Objective: To estimate the incidence and mortality rate of systemic amyloidosis in people affiliated to a Medical Care Program in Buenos Aires, Argentina.
Materials & methods: Prospective cohort study. All affiliates to the Medical Care Program of the Hospital Italiano de Buenos Aires, and incident cases and deaths due to amyloidosis from the Institucional Amyloidosis Registry from January 1, 2011, to December 31, 2022, were included. Incidence and mortality rates were reported per million person-year with their respective 95% confidence intervals (95%CI). Crude, standardized, and stratified rates were determined.
Results: During the study period, 1668182 person-year were at risk. The crude incidence rate was 63 (95%CI 52-76) and the crude mortality rate was 31 (95%CI 23-40) cases per million person-years. The ATTR wild-type amyloidosis subtype exhibited the highest rates, followed by AL  amyloidosis. Men were more affected, especially from the age of 70 years onwards. Additionally, an increase in the incidence and mortality rate was observed throughout the period studied. The standardized incidence rate to the US population was 20 (95%CI 15-25) cases per million person-year.
Summary & Conclusion: The results of this study indicate that amyloidosis remains a rare disease but has increased in incidence in recent years, especially in elderly people. This underlines the importance of further research in epidemiology for a better understanding of the pathology and its evolution.



Epidemiological perspectives of amyloidosis in Argentina: results of an analysis of incidence and mortality in a population affiliated to a Medical Care Program PA110 (#108)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Delfina Cirelli; Carolina Elena Wang; Carlos Federico Varela; María Adela Aguirre; Elsa Mercedes Nucifora; Erika Barbara Brulc; Patricia Beatriz Sorroche; María Soledad Saez; Marcelina Carretero; María Lourdes Posadas Martínez.
Submitting Author: Delfina Cirelli. Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires. Argentina.

**Main Body of the Abstract**
Background: Two-thirds of patients with AL amyloidosis had renal involvement. First-line treatment consists of chemotherapy or chemotherapy followed by autologous stem cell transplantation (ASCT) to reduce light chain production. Renal response can be observed as early as 3 months after initiation of treatment.
Objective: Estimate the percentage of patients with AL amyloidosis and renal involvement who achieved renal response following first-line treatment.
Materials & methods: Closed retrospective cohort study. All consecutive patients belonging to an institutional registry and diagnosed with AL amyloidosis and renal involvement from February 1, 2003, until April 30, 2022, were included and followed for 12 months. The renal response rate was estimated as a percentage with a 95% confidence interval.
Results: Forty-three patients were included. Regarding first-line treatment, 70% (n=30) of patients received chemotherapy exclusively and 30% (n=13) received chemotherapy followed by ASCT. Complete renal response rates were 46% (29-63 95%CI) at 6-month and 43% (26-63 CI95%) at one-year follow-up. In contrast, 26% (13-43 CI95%) and 43% (26-63 CI95%) of patients encountered renal progression at 6-month and on-year follow-up, respectively.
When differentiating groups based on the received first-line treatment regimen, those who received chemotherapy followed by ASCT showed higher complete renal response at both 6 and 12 months, with lower renal progression at 12 months (Table 1).
Summary & conclusion: The first-line treatment improved renal function and reduced proteinuria in a significant percentage of patients. This was observed primarily in those who received chemotherapy followed by ASCT as initial treatment.



Renal response to treatment in patients with Immunoglobulin Light Chain Amyloidosis PA143 (#107)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Marcelina Carretero, Delfina Cirelli, Paula Schwartz, Franco Faelo, Gisela Bendelman, María Agustina Marco, Elsa Nucifora, María Adela Aguirre, María Lourdes Posadas Martínez.
Submitting Author: Delfina Cirelli. Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires. Argentina.

**Main Body of the Abstract**
Background: Health-related quality of life (HRQoL) is a metric that reflects the patient's perception of their physical, mental and social well-being. It is a crucial factor to consider when assessing the impact of systemic amyloidosis on patient's lives.
Objective: To describe HRQoL in patients with systemic transthyretin amyloidosis variant type (ATTRv) within a registry of individuals with amyloidosis.
Materials & methods: Cross-sectional study (2021-2023) of ATTRv amyloidosis patients from an Amyloidosis Registry. HRQoL, assessed through the EuroQoL 5D-3L (EQ-5D-3L), was described by the proportion of patients without problems, with moderate or severe problems in each domain. Visual analog scale was presented with mean and standard deviation or median and interquartile range, depending on the distribution. Finally, the HRQoL was compared with that of the general population.
Results: Twenty-four patients were included, with a median age of 51 years, predominantly women. Paresthesias (88%), weakness, and fatigue (79%) were prevalent symptoms. Nearly all patients experienced impairment in at least one EQ-5D-3L domain. Regarding specific domains, pain or discomfort was the most common complaint. The visual analog scale revealed a median of 52. Compared to the general population, individuals with ATTRv amyloidosis demonstrated a greater compromise in HRQoL across all EQ-5D-3L domains.
Summary & Conclusion: The study reveals substantial impairment in HRQoL for ATTRv amyloidosis patients, emphasizing the need for targeted interventions. These results lay the groundwork for future research and guide clinical approaches to improve the well-being of this affected population.



Health-related quality of life in hereditary transthyretin amyloidosis, a cross-sectional study PC36 (#106)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Olga Gursky

**Main Body of the Abstract**
Apolipoproteins are “amyloid signature proteins”, yet apolipoprotein-amyloid interactions are enigmatic. To understand how apoE interacts with Alzheimer’s amyloid-beta peptide in fibrillary deposits, the NMR structure of full-length human apoE was docked to four structures of patient-derived Abeta(1-40) and Abeta(1-42) fibrils determined previously using cryo-electron microscopy or solid-state NMR. Similar docking was done using the structures of human apoC-III and of an apolipoprotein consensus peptide. In all complexes, conformational changes were required to expose large hydrophobic faces of apolipoprotein amphipathic alpha-helices for sub-stoichiometric binding to hydrophobic surfaces on fibril sides or ends. Basic residues flanking the hydrophobic helical faces in apolipoproteins interacted favorably with acidic residue ladders in some amyloid polymorphs. Molecular dynamics simulations of selected apoE-fibril complexes confirmed their stability. Amyloid binding via cryptic sites, which became exposed upon opening of flexibly linked apolipoprotein alpha-helices, resembled apolipoprotein-lipid binding. This mechanism extends to other apolipoprotein-amyloid interactions. Apolipoprotein binding alongside fibrils could interfere with fibril fragmentation and secondary nucleation, while binding at the fibril ends could halt amyloid elongation and dissolution in a polymorph-specific manner. The proposed mechanism is supported by extensive prior experimental evidence and helps reconcile disparate reports on apoE’s role in Abeta aggregation. Furthermore, apoE domain opening and direct interaction of Arg/Cys158 with amyloid potentially contributes to isoform-specific effects in Alzheimer’s disease. In summary, current modeling supported by prior experimental studies suggests similar mechanisms for apolipoprotein-amyloid and apolipoprotein-lipid interactions; explains why apolipoproteins co-deposit with amyloids; and helps reconcile conflicting reports on the chaperone-like apoE action in Abeta aggregation.



Molecular modeling of apoE interactions with amyloid-beta fibrils from human brain suggests a structural basis for apolipoprotein co-deposition with amyloids PC1 (#28)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Olga Gursky

**Main Body of the Abstract**
Calcific aortic valve disease is a prevalent life-threatening heart disease in search of pharmacological treatments. To find such treatments, we need to better understand modulators of valvular calcification. Amyloid and collagen fibrils are often adjacent to calcified areas in explanted aortic valve tissues. Moreover, explanted valvular amyloid promotes calcification in vitro. Stereochemical complementarity between acidic arrays on the amyloid surface and the 4.7Å Ca-Ca spacing in amorphous hydroxyapatite suggests a template-based mechanism for amyloid-guided calcification, yet the role of collagen is unclear. To explore this role, we used collagens I–IV with various amyloidogenic proteins including apolipoprotein A-I (apoA-I); upon oxidation, apoA-I forms amyloid that deposits in atherosclerotic plagues. Human plasma-purified apoA-I was oxidized (oxA-I) to convert Met residues to Met(O), followed by 72h incubation under amyloid-promoting conditions. Amyloid formation was monitored by spectroscopy (CD, FT IR, fluorescence) and electron microscopy. ELISA showed that formation of apoA-I amyloid oligomers and fibrils enhances apoA-I–collagen binding. To test whether this binding influences biomineralization, apoA-I fibrils mixed with collagen-I (up to 1:1 protein:collagen wt:wt) were incubated in modified simulated body fluid at 37oC for 50h. Abundant hydroxyapatite crystals were observed surrounding apoA-I+collagen-I fibrils; few crystals formed with collagen-I fibrils alone, and no crystals formed with apoA-I fibrils alone. Our results suggests that apoA-I amyloid binds collagen-I, thereby forming acidic arrays on the matrix that promote biomineralization. Other amyloid proteins (lysozyme, insulin and serum amyloid A) showed similar effects. Emerging atomic structures of amyloid-collagen fibrils may help elucidate their role in degenerative calcification.



Amyloid-collagen fibrils as potential templates for pathologic biomineralization in calcific aortic valve disease OC17 (#27)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Anita D'Souza, MD, MS, Associate Professor of Medicine, Medical College of Wisconsin, Milwaukee, WI

**Main Body of the Abstract**
Systemic light chain amyloidosis (AL) patients often have a lag period of increasing symptoms during which they seek healthcare. We leveraged electronic health records (EHR) data from the TriNetX research network to describe the incidence, timing, and co-occurrence of 19 red-flag diagnoses among a cohort of AL patients identified between 10/2015-12/2020. These red-flag diagnoses represented AL features and were identified using ICD codes up to 36 months pre-AL diagnosis. Among 1,401 U.S. patients with at least 36 months of pre-AL EHR data, 46% were females, 16% were non-Hispanic Black, and 6% were Hispanic. The median age was 71 (range, 21–91) years. Dyspnea and fatigue were the most prevalent, identified in 55% and 45% of patients at AL diagnosis at a median time of 8.1 (IQR 2.7, 15.9) and 7.8 (1.9, 15.8) months, respectively (Figure).  The cumulative number of red-flag diagnoses was a median (IQR) of 2 (0-4) at -24 months, 4 (2-7) at -6 months, and 5 (2-9) at AL diagnosis. Analyses of pairwise co-occurrence of diagnoses indicated high association (Cole’s coefficient, CC >0.6), with the highest inter-organ system association between autonomic neuropathy (AN) and dyspnea (CC 0.76, p0.009), neuropathy and purpura (CC 0.68, p<0.001), AN and fatigue (CC 0.68, p0.004), fatigue and purpura (CC0.65, p<0.001), and altered bowels and AN (CC0.60, p0.006). These findings provide novel information about the timing and co-occurrence of red-flag symptoms already discovered by healthcare providers as diagnoses in existing EHR of patients and could be used to develop algorithms for early identification of AL.



Timing and co-occurrence of red-flag diagnoses prior to a diagnosis of systemic light chain (AL) amyloidosis PA5 (#147)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Author: Plínio José Whitaker Wolf
Institution: Instituto Dante Pazzanese de Cardiologia
City: São Paulo
State: São Paulo (SP)

**Main Body of the Abstract**
Introduction: Although hereditary transthyretin amyloidosis (ATTRv) is more frequent in the elderly population, it is not limited to older age groups. There are genetic variants that can lead to a more severe and earlier amyloidosis clinical presentation. We describe a series of cases with onset of symptoms under the age of 25 associated with the identification of a rare variant in the TTR gene.
Results: Three male patients from the same family with ATTRv confirmed by a positive molecular test for the p.F64S pathogenic variant, with a mean age at clinical presentation of 19±3 years. The baseline characteristics of the patients are shown in Table 1. All the patients had a mixed phenotype, with severe polyneuropathy, dysautonomia and cardiomyopathy. All had left ventricular hypertrophy, with a mean septal thickness/posterior wall of 15.6±4/13±3 mm. One patient had recurrent large pericardial effusion. No deaths occurred during follow-up (five years). All the patients received specific treatment for amyloidosis.
Discussion/Conclusion: We describe three relatives with a mixed and very early phenotype of ATTRv, determined by the p.F64S variant. This mutation is very rare and we found 7 cases described in the literature, all very young, with a predominantly polyneuropathic phenotype, but most with associated heart disease. The p.V50M variant can also occur in young people, but this occurs around the third decade of life. In conclusion, amyloidosis should not be seen as a disease exclusive to the elderly population and should therefore be considered as a differential diagnosis for ventricular hypertrophy in young people.



Transthyretin amyloidosis in the second decade of life: a rare genetic variant PB18 (#524)

Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.
BATUHAN BULAN, ISTANBUL UNIVERSITY-CERRAHPASA, CERRAHPASA MEDICAL FACULTY, INTERNAL MEDICINE DEPT., ISTANBUL, TURKEY

Main Body of the Abstract
Background: AL amyloidosis is caused by deposition of misfolded immunuglobulin light chains. There can be a rapid progression to ESKD. In this case report, we described a 63-year-old woman with de novo AL amyloidosis in renal allograft occurring after 4 years following kidney transplantation.
Case: A 63-year-old woman with a history of hypothyroidism, diabetes mellitus and nephrolithiasis underwent living donor kidney transplantation from her sister for ESKD in 2015. She presented with proteinuria in 2019. Laboratory investigations revealed creatinine 2.53 mg/dl, albumin 2.85 g/dl and urinary protein 8.8 g/day.  Renal allograft biopsy disclosed AL amyloidosis. IgG/lambda monoclonal protein was found. Serum free lambda light chain was 256 mg/l with a kappa/lambda ratio of 0.21. The bone marrow biopsy showed 10% lambda restricted plasma cells. The patient had stage IV (revised Mayo 2012) disease with heart, kidney and autonomic nervous system involvement. The native kidney tissue disclosed no evidence of amyloidosis. CyBorD was started and maintenance immunosuppression was continued. After 6 cycles, VGPR with organ response was achieved and maintained for 14 months. The patient died of COVID-19 pneumonia in 2021.
Summary and Conclusion: Recurrence of AL amyloidosis in a renal allograft after transplantation is not an uncommon scenario but de novo AL amyloidosis in kidney graft is extremely rare. The few cases reported and the patient described here are summarized in the table. AL amyloidosis should be included in the differential diagnosis of new onset albuminuria in a patient with kidney transplantation. Concomitant immunosuppressive therapy challenges treatment of these patients.

De Novo AL Amyloidosis In Renal Allograft-Case Report And Literature Review PA83 (#503)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Larissa Ventura Ribeiro Bruscky, Instituto Dante Pazzanese de Cardiologia, São Paulo-SP, Brazil.

**Main Body of the Abstract**
Introduction: Localized amyloidosis refers to the deposition of amyloid fibrils in specific organs. Airways, bladder, eyes and digestive tract are the most common sites. When amyloid deposits are found on biopsy, it is imperative to look for involvement in other sites. We describe 3 cases of amyloidosis that were initially seen as localized and, after further investigation, two of them were systemic.
Methods: Observational case series study
Casuistry: Three patients, all male, presented with localized amyloid fibril deposition. Clinical characteristics are listed in Table 1. P1: had episodes of hoarseness associated with chest pain, fever and diarrhea. A laryngeal biopsy showed amyloid deposits in the trachea. P2 and P3 had tumor lesions on the ocular conjunctiva. Mass spectrometry: P1 and P3 had lambda-type light chain amyloid deposit and P2 macular amyloid deposit. Cardiac magnetic resonance results: P1: significant hypokinesia and late enhancement in the inferolateral wall; P2: symmetrical left ventricular hypertrophy (probably related to aortic stenosis); P3: septal thickness of 13mm and a slight increase in the T1 map (1162).
Comments: Only in P2, who had macular amyloidosis, a protein located exclusively in the skin, it was easy to exclude systemic involvement. In P1 systemic involvement was considered, and the patient received specific therapy for light chain amyloidosis. In P3, the cardiac resonance findings were not sufficient for the hematologist to recommend treatment.
Conclusions: despite laborious diagnostic workout, it is challenge to differentiate between localized and systemic amyloidosis.



Challenge to differentiate between localized and systemic amyloidosis: case series report PC6 (#474)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Larissa Ventura Ribeiro Bruscky. Instituto Dante Pazzanese de Cardiologia, São Paulo-SP. Brazil.

**Main Body of the Abstract**
Introduction: Amyloidosis are protein-misfolding disorders associated with deposition of amyloid proteins in multiple organs and progressive organ dysfunction. Familial transthyretin amyloidosis (ATTRm) usually presents itself as a progressive polyneuropathy, but also as cardiomyopathy, nephropathy and vitreous opacities. Single features rarely remain isolated. We describe a patient with ATTRm who had sustained ventricular tachycardia as an isolated symptom​.
CASE REPORT: A 61-year-old Brazilian man, with medical history of hypertension, Portuguese parents, complaining of chest pain followed by palpitations one hour before admission to the emergency room. Intense sweating and high heart rate (196 beats/min) were observed. ECG revealed sustained ventricular tachycardia. He was successfully submitted to electrical cardioversion and a cardioverter defibrillator was implanted. ​ ​Biological markers for myocardial necrosis were high but a coronary angiogram revealed no significant contribution. Echocardiogram showed ejection fraction of 66%, diffuse hypertrophy (septum 19mm and posterior wall 15mm), moderate atrial enlargement and relative apical sparing pattern. Cardiac magnetic resonance showed diffuse late gadolinium enhancement of non-ischemic pattern, circumferential, and myocardial edema, suggesting amyloidotic cardiomyopathy. Molecular analysis of TTR gene evidenced a p.Val50Met mutation.​
CONCLUSION: TTRm as cause of Sustained Ventricular Tachycardia should be considered.​Val50Met is a pathogenic mutation characterized, mainly, by being clinically expressed by polyneuropathy (PAF). When cardiomyopathy is present, usually heart failure is the main clinical expression. In this case, ventricular arryhthmia was the only feature.  This case highlights the risk of sudden cardiac death in ATTRm.



Sustained Ventricular Tachycardia as an isolated feature of transthyretin amyloidotic cardiomyopathy - Val50Met PB43 (#476)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Larissa Ventura Ribeiro Bruscky. Instituto Dante Pazzanese de Cardiologia, São Paulo-SP. Brazil.

**Main Body of the Abstract**
Introduction: Amyloidoses comprise a family of protein misfolding diseases in which disease-specific precursor proteins aggregate into highly ordered amyloid fibrils. Hereditary systemic amyloidosis usually derived from genetic variants of transthyretin. These autosomal dominant conditions diagnosis has implications for prognosis, genetic counseling, and treatment.
Case report: P1. 41-year-old man with dysautonomia (syncope and chronic diarrhea), reduced left ventricular ejection fraction, dyspnea NYHA II and severe pain in lower and upper limbs​. PYP-Tc99m: HTE/HTD ratio: 2.22. Symptoms onset: 40 years old. 
P2. 67-year-old man, severe bradycardia, syncope and need for a permanent pacemaker associated with severe polyneuropathy.PYP-Tc99m: HTE/HTD ratio: 2.4. Symptoms onset: 50 years old. ​
P3. 66-year-old woman with preserved heart failure, pacemaker at 60 years old and dyspnea NYHA I. PYP-Tc99m: HTE/HTD ratio: 2.0. Symptoms onset: 55 years old.
Discussion and conclusion: More than 120 TTR mutations have been identified. V142l and V50M are the most common variants. The V142I mutation is associated with cardiomyopathy and is more likely to be seen in those with West African ancestry. In the U.S., it is estimated that 3.2% of African Americans have this mutation. In our cardiac amyloidosis center in Brazil, we have a sample of 38 patients with the wild-type form and 138 with the hereditary form. Three patients have a very rare double mutation presentation (p.V142I + p.S70R​ / p.V142I + p.V50M / p.V142I + p.V50M​). Double variants are associated to more severe myxed cardiomyopathy and polyneuropathy phenotype, earlier and more severe symptoms​ and greater uptake in scintigraphy: PYP-Tc99m​.



Transthyretin Amyloidosis: Does more than one pathogenic variant confer higher severity? PC75 (#478)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Vaishali Sanchorawala
Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, MA, USA

**Main Body of the Abstract**
Clinical trials (CTs) have helped pave the way for treatment of AL amyloidosis over the years. Despite notable progress, challenges persist in research, with regard to patient enrollment. This abstract outlines the portfolio of AL amyloidosis CTs at our center during the past three decades and identifies recent impediments to recruitment.
Between 1994 and 2023, a total of 632 participants with AL amyloidosis were enrolled in CTs at the center. There were 12 CTs of stem cell transplantation (SCT) with 341 participants and 24 CTs of non-SCT therapies with 291 participants. The majority of SCT-CTs were investigator-initiated trials (IIT; n=11); only one was a cooperative group conducted trial. Meanwhile, 10 of the 24 non-SCT-CTs were industry sponsored; 8 were IIT; 4 were multicenter IIT; and 2 were cooperative group conducted trials. Representation of racial/ethnic minorities in all trials was 11% (n=70), including 38 (6%) participants who self-identified as Non-Hispanic Black and 19 (3%) as Hispanic.
Over the last 5 years (2018‒2023), 130 patients were prescreened for 9 non-SCT treatment CTs, of whom 79 (61%) failed recruitment (Table 1). The most common reasons affecting enrollment were: patient preference due to trial protocol logistics (27%); dFLC not meeting eligibility (18%); cardiac biomarkers out of range (16%); and failure to meet other CT inclusion criteria (20%).
In conclusion, many participants have successfully enrolled in numerous CTs at our center, despite AL amyloidosis being a rare disease. Minority accrual was low. Both patient-related and protocol-related (i.e., restrictive inclusion criteria) factors frequently impeded CT participation.



Defying The Odds: A 30-Year Journey Through AL Amyloidosis Research With A Focus On Recent Structural/Clinical Barriers To Clinical Trial Enrollment PA154 (#212)

Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.
Name: João Henrique Rissato. Institution: Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo. City: São Paulo. State: São Paulo.

Main Body of the Abstract
Introduction: The gastrointestinal tract may be affected by deposits in the parenchyma and also due changes in the autonomic nervous system. However, heart failure also may cause edema and hypoperfusion leading to an increased gut permeability and predisposes to intestinal microbiome disturbances.
Objective: this study aimed to identify the intestinal microbiome composition in patients with transthyretin amyloidosis with and without cardiac involvement and control group and correlate with echocardiographic parameters and cardiac biomarkers such as troponin and BNP.
Methods: 60 adults were included: 20 with cardiac involvement defined by a ventricular septum thickness > 12 mm (G1), 20 without cardiac involvement (G2) and 20 controls (G3). The microbiome profile was obtained by sequencing the 16S rRNA gene (Illumina® Miseq).
Results: among the 40 patients (G1 and G2), 85% had the hereditary form and 15% the wild form. The most prevalent mutation was Val142Ile (52,9%), followed by Val50Met (17,6%). The differentially abundant bacterial genera in G1 and G2 were: Streptococcus, Lachnospiraceae and Selimonas, while G3 presented a higher relative abundance of Metahanosphaera (figure 1). Butyricoccaceae and Streptococcus were associated with higher levels of troponin I, while the genus Hungatela was associated with higher circulating levels of BNP (p<0.05). Larger left atrial volumes were associated with Lachnospiraceae and higher cardiac mass indexes were associated with Butyricoccaceae (p<0.05).
Conclusions: patients with amyloidosis presented a particular intestinal microbiome profile when compared to control group and there was correlation with echocardiographic  parameters and biomamarkers of heart failure and necrosis.

Analysis of the intestinal microbiome in patients with transthyretin amyloidosis with and without cardiac involvement and its correlation with ecocardiographic parameters and biomarkers.  OC4 (#330)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Fábio Fernandes - Academic Research Organization, Instituto do Coração InCor, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

**Main Body of the Abstract**
Introduction: Transthyretin amyloidosis (ATTR) is a multisystem disease caused by the deposition of fibrillar protein in organs and tissues. ATTR genotypes and phenotypes are highly heterogeneous.
Methods: We present data on physical signs and symptoms, cardiac and neurological assessments and genetics in patients enrolled in the Transthyretin Cardiac Amyloidosis Registry in the state of São Paulo, Brazil.
Results: Six hundred-forty-four patients were enrolled, 505 with the variant form (ATTRv) and 139 with wild-type (ATTRwt). Sixteen different mutations were detected, the most common being Val50Met (48.3%) and V142Ile (40.8%). Overall, more than half of the patients presented cardiological involvement, and the difference in this proportion between the ATTRv and ATTRwt groups was significant (43.9 vs. 89.9%; p<0.001). The neurological phenotype also differed between ATTRv and ATTRwt (56.8 vs. 31.7%; p<0.001). The mixed phenotype was found in 25.6% of the population, without a significant difference between the forms of amyloidosis. A group of patients remained asymptomatic (10.4%), with a lower proportion of asymptomatic ATTRwt patients.
Conclusions: This study details the clinical and genetic spectrum of patients with ATTR in São Paulo, Brazil. This preliminary analysis highlights the considerable phenotypic heterogeneity of neurological and cardiac manifestations in patients with variant and wild-type ATTR.



Clinical and genetic profiles of patients with hereditary and wild-type transthyretin amyloidosis: the Transthyretin Cardiac Amyloidosis Registry in the state of São Paulo, Brazil (REACT-SP) PA86 (#55)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Arianne Clare Agdamag, Cleveland Clinic Foundation, Cleveland, OH

**Main Body of the Abstract**
A 51-year-old Caucasian male with history of carpal tunnel syndrome, spinal stenosis and bicep tendon rupture initially presented with shortness of breath. TTE demonstrated normal LVEF and severe concentric LVH (IVSd 1.92cm, PWd 1.9cm) raising suspicion for amyloidosis. Technetium99m pyrophosphate (99mTc-PYP) scan showed a semi-quantitative visual score of grade 0 and no uptake on SPECT/CT. Cardiac MRI exhibited diffuse patchy mid-wall late gadolinium enhancement and elevated extracellular volume (62%). Laboratory work-up included Hs-TNT 21ng/L, NT proBNP 1711pg/mL, kappa light chain 18.8mg/L, lambda light chain 219.2mg/L, FLC difference 199.8mg/L, K/L ratio 0.09 and immunofixation revealed a poorly defined region of restricted mobility in the lambda lane. Bone marrow biopsy (BMx) showed a lambda restricted plasma cell neoplasm representing 10% of marrow cellularity with no amyloid deposition. Fluorescence in situ hybridization results were normal. Endomyocardial biopsy (EMBx) demonstrated amorphous material strongly positive with thioflavin-S staining and immunohistochemistry observed amyloid deposits positive for lambda light chains. Laser capture microdissection coupled to mass spectrometry (LCM-MS)showed equal abundance of lambda immunoglobulin light chains and transthyretin deposition. Genetic testing was negative. He received daratumumab, cyclophosphamide, bortezomib, and dexamethasone and was eventually started on tafamidis.
This case highlights a rare but clinically relevant concurrent presence of two different types of amyloidosis. Proceeding with simultaneous 99mTc-PYP and hematologic work-up is highly recommended when amyloid is suspected. If initial work-up is suggestive of both AL and ATTR amyloidosis, histopathological investigation with EMBx and BMx is warranted. A thorough and complete diagnostic work-up is needed to ensure appropriate management.



Double Trouble: A case of biopsy proven ATTR and AL cardiac amyloid PA89 (#67)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Hilda Gonzalez Bonilla. Division of Cardiovascular Diseases, Mayo Clinic, Rochester MN. Research collaborator.

**Main Body of the Abstract**
Non-invasive diagnosis of ATTR cardiac amyloidosis (CA) can be established using bone scintigraphy (BS) according to consensus guidelines. We present a case series of patients who were misdiagnosed with ATTR-CA using the non-invasive pathway and were prescribed and/or treated with Tafamidis.
Twenty-six patients were identified from five referral centers. Eighteen (69.2%) were male and median age was 69 years. Twenty-five (96.1%) reported at least one symptom suggestive of CA (Table). Echocardiogram was performed in all, 18 (69.2%) had at least one feature suggestive of CA. Seven of the 12 (46.1%) who had cardiac magnetic resonance (CMR) performed had at least one feature suggestive of CA. Six (23.1%) did not have any feature suggestive of CA on echocardiogram or CMR. All patients had BS that was interpreted as positive in the initial institution. However, 19 (73.1%) of the previously reported positive BS were interpreted as negative at an amyloid referral center, two had an equivocal BS. Eight of 26 did not have SPECT performed with initial BS. Six patients were diagnosed with AL rather than ATTR, in these cases monoclonal protein studies performed at the initial institution were incomplete or misinterpreted.
Almost 25% of patients in this study were found to have AL, highlighting the potentially fatal nature of misdiagnosis using the non-invasive pathway. The remaining patients did not have a diagnosis of amyloidosis after evaluation at a referral center. This study highlights the perils of the non-invasive pathway of ATTR diagnosis if consensus guidelines are not followed.



Mistreatment with Tafamidis for Erroneous Diagnosis of ATTR Cardiac Amyloidosis: Case Series PB76 (#334)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Kouhei Kawaguchi, Department of Clinical Laboratory Medicine, Jichi Medical University / Applied Technology Laboratory, Eiken chemical Co., LTD., Tochigi, Japan

**Main Body of the Abstract**
【Introduction】
AA amyloidosis was caused by fibrillized and tissue deposition of the N-terminal region of serum amyloid A (SAA) as AA protein, but the mechanism is not clear. Lysosomal proteases, which degrade SAA, are believed to play a role in amyloidogenesis. In this study, we analyzed fragments of SAA digested by cathepsin D, a lysosomal protease.
【Materials and methods】
Recombinant human SAA1.1 (rSAA) at 0.2 mg/mL was incubated with cathepsin D (from human liver, 0.2 U/mL) in 50 mM sodium acetate buffer (pH 3.2) for 24 hours at 37℃.
MALDI-TOF MS analysis: The mass spectrometry was performed on a matrix-assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF MS; ultrafleXtreme, Bruker Japan). Spectra were analysed by flexAnalysis (Bruker Japan). Samples were measured by linear positive mode.
【Results】
Full-length rSAA was detected at 11,813.0 m/z with a weak peak and various fragments were detected, mainly at 10,909.7 m/z, 10,539.1 m/z, 9,333.1 m/z, and 4,869.8 m/z. The fragments were estimated aa8-105, aa12-105, aa22-105, and aa63-105 based on their molecular weights.
【Discussion】
Cathepsin D generated various fragments with conserved C-terminal regions from rSAA. Therefore, cathepsin D appeared to have an inhibitory effect on AA amyloidosis. In the future, we would like to further investigate the effects of other lysosomal proteases and post-translational modifications of SAA.



Analysis of SAA fragments digested by a lysosomal protease. PC3 (#73)

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Dipan Uppal, Cleveland Clinic Florida, Weston, FL

**Main Body of the Abstract**
Background: Transthyretin cardiac amyloidosis (ATTR-CA) is most often associated with heart failure with preserved ejection fraction (HFpEF). The incidence of ATTR-CA in patients with lower ejection fractions is not well characterized.
Methods: We performed a single-center retrospective cohort study of consecutive patients with ATTR-CA evaluated between 02/2016 and 12/2022. Data on patient demographics, comorbidities, imaging, and laboratory findings were compared across HF phenotypes.
Results: Our registry contained 213 patients. 21.6% (n=46) presented with heart failure with reduced ejection fraction (HFrEF), 17.8% (n=38) with heart failure with mid-range ejection fraction (HFmrEF), and 60.6% (n=129) with HFpEF at the time of diagnosis with ATTR-CA. The mean age was 78.1± 8.6 years with 91.1% male. Comorbidities included hypertension (78.9%), ischemic heart disease (55.9%), atrial fibrillation (72.8%), and chronic kidney disease (63.4%). Half presented with a NYHA class ³ III at the time of diagnosis. Those presenting with HFrEF or HFmrEF were more likely to have NYHA functional class ³ III (p=0.003), higher NT-pro-BNP (P=0.001), and higher serum creatinine levels (P=0.02) as compared to those with HFpEF. Additionally, with the decline in systolic fraction, end-diastolic left ventricular internal diameter increased significantly (P<0001).
Conclusion: Although ATTR-CA is traditionally thought to be seen primarily among patients with HFpEF, our data suggests that ATTR-CA has a higher prevalence than traditionally described among patients with HFrEF and underscores the importance of heightened clinical suspicion regardless of ejection fraction when considering ATTR-CA. Furthermore, although comorbidities are similar, patients with HFmrEF and HFrEF have worse symptom burden.



Transthyretin Cardiac Amyloid: Broad phenotypic spectrum and implications for diagnosis PB65 (#161)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.