Unveiling the unseen: navigating heart involvement in amyloidosis with biomarkers beyond the horizons of imaging

: Amyloidosis refers to a heterogenous group of systemic diseases characterized by the presence of a misfolded protein that deposits as amyloid fibrils in the interstitium of organs and tissues. The vast majority of cases of cardiac involvement (cardiac amyloidosis-CA) are due to immunoglobulin light chain (AL) amyloidosis, or transthyretin (ATTR) amyloidosis (either in its wild-type form-ATTRwt, or variant-ATTRv). The diagnostic workup of these diseases reflects the differences in terms of aetiology. Although imaging techniques represent fundamental tools in the diagnosis and follow-up of patients CA, they present several limitations. Cardiac biomarkers, particularly natriuretic peptides and troponins, overcome most of these limitations. They can be more sensitive in the detection of early phases of the disease but, overall, they currently represent the most powerful tool to define disease stage, organ response and disease progression. There is mounting evidence regarding the use of specific laboratory biomarkers to monitor treatment response. The information provided by advanced imaging techniques should be regarded as complementary and not as substitute for that provided by laboratory biomarkers, as only these can often be able to unveil the unseen.