Emerging Insights into Granulomatous and Amyloidogenic Cardiomyopathies

Granulomatous and amyloidogenic cardiomyopathies are infiltrative conditions that can be fatal if left untreated. Among these, cardiac amyloidosis and cardiac sarcoidosis are significant but often underdiagnosed causes of heart failure, each serving as cardiac manifestations of broader systemic diseases. Advancements in imaging techniques, along with the emergence of novel therapies—particularly for cardiac amyloidosis—have brought these conditions into sharper focus for both clinicians and researchers. The assessment of patients' cardiac and extracardiac symptoms, combined with echocardiography, is crucial in raising initial suspicion for these diseases. Cardiac magnetic resonance imaging is essential for differentiating between the two, as distinct late gadolinium enhancement patterns are observed in each condition. Additional diagnostic value is provided by positron emission tomography and Technetium-labeled nuclear scintigraphy, which can help confirm the diagnosis in the majority of patients. Early diagnosis is key to improving outcomes. Treatment strategies for these conditions differ significantly: cardiac amyloidosis is primarily managed with disease-modifying therapies for the transthyretin subtype and chemotherapy for the AL subtype, while cardiac sarcoidosis is treated with corticosteroids and immunosuppressive drugs aimed at reducing inflammation.