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Table 1 Comparison of the clinical manifestations of ATTR and COVID-19

From: ATTR amyloidosis during the COVID-19 pandemic: insights from a global medical roundtable

  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, 20,21,22, 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, 70,71,72, 75,76,77, 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]
  1. 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