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Its recognition can be challenging because amyloid cardiomyopathy often coexists with common coronary, valvular, and arrhythmic conditions. A key diagnostic clue is discordance: the apparent coronary, valvular, or hemodynamic abnormality does not fully explain the patient\u2019s symptoms, myocardial phenotype, low-flow physiology, or persistent high-sensitivity cardiac troponin elevation. This review focuses on clinical situations in which interventional cardiologists should suspect CA. We discuss myocardial ischemia and coronary microvascular dysfunction caused by intramural vascular amyloid deposition, extravascular compression, and impaired vasodilator reserve; atrial arrhythmias and catheter ablation; the frequent coexistence of transthyretin cardiac amyloidosis (ATTR-CM) with aortic stenosis in patients undergoing transcatheter aortic valve implantation; and the complementary roles of echocardiography, cardiac computed tomography, cardiovascular magnetic resonance, bone-avid tracer scintigraphy, and invasive hemodynamic assessment. We also propose a practical cath-lab approach that integrates readily available clinical information, recognizes persistent or disproportionate myocardial injury as a diagnostic red flag, promptly distinguishes light-chain from ATTR amyloidosis, and preserves appropriate treatment of coexisting coronary or valvular disease. For the interventional cardiologist, the central principle is simple: when the lesion does not fully explain the patient, look beyond the lesion.<\/jats:p>","DOI":"10.1007\/s12928-026-01358-z","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:41:41Z","timestamp":1791459701000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac amyloidosis: what every interventional cardiologist should know"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2332-9151","authenticated-orcid":false,"given":"Yasuhiro","family":"Izumiya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Kuyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyoko","family":"Hirakawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Hanatani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Usuku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Matsuzawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiichiro","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Tsujita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"1358_CR1","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1001\/jama.2024.0442","volume":"331","author":"FL Ruberg","year":"2024","unstructured":"Ruberg FL, Maurer MS. 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Dr Kuyama has received remuneration for lectures from Pfizer Japan Inc., Alnylam Japan K.K., and Alexion Pharma GK. Dr Matsuzawa has received remuneration for lectures from Alnylam Japan K.K.; Amgen K.K.; AstraZeneca K.K.; Bayer Yakuhin, Ltd.; Nippon Boehringer Ingelheim Co., Ltd.; Canon Medical Systems Corporation; Daiichi Sankyo Co., Ltd.; EA Pharma Co., Ltd.; Eli Lilly Japan K.K.; Fukuda Denshi Co., Ltd.; Kowa Company, Ltd.; Kyowa Kirin Co., Ltd.; M3, Inc.; Mochida Pharmaceutical Co., Ltd.; MSD K.K.; Nishinihon Hospital; Novartis Pharma K.K.; Otsuka Pharmaceutical Co., Ltd.; Taisho Pharmaceutical Co., Ltd.; Teijin Healthcare Ltd.; Tsumura & Co.; and Viatris Inc.; and is affiliated with a department endowed by Nishinihon Hospital and Fukuda Denshi Co., Ltd. Dr Yamamoto has received honoraria from AstraZeneca, Novartis, Otsuka Pharma, and Daiichi Sankyo. Dr Tsujita has received research grants from AMI Co., Ltd.; Bayer Yakuhin, Ltd.; Bristol-Myers K.K.; EA Pharma Co., Ltd.; and Mochida Pharmaceutical Co., Ltd.; scholarship funds from AMI Co., Ltd.; Bayer Yakuhin, Ltd.; Boehringer Ingelheim Japan; Chugai Pharmaceutical Co., Ltd.; Daiichi Sankyo Co., Ltd.; Edwards Lifesciences Corporation; Johnson & Johnson K.K.; Ono Pharmaceutical Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; and Takeda Pharmaceutical Co., Ltd.; honoraria from Amgen K.K.; Bayer Yakuhin, Ltd.; Daiichi Sankyo Co., Ltd.; Kowa Pharmaceutical Co., Ltd.; Novartis Pharma K.K.; Otsuka Pharmaceutical Co., Ltd.; and Pfizer Japan Inc.; and is affiliated with endowed departments supported by Abbott Japan Co., Ltd.; Boston Scientific Japan K.K.; Fides-one, Inc.; GM Medical Co., Ltd.; ITI Co., Ltd.; Kaneka Medix Co., Ltd.; Nipro Corporation; Terumo Corporation; Abbott Medical Co., Ltd.; Cardinal Health Japan; Fukuda Denshi Co., Ltd.; Japan Lifeline Co., Ltd.; Medical Appliance Co., Ltd.; and Medtronic Japan Co., Ltd. The remaining authors have nothing to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}