Updates in cardiac amyloidosis: a review

Sanjay M Banypersad, James C Moon, Carol Whelan, Philip N Hawkins, Ashutosh D Wechalekar, Sanjay M Banypersad, James C Moon, Carol Whelan, Philip N Hawkins, Ashutosh D Wechalekar

No abstract available

Keywords: cardiac amyloidosis; infiltrative cardiomypathy; treatment.

Figures

Figure 1.
Figure 1.
ECG of a patient with cardiac AL amyloidosis showing small QRS voltages (defined as ≤6 mm height), predominantly in the limb leads and pseudoinfarction pattern in the anterior leads.
Figure 2.
Figure 2.
Transthoracic echocardiogram with speckle tracking. The red and yellow lines represent longitudinal motion in the basal segments, whereas the purple and green lines represent apical motion. This shows loss of longitudinal ventricular contraction at the base compared to apex.
Figure 3.
Figure 3.
CMR with the classic amyloid global, subendocardial late gadolinium enhancement pattern in the left ventricle with blood and mid-/epimyocardium nulling together.
Figure 4.
Figure 4.
Sequential static images from a CMR TI scout sequence. As the inversion time (TI) increases, myocardium nulls first (arrow in image 3), followed by blood afterwards (arrow in image 6), implying that there is more gadolinium contrast in the myocardium than blood—a degree of interstitial expansion such that the “myocrit” is smaller than the hematocrit.
Figure 5.
Figure 5.
A positive 99mTc-DPD scan for TTR cardiac amyloid (left), showing uptake in the heart (arrow) and reduced bone uptake. The right-hand panel shows a fused CT/SPECT image showing myocardial uptake with greater uptake in the septum.
Figure 6.
Figure 6.
An endomyocardial biopsy of a patient with cardiac AL amyloidosis stained as follows: (A) Congo red only; (B) Apple-green birefringence under polarized light; (C) Congo red with lambda overlay (negative); (D) Congo red with kappa overlay (positive).

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