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Case Reports
. 2014 May;7(3):552-62.
doi: 10.1161/CIRCIMAGING.113.001396.

How to image cardiac amyloidosis

Rodney H Falk  1 , Candida C Quarta  1 , Sharmila Dorbala  2
Affiliations
Case Reports

How to image cardiac amyloidosis

Rodney H Falk et al. Circ Cardiovasc Imaging. 2014 May.
No abstract available

Keywords: amyloidosis; cardiac imaging techniques; echocardiography; multimodal imaging; radionuclide imaging.

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Figures

Figure 1
Figure 1. ECG
A 12 lead ECG showing first degree AV block with atrial premature beats and pseudo Q waves without typical low voltage complexes.
Figure 2
Figure 2. The value of tissue Doppler imaging in early diagnosis of cardiac amyloidosis
Images from a patient with AL amyloidosis demonstrate relatively normal mitral inflow parameters (E and A waves with normal deceleration time), but, abnormal pulmonary venous Doppler flow (diastolic predominance) and abnormal tissue Doppler images showing a reversed e’ and a’ ratio suggesting pseudonormalization of transmitral flow. E/e’ is elevated consistent with elevated left ventricular filling pressure.
Figure 3
Figure 3. The right ventricle in cardiac amyloidosis
Images from a patient with wild-type ATTR (senile systemic) amyloidosis, showing increased right ventricular wall thickness with a small cavity size (A). Myocardial relaxation velocities on tissue Doppler imaging are reduced (B) and tricuspid annular plane excursion is reduced (B).
Figure 4
Figure 4. Left ventricular strain imaging in cardiac amyloidosis
Apical 4-chamber peak systolic strain image illustrating a classic strain pattern of relatively well preserved apical strain (green and blue lines) with significant basal impairment (red and yellow lines). This is seen in the series of curves as well as the “bulls-eye” color coded strain image.
Figure 5
Figure 5. Loss of atrial function in cardiac amyloidosis
A transmitral Doppler image (A) showing a normal deceleration time but a very small A wave in an ATTR patient in sinus rhythm who presented with stroke, due to thrombus formation related to left atrial dysfunction. The pulmonary venous flow in a TTR amyloidosis patient (B) demonstrating almost exclusive diastolic flow due to restrictive filling-the atrium functions as a conduit with loss of contractile and reservoir function. This patient also had spontaneous echo contrast in the left ventricle (see Supplemental Video 2).
Figure 6
Figure 6. Atrial strain cardiac amyloidosis
Atrial strain is significantly impaired globally in a subject with ATTR cardiac amyloidosis (A) contrasted with normal atrial strain in a gene positive phenotype negative subject (B).
Figure 7
Figure 7. Typical rest cardiac magnetic resonance imaging features in a patient with familial ATTR cardiac amyloidosis
Late gadolinium enhanced images demonstrate diffuse LGE in the left ventricular myocardium (A) contrasted with dark myocardium a normal patient (B). The bottom panel (C) demonstrates LGE in the atrial wall, a characteristic feature of cardiac amyloidosis.
Figure 8
Figure 8. Tc-99m pyrophosphate (PYP) SPECT in cardiac amyloidosis
Note intense diffuse rest left and right ventricular myocardial uptake in a patient with ATTR cardiac amyloidosis (Top panel, standard cardiac imaging planes of short axis, horizontal long axis and vertical long axis projections). The bottom panel (standard cardiac imaging planes as above) shows blood pool activity and no myocardial uptake in a patient with non-amyloid LVH (left ventricular hypertrophy).
Figure 9
Figure 9. F-18 florbetapir imaging in cardiac amyloidosis
RestF-18 florbetapir PET images showing diffuse biventricular uptake of radiotracer in a patient with ATTR cardiac amyloidosis.
Figure 10
Figure 10. A Proposed diagnostic algorithm for the evaluation of patients with suspected cardiac amyloidosis
See this image and copyright information in PMC

References

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