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. 2025 Oct 9;13(10):e71207.
doi: 10.1002/ccr3.71207. eCollection 2025 Oct.

Co-Existing ATTR Amyloidosis and Coronary Artery Disease: A Risky Combination

Arnaud Planchat  1 , Damien Guijarro  1 , Yazan Musayeb  1 , Georgios Giannakopoulos  1 , Raphaël Giraud  2 , Nana K Poku  1 , Dre Agathe Py  1 , Stéphane Noble  1
Affiliations

Co-Existing ATTR Amyloidosis and Coronary Artery Disease: A Risky Combination

Arnaud Planchat et al. Clin Case Rep. .

Abstract

The coexistence of cardiac amyloidosis with coronary artery disease is a complex diagnosis and a challenging clinical scenario. Amyloid fibril deposition contributes to arteriosclerosis, and amyloidosis is also recognized to be associated with intramural microvascular disease. The restrictive heart failure associated with amyloidosis worsened the complication of PCI. A multimodal imaging approach is necessary when cardiac amyloidosis is highly suspected.

Keywords: ATTR cardiomyopathy; complex percutaneous coronary intervention; coronary artery disease; multimodal imaging.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
(A) coronary angiogram, RAO caudal view, the arrow shows an angiographically significant proximal circumflex artery stenosis. (B) Optical coherence tomography (OCT) showed a lipid‐rich plaque with a thin cap and a minimum lumen area of 1.76 mm2, indicating a significant proximal stenosis before the angioplasty. (C) coronary angiogram, RAO caudal view, after angioplasty of the proximal circumflex artery with pre‐dilatation, implantation of a 3.5 × 30 mm stent (ONYX FRONTIER (Medtronic, Minneapolis, Minnesota, USA)) and post‐dilatation. Angiographic control revealed no reflow secondary to distal embolization.
FIGURE 2
FIGURE 2
Technetium 99 m Tc‐pyrophosphate bone scintigraphy showed a PERUGINI grade 2 cardiac uptake encompassing the basal segments and mid‐anteroseptal segment on SPECT–CT images, suggesting senile or hereditary cardiac amyloidosis. Contrast on planar images does not make myocardial uptake clearly visible, unlike SPECT.
See this image and copyright information in PMC

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