Unveiling Cardiac Amyloidosis: A Case Report Exploring The Role of Multimodal Imaging
Abstract
Background: Cardiac Amyloidosis (CA) is a condition caused by the deposition of amyloid fibrils in the heart. The diagnosis of CA can be challenging and requires a high index of suspicion. Multimodality imaging, including echocardiography and Cardiac Magnetic Resonance (CMR), plays a crucial role in the diagnosis, evaluation, and management of CA. This case report presents a patient with suspected CA and highlights the role of multimodality imaging in diagnosis.
Case Illustrations: A 49-year-old male with previously diagnosed hypertension came with progressive dyspnea, fatigue, and lower extremity edema. Initial clinical suspicion for Heart Failure with preserved Ejection Fraction (HFpEF) with increased thickness in the Interventricular Septum (IVS) was raised. Electrocardiography showed Left Ventricular Hypertrophy (LVH). Further diagnostic work-up revealed evidence of CA. Both multimodal imaging, including echocardiography and cardiac Magnetic Resonance Imaging (MRI), were used to confirm the diagnosis.
The patient underwent comprehensive multimodal imaging, which included: 1) Echocardiography showed LVH with diastolic dysfunction (E’ <5), myocardial sparkling, and cherry on top appearance in Global Longitudinal Strain (GLS) analysis with reduced GLS, suggestive of amyloid infiltration; 2) Cardiac MRI demonstrated diffuse subendocardial Late Gadolinium Enhancement (LGE) patterns typical of amyloid deposition.
The combination of imaging findings led to the diagnosis of CA. There was no Endomyocardial Biopsy (EMB) needed to reveal amyloid deposits. The patient was started on symptomatic management for heart failure.
Conclusion: This case highlights the importance of multimodality imaging in the diagnosis of CA. Echocardiography, CMR, and nuclear imaging are complementary tools that enhance diagnostic accuracy and guide treatment decisions. Early recognition of CA is crucial for appropriate management and better prognosis.
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References
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