Contrast adenosine stress echocardiography revealed markedly delayed myocardial perfusion and reduced coronary flow velocity reserve (CFVR-Vmean 1.8) indicating microvascular dysfunction in a patient with AL cardiac amyloidosis and non-obstructive epicardial coronaries.
Case Report (n=1)
No
Contrast adenosine stress echocardiography with CFVR measurement is a practical, noninvasive tool for detecting coronary microvascular dysfunction in patients with cardiac AL amyloidosis presenting with angina.
Effect estimate: CFVR-Vmean 1.8 (reduced; abnormal <2)
Cardiac amyloidosis (CA) is a rare but increasingly recognized cause of restrictive cardiomyopathy. Noninvasive assessment of coronary microvascular dysfunction in CA can facilitate earlier diagnosis and improve disease monitoring. We present a case of light-chain (AL) cardiac amyloidosis manifesting as exertional angina with non-obstructive epicardial coronary arteries, in which contrast adenosine stress echocardiography combined with Doppler-derived coronary flow velocity reserve (CFVR) measurement revealed impaired myocardial perfusion and reduced CFVR. The findings were consistent with cardiac magnetic resonance (CMR) and laboratory results, confirming the diagnosis of CA. This case demonstrates the clinical application of contrast adenosine stress echocardiography as a practical adjunct to advanced imaging modalities for evaluating microvascular dysfunction in CA.
Dai et al. (Thu,) conducted a case report in 59-year-old man with systemic light-chain (AL) cardiac amyloidosis presenting as exertional angina with non-obstructive epicardial coronary arteries and microvascular dysfunction (n=1). Contrast adenosine stress echocardiography with Doppler-derived coronary flow velocity reserve (CFVR) measurement vs. None was evaluated on Coronary microvascular function assessed by myocardial perfusion and coronary flow velocity reserve (CFVR) in mid-LAD (CFVR-Vmean 1.8 (reduced; abnormal <2)). Contrast adenosine stress echocardiography revealed markedly delayed myocardial perfusion and reduced coronary flow velocity reserve (CFVR-Vmean 1.8) indicating microvascular dysfunction in a patient with AL cardiac amyloidosis and non-obstructive epicardial coronaries.