A 60-year-old male presenting with typical echocardiographic apical sparing suggestive of cardiac amyloidosis had negative confirmatory imaging and was ultimately diagnosed with smoldering multiple myeloma.
Case Report (n=1)
No
Typical echocardiographic findings of cardiac amyloidosis, such as apical sparing, can be misleading and may require further confirmatory testing like tissue biopsy, especially in patients with non-ischemic cardiomyopathy and smoldering multiple myeloma.
Amyloidosis is a leading cause of infiltrative cardiomyopathy and in turn heart failure with preserved ejection fraction. Amyloidosis is mainly classified into amyloid light chain (AL) or primary amyloidosis and transthyretin amyloidosis (ATTR) that is subdivided into wild-type ATTR (ATTRwt) and hereditary or familial transthyretin-related amyloidosis (hATTR). Moreover, strain preservation pattern in the left ventricular apex in echocardiography suggests cardiac amyloidosis and cardiac magnetic resonance (CMR) could identify an infiltrative process. Similarly, the radiotracer uptake of technetium-99m pyrophosphate by myocardium could indicate transthyretin accumulation. In contrast, serum-free light chain (FLC) alongside serum and urine immunoelectrophoresis could indicate AL amyloidosis. Here, we present a case of a 60-year-old male with a classical apical sparing on echocardiography but with an unremarkable CMR and technetium-99 m pyrophosphate.
Gaibor et al. (Thu,) conducted a case report in Nonischemic cardiomyopathy and smoldering multiple myeloma (n=1). Diagnostic imaging (Echocardiography, CMR, Technetium-99m Pyrophosphate) was evaluated on Confirmation of cardiac amyloidosis. A 60-year-old male presenting with typical echocardiographic apical sparing suggestive of cardiac amyloidosis had negative confirmatory imaging and was ultimately diagnosed with smoldering multiple myeloma.