Invasive Pressure-Volume Loop and PET-MR Phenotyping in Transthyretin Cardiac Amyloidosis: A Multimodal Imaging Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) (n=1). Intervention: Advanced multimodal imaging (PET-MR, invasive pressure-volume loop).

Q: What does this research mean for the field?

Advanced multimodal imaging confirmed biventricular stiffness and impaired contractile reserve in a patient with wild-type transthyretin cardiac amyloidosis, guiding early Tafamidis treatment. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ashwin Venkateshvaran; Björn Pilebro; Sandra Arvidsson; Anna Ekman; Per Lindqvist

doi:10.1093/ehjcr/ytag085

January 30, 2026European Heart Journal - Case ReportsOpen Access

Invasive Pressure-Volume Loop and PET-MR Phenotyping in Transthyretin Cardiac Amyloidosis: A Multimodal Imaging Case Report

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Key result

Advanced multimodal imaging confirms biventricular stiffness and impaired contractile reserve in an ATTRwt-CM patient.

n=1

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Why the study?

Cardiac amyloidosis is an under-recognized cause of heart failure in elderly patients, and novel tools may provide enhanced disease characterization beyond traditional diagnostics.

Key Points

To explore advanced multimodal imaging techniques for effective diagnosis and management of transthyretin cardiac amyloidosis.
Case study of a 78-year-old male with heart failure symptoms.
Utilized advanced imaging including echocardiography, DPD scintigraphy, PET imaging, and cardiac MR.
Invasive pressure-volume loop assessment conducted to evaluate cardiac function.
Confirmed diagnosis of wild-type transthyretin cardiac amyloidosis through multimodal imaging.
Identified significant biventricular stiffness and impaired contractile reserve.
Facilitated early initiation of Tafamidis treatment despite minimal symptoms.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

1 78-year-old man with progressive symptoms of heart failure diagnosed with wild-type transthyretin cardiac amyloidosis (ATTRwt-CM).

I

Intervention

Advanced multimodal imaging (speckle-tracking echocardiography, DPD scintigraphy, PET, cardiac MR) and invasive pressure-volume loop assessment.

Advanced multimodal imaging combined with invasive hemodynamics can comprehensively phenotype cardiac amyloidosis to guide early targeted therapy.

Implication

May support early targeted therapy in ATTRwt-CM via detailed phenotyping; hypothesis-generating and requires prospective validation.

Abstract

Background Cardiac amyloidosis (CA) is an under-recognized cause of heart failure in elderly patients. While diagnosis has traditionally relied on echocardiographic red flags and bone scintigraphy, novel tools may provide enhanced disease characterization. Case summary We present the case of a 78-year-old man with progressive symptoms of heart failure who was diagnosed with wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) through conventional and advanced multimodal imaging. Initial clues included a discordance between QRS voltages on electrocardiography and increased left ventricular wall thickness on echocardiography, along with signs of elevated filling pressures. Speckle-tracking echocardiography revealed impaired regional myocardial deformation, global function and work energetics. Serum and urine immunofixation excluded light chain (AL) amyloidosis. DPD scintigraphy confirmed amyloid deposition with characteristic distribution. Genetic testing ruled out hereditary variants. PET imaging demonstrated myocardial uptake suggestive of amyloid infiltration and microcalcification. Cardiac MR revealed elevated native T1 and extracellular volume fractions. Invasive pressure-volume loop assessment confirmed biventricular stiffness and impaired contractile reserve, despite clinical compensation at rest. These findings supported early initiation of Tafamidis in a minimally symptomatic patient. Discussion This case highlights the role of advanced diagnostics in refining cardiac amyloidosis phenotyping and guiding individualized therapeutic decisions.

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Cite This Study

Venkateshvaran et al. (2026) conducted a case report in wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) (n=1). Advanced multimodal imaging (PET-MR, invasive pressure-volume loop) was evaluated. Advanced multimodal imaging, including PET-MR and invasive pressure-volume loop assessment, confirmed biventricular stiffness and impaired contractile reserve in a 78-year-old man with ATTRwt-CM.

synapsesocial.com/papers/698586118f7c464f23009f0c https://doi.org/10.1093/ehjcr/ytag085