Key result
CMR identifies atypical AL cardiac amyloidosis presenting as dilated cardiomyopathy without classic echocardiographic features.
Why the study?
AL amyloidosis is rapidly progressive with high mortality if diagnosis is delayed, making early detection crucial, but echocardiography may have limitations in identifying cardiac amyloidosis.
Case Report (n=1)
Cardiac amyloidosis may present as dilated cardiomyopathy without classic echocardiographic features, emphasizing the value of early cardiac magnetic resonance imaging for accurate and timely diagnosis.
Consider CMR in dilated cardiomyopathy without classic echo features; extends diagnostic utility but leaves broader applicability open.
BACKGROUND: Amyloid light chain (AL) amyloidosis is a rapidly progressive disease with significant untreated mortality especially when diagnosis is delayed, making early detection of disease crucial. Various cardiac imaging modalities are emerging as alternatives to echocardiography for the early detection of this disease. CASE SUMMARY: A patient presented with progressive heart failure symptoms and was evaluated with an echocardiogram showing a mildly dilated left ventricle, moderate systolic dysfunction, only mildly increased left ventricular wall thickness, and reduced global longitudinal strain without apical sparing. Cardiac magnetic resonance (CMR) showed diffuse, patchy late gadolinium enhancement. Endomyocardial biopsy confirmed AL cardiac amyloidosis (CA). The patient was treated with guideline-directed medical therapy and chemotherapy agents. DISCUSSION: Although echocardiography has great utility as a screening tool for cardiac amyloidosis given its widespread availability, this case highlights its potential limitations and emphasizes the importance of CMR for evaluation of dilated cardiomyopathies and CA detection. TAKE-HOME MESSAGES: CA may present with dilated cardiomyopathy and lack classic echocardiographic features. Early CMR may facilitate timely diagnosis of CA.
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Kidess et al. (2026) conducted a case report in AL cardiac amyloidosis (n=1). Cardiac magnetic resonance (CMR) vs. Echocardiography was evaluated. Cardiac magnetic resonance facilitated the diagnosis of AL cardiac amyloidosis in a patient presenting with dilated cardiomyopathy and lacking classic echocardiographic features.
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