Key result
Multimodality imaging establishes non-invasive diagnosis of severe wild-type ATTR amyloidosis, obviating endomyocardial biopsy.
Why the study?
Cardiac amyloidosis diagnosis has been challenging due to non-specific clinical features and reliance on biopsy, despite advances in cardiovascular imaging improving early detection.
Case Report (n=1)
This case underscores that structured multimodality imaging (strain echocardiography, CMR, and bone scintigraphy) can reliably confirm advanced four-chamber ATTR cardiac amyloidosis non-invasively, eliminating the need for high-risk endomyocardial biopsy.
May support non-invasive diagnosis of advanced ATTR amyloidosis in select cases; hypothesis-generating and leaves open broader validation.
Background: Cardiac amyloidosis results from the deposition of amyloid fibrils in the myocardial extracellular matrix, leading to restrictive cardiomyopathy and heart failure. Diagnosis has traditionally been challenging owing to non-specific clinical features and reliance on endomyocardial biopsy. Advances in cardiovascular imaging have, however, improved early detection. Case summary: We present a 74-year-old man with progressive dyspnea on exertion and bilateral pedal edema of three months' duration. Cardiac amyloidosis was suspected on the basis of discordance between electrocardiographic and echocardiographic findings, and was confirmed using global longitudinal strain (GLS), cardiac magnetic resonance imaging (CMR), and bone scintigraphy. Conclusion: This case underscores the importance of recognizing cardiac amyloidosis as an underdiagnosed cause of heart failure. Modern imaging modalities facilitate non-invasive, early diagnosis, often obviating the need for biopsy. Early identification is crucial, as emerging therapies offer the potential to modify disease progression and improve outcomes in a condition once considered incurable.
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Sravanth Gandavarapu (2026) conducted a case report in ATTR cardiac amyloidosis (n=1). Multimodality imaging (Echocardiography, CMR, and 99mTc-PYP scintigraphy) was evaluated. Multimodality imaging successfully established a non-invasive diagnosis of severe, four-chamber wild-type ATTR cardiac amyloidosis, obviating the need for an endomyocardial biopsy.
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