When Hematologic Response Does Not Translate to Cardiac Recovery in AL Amyloidosis

Figures

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  Figure 1. Electrocardiogram Showing Low QRS Voltage

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  Figure 2. Two-Dimensional Echocardiogram (A) Parasternal long-axis view showing concentric left ventricular thickening. (B) Apical 4-chamber view showing biatrial enlargement. (C) Right ventricle–focused view showing mild right ventricular dilation. (D) Parasternal short-axis view showing left ventricular thickening. (E) Strain imaging showing apical sparing.

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  Figure 3. Cardiac Magnetic Resonance Image (A) Short-axis basal left ventricular steady-state free precession cine image in end diastole. (B) Four-chamber steady-state free precession cine image in end diastole, demonstrating biventricular wall thickening and biatrial enlargement. (C and D) Phase-sensitive inversion recovery postgadolinium images with gadolinium uptake in the myocardium, particularly the basal and mid–left ventricular segments (image D), showing absence of gadolinium in the blood pool at an inversion time of 320 ms after a double dose of gadolinium contrast. Images were acquired approximately 10 to 12 minutes after administering gadolinium contrast. These findings are characteristic of cardiac amyloidosis.

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  Figure 4. Temporal Relationship Between Difference in Free Light-Chain Reduction and Clinical Status FLC = free light chain.