Evaluation and Management of the Cardiac Amyloidosis
Joseph B. Selvanayagam, FRACP, DPhil*, ,*,
Philip N. Hawkins, PhD, FRCP, FRCPath ,
Biju Paul, MBBS,
Saul G. Myerson, MD, MRCP* and
Stefan Neubauer, MD, FRCP*
* Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
National Amyloidosis Centre, Department of Medicine, Royal Free and University College Medical School, London, United Kingdom
Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia.
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Figure 1 2D Echocardiographic Image (Parasternal Long-Axis View) From a Patient With AL Cardiac Amyloidosis
Two-dimensional (2D) echocardiographic image (parasternal long-axis view) from a patient with AL cardiac amyloidosis showing normal biventricular dimensions, granular "sparkling" ventricular wall appearance, concentric left ventricular wall thickening, and thickened mitral valve leaflets suggesting infiltration. Ao = aorta; IVS = interventricular septum; LA = left atrium; LV = left ventricle; RV = right ventricle.
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Figure 3 End-Diastolic Frames of Cines
Horizontal long-axis (A) and short-axis (B) at the mid-ventricular level, showing pleural (*) and pericardial effusions (**) and asymmetrical hypertrophy (maximal end-diastolic wall thickness: septum 22 mm, lateral wall 9 mm, wall thickness ratio of 2.6). Corresponding images using the delayed-enhancement magnetic resonance imaging technique: C and D, respectively. The horizontal long-axis image demonstrates global subendocardial hyperenhancement of both ventricles, both atria and the interatrial septum. The short-axis image displays a ring of subendocardial hyperenhancement (arrows).
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Figure 4 Flow Diagram Outlining the Evaluation of a Patient With Suspected Cardiac Amyloidosis
BNP = B-type natriuretic peptide; CMR = cardiovascular magnetic resonance; DNA = deoxyribonucleic acid; ECG = electrocardiogram; LV = left ventricle; SAP = serum amyloid P component; TTR = transthyretin.
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