case_images: PMC9113125_01
case_images: PMC9113125_02
case_images: PMC9113125_03
case_images: PMC9113125_04
case_images: PMC9113125_05
case_images: Continued.
case_images: PGPM-15-499-g0001.jpg
case_images: PMC9113125_05_PGPM-15-499-g0001.jpg
case_images: f0001a
case_images: A further echocardiogram showed marked hypertrophy (interventricular septal thickness: 20 mm, posterior wall of left ventricle: 14 mm) with slightly reduced pump function (EF 45%), signs of increased filling pressure and a severe reduction of longitudinal deformation indices (global longitudinal strain, GL2D-strain: -6.2%), with an "apical sparing pattern" specific for cardiac amyloidosis (Figure 1A and B). At the follow-up (9 months later), the patient reported less fatigue in daily physical activities with a slight improvement in cardiac ejection fraction (EF 54% vs 45%) and systolic longitudinal function (GL2D-strain -11.4% vs -6.4%) (Figure 1C).
case_images: (A) Increased echogenicity of the thickened intraventricular septum, with a speckled appearance (B). The strain of the basal walls is severely reduced in comparison to the apical strain, preserved (C). Improvement in the systolic longitudinal function at follow-up.
case_images: PGPM-15-499-g0002.jpg
case_images: PMC9113125_05_PGPM-15-499-g0002.jpg
case_images: f0001b
case_images: Tc99-HMDP bone scintigraphy, in order to differentiate AL from TTR amyloidosis. The test showed an intense fixation of the radiotracers at myocardial level with high heart/whole body uptake ratio (and at the level of the left femur, compatible with known trochanteric fracture) (Figure 2), suggestive of a form related to TTR.
case_images: PMC9113125_06
case_images: PMC9113125_07