A Case of Cardiac Amyloidosis with Reduced Longitudinal Strain in All Cardiac Chambers

A 83-year-old man with a history of hypertension and cardiac amyloidosis was admitted to our hospital due to progressive dyspnea on effort. His electrocardiogram showed intraventricular conduction delay and poor R wave progression in the pericardial leads. 99mTcPYP SPECT showed diffuse uptake throughout the myocardium of 4 chambers, indicating amyloid deposition into the both ventricles as well as both atrial myocardium. Echocardiography revealed diffuse biventricular thickening, and decreased left ventricular (LV) ejection fraction of 40%. Two-dimensional speckle-tracking echocardiography showed a typical bull's-eye pattern with progressively reduced segmental longitudinal strain (LS) gradient from the base to the apex of the LV. LS values in each cardiac chambers were decreased: LV LS 6.9%, left atrial LS 3.8%, right ventricular LS 8.2%, right atrial LS 10.6% compared with those of two years ago. These results suggest that cardiac amyloidosis involved all chambers as well as 99mTcPYP SPECT and high risk of worsening heart failure. Previous studies reported that the LV LS is the independent predictor of adverse outcome in cardiac amyloidosis. Identification of patients at high risk for cardiac events would be helpful to initiate proper therapy, which may produce better outcome. We reported an interesting case of cardiac amyloidosis with all cardiac chambers are involved. When we perform echocardiography for cardiac amyloidosis, adding a four chamber LS will give us useful information.