Figure 2
Two dimensional echocardiographic speckle tracking LV longitudinal
strain imaging curves are shown in apical 4 chamber, 2 chamber and long
axis views along with bull’s eye map in A. Magnified bulls eye map is
shown in B. Global averaged LV longitudinal peak systolic strain is
abnormal at -8 % (normal = more negative than -18%) along with
prominent apical sparing pattern highly suggestive of cardiac
amyloidosis. Cardiac magnetic resonance image with gadolinium contrast
(C) shows diffuse predominantly subendocardial late gadolinium
enhancement of left and right ventricles. LV ejection fraction was 59%
with preserved left ventricular volumes. Right ventricular volumes were
preserved with mild diffuse systolic dysfunction, right ventricular
ejection fraction of 41%. Left greater than right biatrial delayed
gadolinium endocardial enhancement is also seen with normal left atrial
volume. There is mild thickening of the interatrial septum. Pre-contrast
T1 mapping value was significantly elevated at greater than 1300 ms
(normal 1020 ms) (D) due to alteration in myocardial structure from
amyloid deposition.