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.