PMC5348456_01
A chest radiograph showing cardiomegaly. The patient's cardiothoracic ratio was 65%.
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Cardiomegaly was detected on a chest radiograph (Fig. 1).
An electrocardiogram showed low QRS voltages in the limb leads and poor R-wave progression in the chest leads (the pseudo-infarction pattern). An abnormal Q wave was also detected in leads V1-4.
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The electrocardiogram (ECG) revealed a low QRS voltage in the limb leads, poor R-wave progression in the chest leads and an abnormal Q wave in leads V1-4 (Fig. 2).
A transthoracic echocardiogram (long axis view) showed LV wall hypertrophy (A) and the patient's mitral inflow profile showed a pseudo-normal mitral inflow filling pattern (B).
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On transthoracic echocardiography, LV wall hypertrophy (end-diastolic interventricular septal wall thickness, 14 mm; end-diastolic LV posterior wall thickness, 15 mm) was detected (Fig. 3A). Her lateral mitral annular diastolic velocity (e') had decreased to 2.2 cm/s, indicating that she had a pseudo-normal mitral inflow filling pattern (Fig. 3B).
A "bull's-eye" plot (a color-coded map of LV peak systolic longitudinal strain) showed a base-to-apex strain gradient: the longitudinal strain was markedly reduced in the basal and mid-ventricular wall segments while it was preserved in the apical segments. This finding is known as the relative apical sparing pattern.
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On the other hand, 2-D STE showed a marked reduction in the longitudinal strain of the basal wall segments and normal strain levels in the apical segments (Fig. 4).
The patient's clinical course. Catheter ablation (as a treatment for paroxysmal atrial fibrillation) led to a reduction in the patient's serum BNP levels. After the procedure, bortezomib-based chemotherapy was initiated. The patient's clinical symptoms were immediately relieved, and her BNP levels continued to decrease. These improvements were accompanied by a reduction in her IgG levels. Four months after the initiation of chemotherapy, M-protein disappeared from the patient's serum.
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These improvements were accompanied by improvements in the serological markers of multiple myeloma (e.g., her serum IgG level fell) (Fig. 5).
Sequential two-dimensional speckle tracking echocardiographic examinations. In spite of the improvements in the patient's clinical symptoms and laboratory findings, the relative apical sparing pattern remained, and her global longitudinal strain only showed a slight improvement. GLS: global longitudinal strain
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In spite of the above-mentioned improvements in the patient's clinical symptoms and laboratory findings, the relative apical sparing pattern did not change from 2-D STE, and there was only a slight improvement in her global longitudinal strain (Fig. 6).