PMC9863331_01
ECG showing normal sinus rhythm with first-degree atrioventricular block and left axis deviation.
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Electrocardiogram (ECG) (Figure 1) showed normal sinus rhythm with first-degree atrioventricular block, left axis deviation, and low voltage in limb leads.
ECHO showing a discrepancy between the wall mass and electrical activity on ECG.
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No prior echocardiogram (ECHO) was available, so an initial ECHO was obtained showing preserved ventricular ejection fraction (EF), moderate left ventricular hypertrophy (LVH), stage II diastolic dysfunction, and small pericardial effusion (Figure 2 and Figure 3).
Pulse-wave Tissue Doppler ECHO showing elevated E/E' ratio and low mitral annulus velocities suggestive of diastolic dysfunction.
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No prior echocardiogram (ECHO) was available, so an initial ECHO was obtained showing preserved ventricular ejection fraction (EF), moderate left ventricular hypertrophy (LVH), stage II diastolic dysfunction, and small pericardial effusion (Figure 2 and Figure 3).
SPECT in an ATTR cardiac amyloidosis patient. Evidence of uptake of 99mTc-PYP in the myocardium. (a) Quantitative SPECT/CT; (b) Semiquantitative analysis of 99mTc-PYP myocardial uptake.
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Next, we performed a 99Technetium pyrophosphate (99mTc-PYP) planar scintigraphy (Figure 4).
Heart-to-contralateral ratio was calculated by drawing a region of interest over the heart, mirroring it to the contralateral chest, and calculating the ratio of heart ROI to contralateral chest ROI mean counts. The representative image demonstrates a H/CL ratio of 1.6. (H/CL, heart-to-contralateral; ROI, region of interest).
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A quantitative analysis of the heart retention pattern showed a heart-to-contralateral lung (H/Cl) ratio of 1.66 (Figure 5), strongly suggestive of amyloid deposition.