The Efficacy of 2d Speckle Tracking Strain Imaging in Diagnosing Cardiac Amyloidosis

A 63 year-old female visited our department due to exertional dyspnea one year ago. Chest X-ray showed cardiomegaly. ECG revealed low QRS voltage and pseudo-anterior infarction. Echocardiography showed concentric LVH with normal ejection fraction. Coronary angiogram was also performed, resulted in no coronary stenosis. She was diagnosed with heart failure with preserved ejection fraction and was treated medically. LVH was present on echocardiography, but high voltage was not found on ECG. This discrepancy was suggestive of infiltrative cardiomyopathy. Four months ago, myocardial biopsy was performed, but amyloid deposits were not proven. Three months ago, she was admitted to our department due to congestive heart failure for the third time. She also suffered from cervical spine fracture concomitantly. After bone marrow examination, she was diagnosed with multiple myeloma. Echocardiography showed granular sparkling in the left ventricular wall. However, biopsy from duodenum and rectum revealed no amyloid deposits. 2D speckle tracking strain imaging showed marked reduction of strain in the basal wall segments with relative apical sparing. This appearance is said to suggest cardiac amyloidosis. After Bortezomib-based chemotherapy was initiated, she was relieved of symptoms. Abdominal wall fat pad biopsy was performed afterwards, and amyloid deposits were proven. In this patient, (not only granular sparkling, but also) relative apical sparing found on 2D speckle tracking strain imaging contributes in diagnosing cardiac amyloidosis.