Multimodality assessments of wild‐type transthyretin cardiac amyloidosis with no ventricular hypertrophy

Abstract

Abstract While patients with transthyretin cardiac amyloidosis (ATTR‐CA) typically present with concentric or asymmetric hypertrophy, a small percentage of ATTR‐CA is known to present with ‘atypical’ cardiac morphologies such as eccentric hypertrophy or even no hypertrophy. However, detailed report of multimodality assessments of ATTR‐CA with no ventricular hypertrophy is lacking. Herein, we report detailed multimodality assessments of an 81‐year‐old Japanese woman with heart failure and history of carpal tunnel syndrome and lumbar canal stenosis, presenting no ventricular hypertrophy and negative 99mtechnetium‐pyrophosphate scintigraphy, who was eventually diagnosed as having wild‐type ATTR‐CA. Our case highlights the role of multimodality assessments for early diagnosis of ATTR‐CA in patients with atypical cardiac morphologies and also emphasizes the limitations of bone scintigraphy and the importance of considering ATTR‐CA in patients with non‐cardiac manifestations of ATTR amyloidosis.

Keywords

• Amyloid cardiomyopathy
• Pyrophosphate scintigraphy
• False negative
• Tafamidis
• Heart failure
• Cardiovascular magnetic resonance