Arq Bras Cardiol: Imagem cardiovasc 2020; 33(1): 1-4

Longitudinal Strain and Cardiac Amyloidosis: Case Reports

DOI: 10.5935/2318-8219.20200009

Abstract

Introduction

Cardiac involvement in patients with systemic amyloidosis indicates a worse prognosis. Moreover, the diagnosis is delayed, since the signs and symptoms of this disease are nonspecific. Global longitudinal strain has been shown to be an important predictor of cardiac events. We report four cases of patients with cardiac amyloidosis submitted to ECHO Strain and magnetic resonance for comparison and diagnostic confirmation.

Case reports

The medical records of four patients with cardiac amyloidosis admitted in 2017 at a tertiary hospital were evaluated. The preservation of the apical segments of the ventricle was the pattern found in all global longitudinal strain. Magnetic resonance image showed predominantly subendocardial, diffuse and circumferential mesocardial late enhancement in all patients reported.

Discussion

On the spectrum of clinical manifestations of cardiac amyloidosis, heart failure was the most prevalent among the patients reported. Magnetic resonance image showed patterns of myocardial thickening and late subendocardial enhancement. In global longitudinal strain, we observed the preservation of the deformity in the apical segments, associated with a significant reduction of the deformity in the basal and middle segments of the left ventricle. The global longitudinal strain also allows differential diagnosis with hypertrophic cardiomyopathy and its findings were consistent with those of the magnetic resonance image, which reinforces its value in the early detection of the condition.