Source
Sciencedirect
Abstract
Background
Cardiac amyloidosis is frequently underdiagnosed and rarer forms (e.g., non-transthyretin or light chain amyloidosis) can be challenging to uncover.
Case summary
A 71-year-old male with reduced kidney function presented with new-onset heart failure, concentric left ventricular hypertrophy, and an "apical sparing" strain pattern. Cardiovascular magnetic resonance (CMR) confirmed an infiltrative phenotype with suggestive late gadolinium enhancement and parametric mapping pattern. However, bone scintigraphy and monoclonal protein screening were negative, and therefore, an endomyocardial biopsy was performed. After negative immunohistochemistry, mass spectrometry-based proteomics finally identified Apolipoprotein A-IV (ApoA-IV) amyloidosis.
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