Paul Scully1,2,7, Ernst Klotz3, Michael Mullen1, Guy Lloyd1, Leon Menezes1,4, Philip Hawkins5, Francesca Pugliese1,6, James Moon1,21Barts Heart Centre, St. Bartholomew’s Hospital, UK
2Institute of Cardiovascular Sciences, University College London, UK
3Siemens Healthineers, Forchheim, Germany
4Institute of Nuclear Medicine, University College London, UK
5National Amyloidosis Centre, University College London, UK
6William Harvey Research Institute, Queen Mary University of London, UK
7Electronic correspondence: email@example.com
An 88-year-old man was referred for consideration of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis (AS). Transthoracic echocardiography confirmed severe AS, but also showed disproportionate left ventricular hypertrophy, with restrictive diastology and impaired global longitudinal strain, with an apical sparing pattern. In view of these echocardiographic appearances and a history of bilateral carpal tunnel decompressions, the patient was referred for 99mTc-3,3-diphosphono-1,2-propanodicarboxylic
acid (DPD) scintigraphy prior to TAVI, which revealed Perugini Grade 2 cardiac uptake diagnostic of cardiac amyloidosis. Extracellular volume (ECV) quantification was also performed, as part of the TAVI work-up computed tomography (CT), using a single 3-min post-contrast acquisition. The ECV was elevated (base 51 ± 4%, mid 46 ± 5%, apex 41 ± 5%), consistent with cardiac amyloidosis.
The Journal of Heart Valve Disease 2018;27:194-196
|Dual Aortic Stenosis and Amyloid Pathology|
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