Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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Abnormal Myocardial Blood Flow Reserve Observed in Cardiac Amyloidosis

  • Nam, Michael Chi Yuan (Department of Cardiology, Sunshine Coast Hospital and Health Service) ;
  • B.Tech, Karen Nel (Department of Cardiology, Sunshine Coast Hospital and Health Service) ;
  • Senior, Roxy (Department of Cardiology, Royal Brompton and Harefield NHS Trust) ;
  • Greaves, Kim (Department of Cardiology, Sunshine Coast Hospital and Health Service)
  • Received : 2015.07.10
  • Accepted : 2016.02.01
  • Published : 2016.03.27
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Abstract

We performed real-time myocardial contrast echocardiography on a patient with cardiac amyloidosis and previous normal coronary angiography presenting with atypical chest pain to assess myocardial blood flow reserve (MBFR). Myocardial contrast echocardiography was performed and flash microbubble destruction and replenishment analysis was used to calculate myocardial blood flow. Dipyridamole was used to achieve hyperemia. MBFR was derived from the ratio of peak myocardial blood flow at hyperemia and rest. The results show a marked reduction in MBFR in our patient. Previous reports of luminal obstruction of intramyocardial rather than epicardial vessels by amyloid deposition may be causing microvascular dysfunction.

Keywords

References

  1. Narang R, Chopra P, Wasir HS. Cardiac amyloidosis presenting as ischemic heart disease. A case report and review of literature. Cardiology 1993;82:294-300. https://doi.org/10.1159/000175878
  2. Neben-Wittich MA, Wittich CM, Mueller PS, Larson DR, Gertz MA, Edwards WD. Obstructive intramural coronary amyloidosis and myocardial ischemia are common in primary amyloidosis. Am J Med 2005;118:1287.
  3. Vogelsberg H, Mahrholdt H, Deluigi CC, Yilmaz A, Kispert EM, Greulich S, Klingel K, Kandolf R, Sechtem U. Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol 2008;51:1022-30. https://doi.org/10.1016/j.jacc.2007.10.049
  4. Wei K, Ragosta M, Thorpe J, Coggins M, Moos S, Kaul S. Noninvasive quantification of coronary blood flow reserve in humans using myocardial contrast echocardiography. Circulation 2001;103:2560-5. https://doi.org/10.1161/01.CIR.103.21.2560
  5. Rana O, Byrne CD, Kerr D, Coppini DV, Zouwail S, Senior R, Begley J, Walker JJ, Greaves K. Acute hypoglycemia decreases myocardial blood flow reserve in patients with type 1 diabetes mellitus and in healthy humans. Circulation 2011;124:1548-56. https://doi.org/10.1161/CIRCULATIONAHA.110.992297
  6. Camici PG, Crea F. Coronary microvascular dysfunction. N Engl J Med 2007;356:830-40. https://doi.org/10.1056/NEJMra061889
  7. Mueller PS, Edwards WD, Gertz MA. Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis. Am J Med 2000;109:181-8. https://doi.org/10.1016/S0002-9343(00)00471-X
  8. Apridonidze T, Steingart RM, Comenzo RL, Hoffman J, Goldsmith Y, Bella JN, Landau H, Liu JE. Clinical and echocardiographic correlates of elevated troponin in amyloid light-chain cardiac amyloidosis. Am J Cardiol 2012;110:1180-4. https://doi.org/10.1016/j.amjcard.2012.05.061
  9. Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P. Contrast echocardiography: evidence-based recommendations by European Association of Echocardiography. Eur J Echocardiogr 2009;10:194-212.
  10. Al Suwaidi J, Velianou JL, Gertz MA, Cannon RO 3rd, Higano ST, Holmes DR Jr, Lerman A. Systemic amyloidosis presenting with angina pectoris. Ann Intern Med 1999;131:838-41.
  11. Abdelmoneim SS, Bernier M, Bellavia D, Syed IS, Mankad SV, Chandrasekaran K, Pellikka PA, Mulvagh SL. Myocardial contrast echocardiography in biopsy-proven primary cardiac amyloidosis. Eur J Echocardiogr 2008;9:338-41.