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Erschienen in: Heart and Vessels 6/2016

21.03.2015 | Case Report

Late gadolinium enhancement in cardiac amyloidosis: attributable both to interstitial amyloid deposition and subendocardial fibrosis caused by ischemia

verfasst von: Hiromi Hashimura, Hatsue Ishibashi-Ueda, Yumiko Yonemoto, Keiko Ohta-Ogo, Taka-aki Matsuyama, Yoshihiko Ikeda, Yoshiaki Morita, Naoaki Yamada, Hiroki Yasui, Hiroaki Naito

Erschienen in: Heart and Vessels | Ausgabe 6/2016

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Abstract

Gadolinium contrast agents used for late gadolinium enhancement (LGE) distribute in the extracellular space. Global diffuse myocardial LGE pronounced in the subendocardial layers is common in cardiac amyloidosis. However, the pathophysiological basis of these findings has not been sufficiently explained. A 64-year-old man was admitted to our hospital with leg edema and nocturnal dyspnea. Bence Jones protein was positive in the urine, and an endomyocardial and skin biopsy showed light-chain (AL) amyloidosis. He died of ventricular fibrillation 3 months later. 9 days before death, the patient was examined by cardiac magnetic resonance (CMR) imaging on a 3-T system. We acquired LGE data at 2, 5, 10, and 20 min after the injection of gadolinium contrast agents, with a fixed inversion time of 350 ms. Myocardial LGE developed sequentially. The myocardium was diffusely enhanced at 2 min, except for the subendocardium, but LGE had extended to almost the entire left ventricle at 5 min and predominantly localized to the subendocardial region at 10 and 20 min. An autopsy revealed massive and diffused amyloid deposits in perimyocytes throughout the myocardium. Old and recent ischemic findings, such as replacement fibrosis and coagulative myocyte necrosis, were evident in the subendocardium. In the intramural coronary arteries, mild amyloid deposits were present within the subepicardial to the mid layer of the left ventricle, but no stenotic lesions were evident. However, capillaries were obstructed by amyloid deposits in the subendocardium. In conclusion, the late phase of dynamic LGE (at 10 and 20 min) visualized in the subendocardium corresponded to the interstitial amyloid deposition and subendocardial fibrosis caused by ischemia in our patient.
Literatur
1.
Zurück zum Zitat Burke A, Tavora F (2011) restrictive cardiomyopathy and cardiac amyloidosis. practical cardiovascular pathology. Lippincott Williams and Wilkis, Philadelphia, pp 184–194 Burke A, Tavora F (2011) restrictive cardiomyopathy and cardiac amyloidosis. practical cardiovascular pathology. Lippincott Williams and Wilkis, Philadelphia, pp 184–194
2.
Zurück zum Zitat Neben-Wittich MA, Wittich CM, Mueller PS, Larson DR, Gertz MA, Edwards WD (2005) Obstructive intramural coronary amyloidosis and myocardial ischemia are common in primary amyloidosis. Am J Med 118:1287CrossRefPubMed Neben-Wittich MA, Wittich CM, Mueller PS, Larson DR, Gertz MA, Edwards WD (2005) Obstructive intramural coronary amyloidosis and myocardial ischemia are common in primary amyloidosis. Am J Med 118:1287CrossRefPubMed
3.
Zurück zum Zitat Hosch W, Kristen AV, Libicher M, Dengler TJ, Aulmann S, Heye T (2008) Late enhancement in cardiac amyloidosis: correlation of MRI enhancement pattern with histopathological findings. Amyloid 15:196–204CrossRefPubMed Hosch W, Kristen AV, Libicher M, Dengler TJ, Aulmann S, Heye T (2008) Late enhancement in cardiac amyloidosis: correlation of MRI enhancement pattern with histopathological findings. Amyloid 15:196–204CrossRefPubMed
4.
Zurück zum Zitat Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I (2005) Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation 111:186–193CrossRefPubMed Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I (2005) Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation 111:186–193CrossRefPubMed
5.
Zurück zum Zitat Perugini E, Rapezzi C, Piva T, Leone O, Bacchi-Reggiani L, Riva L (2006) Non-invasive evaluation of the myocardial substrate of cardiac amyloidosis by gadolinium cardiac magnetic resonance. Heart 92:343–349CrossRefPubMedPubMedCentral Perugini E, Rapezzi C, Piva T, Leone O, Bacchi-Reggiani L, Riva L (2006) Non-invasive evaluation of the myocardial substrate of cardiac amyloidosis by gadolinium cardiac magnetic resonance. Heart 92:343–349CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Kono AK, Yamada N, Higashi M, Kanzaki S, Hashimura H, Morita Y, Sakuma T, Noguchi T, Naito H, Sugimura K (2011) Dynamic late gadolinium enhancement simply quantified using myocardium to lumen signal ratio: normal range of ratio and diffuse abnormal enhancement of cardiac amyloidosis. J Magn Reson Imaging 34:50–55CrossRefPubMed Kono AK, Yamada N, Higashi M, Kanzaki S, Hashimura H, Morita Y, Sakuma T, Noguchi T, Naito H, Sugimura K (2011) Dynamic late gadolinium enhancement simply quantified using myocardium to lumen signal ratio: normal range of ratio and diffuse abnormal enhancement of cardiac amyloidosis. J Magn Reson Imaging 34:50–55CrossRefPubMed
7.
Zurück zum Zitat Vogelsberg H, Mahrholdt H, Deluigi CC, Yilmaz A, Kispert EM, Greulich S (2008) Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol 51:1022–1030CrossRefPubMed Vogelsberg H, Mahrholdt H, Deluigi CC, Yilmaz A, Kispert EM, Greulich S (2008) Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol 51:1022–1030CrossRefPubMed
8.
Zurück zum Zitat Smith RR, Hutchins GM (1979) Ischemic heart disease secondary to amyloidosis of intramyocardial arteries. Am J Cardiol 44:413–417CrossRefPubMed Smith RR, Hutchins GM (1979) Ischemic heart disease secondary to amyloidosis of intramyocardial arteries. Am J Cardiol 44:413–417CrossRefPubMed
9.
Zurück zum Zitat Yagishita A, Tanimoto S, Tanabe K, Isogawa A, Taniguchi M, Shiba T (2009) Cardiac amyloidosis presumptively diagnosed as cardiac syndrome X. Circ J 73:1349–1351CrossRefPubMed Yagishita A, Tanimoto S, Tanabe K, Isogawa A, Taniguchi M, Shiba T (2009) Cardiac amyloidosis presumptively diagnosed as cardiac syndrome X. Circ J 73:1349–1351CrossRefPubMed
10.
Zurück zum Zitat Morin J, Schreiber WE, Lee C (2013) Sudden death due to undiagnosed primary amyloidosis. J Forensic Sci 58(Suppl 1):S250–S252CrossRefPubMed Morin J, Schreiber WE, Lee C (2013) Sudden death due to undiagnosed primary amyloidosis. J Forensic Sci 58(Suppl 1):S250–S252CrossRefPubMed
11.
Zurück zum Zitat Mueller PS, Edwards WD, Gertz MA (2000) Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis. Am J Med 109:181–188CrossRefPubMed Mueller PS, Edwards WD, Gertz MA (2000) Symptomatic ischemic heart disease resulting from obstructive intramural coronary amyloidosis. Am J Med 109:181–188CrossRefPubMed
12.
Zurück zum Zitat Tsai SB, Seldin DC, Wu H, O’Hara C, Ruberg FL, Sanchorawala V (2011) Myocardial infarction with “clean coronaries” caused by amyloid light-chain AL amyloidosis: a case report and literature review. Amyloid 18:160–164CrossRefPubMed Tsai SB, Seldin DC, Wu H, O’Hara C, Ruberg FL, Sanchorawala V (2011) Myocardial infarction with “clean coronaries” caused by amyloid light-chain AL amyloidosis: a case report and literature review. Amyloid 18:160–164CrossRefPubMed
13.
Zurück zum Zitat Wittich CM, Neben-Wittich MA, Mueller PS, Gertz MA, Edwards WD (2007) Deposition of amyloid proteins in the epicardial coronary arteries of 58 patients with primary systemic amyloidosis. Cardiovasc Pathol 16:75–78CrossRefPubMed Wittich CM, Neben-Wittich MA, Mueller PS, Gertz MA, Edwards WD (2007) Deposition of amyloid proteins in the epicardial coronary arteries of 58 patients with primary systemic amyloidosis. Cardiovasc Pathol 16:75–78CrossRefPubMed
14.
Zurück zum Zitat Syed IS, Glockner JF, Feng D, Araoz PA, Martinez MW, Edwards WD (2010) Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. JACC Cardiovasc Imaging 3:155–164CrossRefPubMed Syed IS, Glockner JF, Feng D, Araoz PA, Martinez MW, Edwards WD (2010) Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. JACC Cardiovasc Imaging 3:155–164CrossRefPubMed
15.
Zurück zum Zitat Minutoli F, Di Bella G, Mazzeo A, Donato R, Russo M, Scribano E, Baldari S (2013) Comparison between (99 m) Tc-diphosphonate imaging and MRI with late gadolinium enhancement in evaluating cardiac involvement in patients with transthyretin familial amyloid polyneuropathy. AJR Am J Roentgenol 200:W256–W265CrossRefPubMed Minutoli F, Di Bella G, Mazzeo A, Donato R, Russo M, Scribano E, Baldari S (2013) Comparison between (99 m) Tc-diphosphonate imaging and MRI with late gadolinium enhancement in evaluating cardiac involvement in patients with transthyretin familial amyloid polyneuropathy. AJR Am J Roentgenol 200:W256–W265CrossRefPubMed
16.
Zurück zum Zitat Di Bella G, Minutoli F, Mazzeo A, Vita G, Oreto G, Carerj S, Anfuso C, Russo M, Gaeta M (2010) MRI of cardiac involvement in transthyretin familial amyloid polyneuropathy. AJR Am J Roentgenol 195:W394–W399CrossRefPubMed Di Bella G, Minutoli F, Mazzeo A, Vita G, Oreto G, Carerj S, Anfuso C, Russo M, Gaeta M (2010) MRI of cardiac involvement in transthyretin familial amyloid polyneuropathy. AJR Am J Roentgenol 195:W394–W399CrossRefPubMed
17.
Zurück zum Zitat vanden Driesen RI, Slaughter RE, Strugnell WE (2006) MR findings in cardiac amyloidosis. AJR Am J Roentgenol 186:1682–1685CrossRefPubMed vanden Driesen RI, Slaughter RE, Strugnell WE (2006) MR findings in cardiac amyloidosis. AJR Am J Roentgenol 186:1682–1685CrossRefPubMed
19.
Zurück zum Zitat Minutoli F, Di Bella G, Sindoni A, Vita G, Baldari S (2013) Effectiveness of skeletal scintigraphy in transthyretin-related amyloidosis. Int J Cardiol 168:4988–4989CrossRefPubMed Minutoli F, Di Bella G, Sindoni A, Vita G, Baldari S (2013) Effectiveness of skeletal scintigraphy in transthyretin-related amyloidosis. Int J Cardiol 168:4988–4989CrossRefPubMed
20.
Zurück zum Zitat Maceira AM, Prasad SK, Hawkins PN, Roughton M, Pennell DJ (2008) Cardiovascular magnetic resonance and prognosis in cardiac amyloidosis. J Cardiovasc Magn Reson 10:54CrossRefPubMedPubMedCentral Maceira AM, Prasad SK, Hawkins PN, Roughton M, Pennell DJ (2008) Cardiovascular magnetic resonance and prognosis in cardiac amyloidosis. J Cardiovasc Magn Reson 10:54CrossRefPubMedPubMedCentral
Metadaten
Titel
Late gadolinium enhancement in cardiac amyloidosis: attributable both to interstitial amyloid deposition and subendocardial fibrosis caused by ischemia
verfasst von
Hiromi Hashimura
Hatsue Ishibashi-Ueda
Yumiko Yonemoto
Keiko Ohta-Ogo
Taka-aki Matsuyama
Yoshihiko Ikeda
Yoshiaki Morita
Naoaki Yamada
Hiroki Yasui
Hiroaki Naito
Publikationsdatum
21.03.2015
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 6/2016
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-015-0658-0

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