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European Journal of Echocardiography 2008 9(2):338-341; doi:10.1093/ejechocard/jen017
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Published on behalf of the European Society of Cardiography. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Myocardial contrast echocardiography in biopsy-proven primary cardiac amyloidosis

Sahar S. Abdelmoneim, Mathieu Bernier, Diego Bellavia, Imran S. Syed, Sunil V. Mankad, Krishnaswamy Chandrasekaran, Patricia A. Pellikka and Sharon L. Mulvagh*

Mayo Cardiovascular Ultrasound Imaging and Hemodynamic Laboratory, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA

Received 15 October 2007; accepted after revision 2 January 2008.

* Corresponding author. Tel: +1 507 284 8612. E-mail address: smulvagh{at}mayo.edu


  Abstract

Cardiac vasculature is affected in 88–90% of patients with primary cardiac amyloidosis (CA). Myocardial contrast echocardiography (MCE) relies on the ultrasound detection of microbubble contrast agents that are solely confined to the intravascular space, and are therefore useful in the evaluation of flow in the microvasculature. This is the first case report describing the use of MCE during vasodilator stress to evaluate coronary flow reserve in a patient with biopsy-proven primary CA and angiographically normal coronaries. Qualitative MCE demonstrated delayed replenishment of microbubbles during peak stress; quantitative analysis was consistent with a reduction in total myocardial blood flow and reserve values. Comparative imaging modalities including strain and strain rate imaging, magnetic resonance imaging, and myocardial scintigraphy were suggestive to the diagnosis of CA. In conclusion, MCE is a method for recognition of microvascular dysfunction, and might be considered as a useful tool to augment echocardiographic assessment in the early diagnosis of CA.

Keywords: Amyloidosis; Contrast; Echocardiography


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