Nuclear Cardiology Around the World: A PatientFirst Approach

Case 3 Slides

Pdf Summary

A 76-year-old man with a history of hypertension, diabetes, previous colon cancer surgery, atrial fibrillation, and recent cardiac evaluations presented with suspected cardiac amyloidosis. Investigations revealed marked thickening of the left ventricle wall, preserved ejection fraction, and moderate aortic stenosis. Further tests confirmed cardiac amyloidosis of the wild-type ATTR type. Despite normal cardiac biomarkers, he developed worsening dyspnea and was found to have severe tricuspid aortic stenosis. He underwent transcatheter aortic valve replacement (TAVR) with post-procedural pacemaker implantation due to bradycardic atrial fibrillation. The case highlighted the coexistence of aortic stenosis and cardiac amyloidosis, particularly in older patients being evaluated for TAVR. The importance of differentiating between ATTR and AL type amyloidosis was emphasized, with the recommendation not to withhold TAVR in cases of coexisting aortic stenosis and cardiac amyloidosis. Potential areas for further discussion included the choice of imaging tracers, the presence of equivocal scans, the role of SPECT imaging, and the need for follow-up imaging in such cases. Overall, the case underscored the complexity of managing dual pathology in patients with aortic stenosis and cardiac amyloidosis, highlighting the importance of a multidisciplinary approach in decision-making and treatment.

Keywords

cardiac amyloidosis

aortic stenosis

TAVR

transcatheter aortic valve replacement

ATTR type amyloidosis

AL type amyloidosis

left ventricle thickening

bradycardic atrial fibrillation

multidisciplinary approach

dual pathology management