To the content
1 . 2025

Clinical case of primary AL amyloidosis with predominant involvement of the heart and pericardium

Abstract

This work presents the clinical case of cardiac AL-amyloidosis apparently resulting from previous coronavirus infection and COVID-19 vaccination. The course of the disease was complicated by the development of a restrictive-hypertrophic phenotype of cardiomyopathy and chronic heart failure. This text presents the results of laboratory and instrumental studies, as well as the effective therapy being carried out. Particular attention is paid to the importance of echocardiography and magnetic resonance imaging in the diagnosis of cardiac amyloidosis, which help optimize the diagnosis process and initiate timely therapy.

Keywords: cardiac AL-amyloidosis; echocardiography; magnetic resonance imaging

Funding. The study had no sponsor support.

Conflict of interest. The authors declare no conflict of interest.

For citation: Sedov V.P., Blagova O.V., Sarkisova N.D., Kukarkina M.D., Rumyantsev D.A., Ustuzhanin D.V. Clinical case of primary AL amyloidosis with predominant involvement of the heart and pericardium. Clinical and Experimental Surgery. Petrovsky Journal. 2025; 13 (1): 112–9. DOI: https://doi.org/10.33029/2308-1198-2025-13-1-112-119 (in Russian)

References

  1. Gilstrap L.G., Dominici F., Wang Y., El-Sady M.S., Singh A., Di Carli M.F., et al. Epidemiology of cardiac amyloidosis-associated heart failure hospitalizations among fee-for-service medicare beneficiaries in the United States. Circ Heart Fail. 2019; 12 (6): 1–17.
  2. Dorbala S., Cuddy S., Falk R. How to image cardiac amyloidosis: a practical approach. JACC Cardiovasc Imaging. 2020; 13 (6): 1368–83.
  3. Tereshchenko S.N., Zhirov I.V., Moiseeva O.M., Adasheva T.V., Ansheles A.A., Barbarash O.L., et al. Practical recommendations for the diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM or transthyretin cardiac amyloidosis). Terapevticheskiy arkhiv [Therapeutic Archive]. 2022; 94 (4): 584–95. (in Russian)
  4. Giblin G.T., Cuddy S.A.M. Multimodality imaging in cardiac amyloidosis. Curr Cardiol Rep. 2021; 23 (10): 134.
  5. Buxbaum J.N., Dispenzieri A., Eisenberg D.S., et al. Amyloid nomenclature 2022: update, novel proteins, and recommendations by the International Society of Amyloidosis (ISA) Nomenclature Committee. Amyloid. 2022; 29 (4): 213–9.
  6. Pieri M., Ciotti M., Nuccetelli M., Perrone M.A., Caliò M.T., Lia M.S., et al. Serum Amyloid A Protein as a useful biomarker to predict COVID-19 patients severity and prognosis. Int Immunopharmacol. 2021; 95 (107 512): 1–4.
  7. Rameev V.V., Kozlovskaya L.V., Zhdanova E.A., Gudkova K.V. Cardiorenal relationships in systemic amyloidosis. Terapevticheskiy arkhiv [Therapeutic Archive]. 2013; 85 (6): 51–9. (in Russian)
  8. Reznik E.V., Nguyen T.L., Kudryavtseva M.M., Golukhov G.N. Comparison of cardiac amyloidosis and hypertrophic cardiomyopathy: a retrospective analysis of the characteristics of heart and kidney damage. Rossiyskiy kardiologicheskiy zhurnal [Russian Journal of Cardiology]. 2023; 28 (11): 53–9. (in Russian)
  9. Phelan D., Collier P., Thavendiranathan P., Popović Z.B., Hanna M., Plana J.C., et al. Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis. Heart. 2012; 98 (19): 1442–8.
  10. Huntjens P.R., Zhang K.W., Soyama Y., Karmpalioti M., Lenihan D.J., Gorcsan J. Prognostic utility of echocardiographic atrial and ventricular strain imaging in patients with cardiac amyloidosis. JACC Cardiovasc Imaging. 2021; 14 (8): 1508–19.
  11. Lei C., Zhu X., Hsi D.H., Wang J., Zuo L., Ta S., et al. Predictors of cardiac involvement and survival in patients with primary systemic light-chain amyloidosis: roles of the clinical, chemical, and 3-D speckle tracking echocardiography parameters. BMC Cardiovasc Disord. 2021; 21 (1): 1–11.
  12. Luszczak J., Olszowska M., Drapisz S., Plazak W., Kaznica-Wiatr M., Karch I., et al. Assessment of left ventricle function in aortic stenosis: mitral annular plane systolic excursion is not inferior to speckle tracking echocardiography derived global longitudinal peak strain. Cardiovasc Ultrasound. 2013; 11 (45): 1–8.
  13. Seward J.B., Casaclang-Verzosa G. Infiltrative cardiovascular diseases: cardiomyopathies that look alike. J Am Coll Cardiol. 2010; 55 (17): 1769–79.
  14. Reznik E.V., Nguyen T.L., Ustyuzhanin D.V., Semyachkina A.N. Shkol’nikova M.A. «Red flags» of diagnostics of infiltrative heart diseases. Rossiyskiy kardiologicheskiy zhurnal [Russian Journal of Cardiology]. 2023; 28 (1S): 40–51. (in Russian)
  15. Dima D., Mazzoni S., Anwer F., Khouri J., Samaras C., Valent J., et al. Diagnostic and treatment strategies for AL amyloidosis in an era of therapeutic innovation. JCO Oncol Pract. 2023; 19 (5): 265–75.
  16. Comenzo R.L. Systemic immunoglobulin light-chain amyloidosis. Clin Lymphoma Myeloma. 2006; 7 (3): 182–5.
  17. Zanwar S., Gertz M.A., Muchtar E. Immunoglobulin light chain amyloidosis: diagnosis and risk assessment. J Natl Compr Canc Netw. 2023; 21 (1): 83–90.
  18. Garcia Y., Collins A.B., Stone J.R. Abdominal fat pad excisional biopsy for the diagnosis and typing of systemic amyloidosis. Hum Pathol. 2018; 72: 71–9.
  19. Dorbala S., Ando Y., Bokhari S., Dispenzieri A., Falk R., Ferrari V., et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol. 2019; 26 (6): 2065–123.
  20. Vaxman I., Dispenzieri A., Muchtar E., Gertz M. New developments in diagnosis, risk assessment and management in systemic amyloidosis. Blood Rev. 2020; 40: 1–33.
  21. Kyle R.A., San-Miguel J.F., Mateos M.V., Rajkumar S.V. Monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Hematol Oncol Clin North Am. 2014; 28 (5): 775–90.
  22. Muchtar E., Dispenzieri A., Gertz M.A., Kumar S.K., Buadi F.K., Leung N., et al. Treatment of AL amyloidosis: Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) Consensus Statement 2020 Update. Mayo Clin Proc. 2021; 96 (6): 1546–77.
  23. Gillmore J.D., Maurer M.S., Falk R.H., Merlini G., Damy T., Dispenzieri A., et al. Nonbiopsy diagnosis of cardiac transthyretin Circulation. 2016; 133 (24): 2404–12.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)
geotar-digit

Journals of «GEOTAR-Media»