{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:40Z","timestamp":1753876180074,"version":"3.41.2"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,1,11]],"date-time":"2021-01-11T00:00:00Z","timestamp":1610323200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cardiac amyloidosis is an important cause for heart failure with preserved ejection fraction. It is often under diagnosed due to the fact that clinicians do not always recognize the specific diagnostic findings associated with this disease, also leading to the wrong diagnosis. When left untreated further irreversible organ dysfunction occurs, with high morbidity and mortality rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 71-year-old patient presented with progressive exertional dyspnoea and angina pectoris at the outpatient clinic. Medical history noted a percutaneous coronary intervention of the right coronary artery due to stable angina pectoris. The electrocardiogram showed low voltage in the limb leads and pseudo-infarct pattern in the precordial leads. Echocardiographic findings included left and right ventricular hypertrophy, decreased left ventricular systolic function, restrictive diastolic function, and \u2018relative\u2019 apical sparing of the left ventricle. This led to the suspicion of cardiac amyloidosis, which was confirmed with a positive bone scintigraphy using 99mTechnecium-DPD and the absence of monoclonal proteins. Treatment with Tafamidis was initiated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Electrocardiographic findings suggestive of cardiac amyloidosis are low voltage in the limb leads and\/or a pseudo-infarct pattern in the precordial leads. Important echocardiographic findings are left and right ventricular hypertrophy, restrictive diastolic function, \u2018relative\u2019 apical sparing of the left ventricle and impaired left atrial strain. The next step in confirming the diagnosis is 99mTechnecium PYP\/DPD\/HMDP bone scintigraphy and testing for monoclonal proteins. The diagnosis ATTR amyloidosis is confirmed by the combination of positive bone scintigraphy (Perugini Grade 2 or 3) and the absence of monoclonal proteins, without the necessity of performing an endomyocardial biopsy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaa426","type":"journal-article","created":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T05:47:29Z","timestamp":1612331249000},"source":"Crossref","is-referenced-by-count":0,"title":["Case report regarding the evolution of electrocardiographic and echocardiographic features in cardiac amyloidosis"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6693-7355","authenticated-orcid":false,"given":"Fabienne E","family":"Vervaat","sequence":"first","affiliation":[{"name":"Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8358-2231","authenticated-orcid":false,"given":"Sjoerd","family":"Bouwmeester","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pieter-Jan","family":"Vlaar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,11]]},"reference":[{"key":"2021062103091130100_ytaa426-B1","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.jcmg.2019.07.015","article-title":"How to image cardiac amyloidosis a practical approach","volume":"13","author":"Dorbala","year":"2020","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021062103091130100_ytaa426-B2","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.jchf.2014.03.009","article-title":"Coronary microvascular dysfunction is related to abnormalities in myocardial structure and function in cardiac amyloidosis","volume":"2","author":"Dorbala","year":"2014","journal-title":"JACC Heart Fail"},{"key":"2021062103091130100_ytaa426-B3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/anec.12018","article-title":"The findings of electrocardiography in patients with cardiac amyloidosis","volume":"18","author":"Cheng","year":"2013","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"2021062103091130100_ytaa426-B4","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.amjcard.2004.10.028","article-title":"Electrocardiographic findings in primary systemic amyloidosis and biopsy-proven cardiac involvement","volume":"95","author":"Murtagh","year":"2005","journal-title":"Am J Cardiol"},{"key":"2021062103091130100_ytaa426-B5","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.ijcard.2016.04.030","article-title":"Are classic predictors of voltage valid in cardiac amyloidosis? A contemporary analysis of electrocardiographic findings","volume":"214","author":"Sperry","year":"2016","journal-title":"Int J Cardiol"},{"key":"2021062103091130100_ytaa426-B6","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1136\/heartjnl-2012-302353","article-title":"Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis","volume":"98","author":"Phelan","year":"2012","journal-title":"Heart"},{"key":"2021062103091130100_ytaa426-B7","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1002\/clc.22353","article-title":"Echocardiographic and biohumoral characteristics in patients with AL and ATTR amyloidosis at diagnosis","volume":"38","author":"Cappelli","year":"2015","journal-title":"Clin Cardiol"},{"key":"2021062103091130100_ytaa426-B8","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.1161\/CIRCULATIONAHA.116.021612","article-title":"Non-biopsy diagnosis of cardiac transthyretin amyloidosis","volume":"133","author":"Gillmore","year":"2016","journal-title":"Circulation"},{"key":"2021062103091130100_ytaa426-B9","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1016\/j.jacc.2005.05.073","article-title":"Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy","volume":"46","author":"Perugini","year":"2005","journal-title":"J Am Coll Cardiol"},{"key":"2021062103091130100_ytaa426-B10","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1016\/j.jcmg.2019.10.015","article-title":"Low sensitivity of bone scintigraphy in detecting Phe4Leu mutation-related transthyretin cardiac amyloidosis","volume":"13","author":"Musumeci","journal-title":"JACC Cardiovasc Imaging"},{"key":"2021062103091130100_ytaa426-B11","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1056\/NEJMoa1805689","article-title":"Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy","volume":"379","author":"Maurer","year":"2018","journal-title":"N Engl J Med"},{"key":"2021062103091130100_ytaa426-B12","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1161\/CIRCULATIONAHA.118.035831","article-title":"Effects of patisiran, an RNA interference therapeutic, on cardiac parameters in patients with hereditary transthyretin-mediated amyloidosis","volume":"139","author":"Solomon","year":"2019","journal-title":"Circulation"},{"key":"2021062103091130100_ytaa426-B13","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1080\/13506129.2019.1685487","article-title":"Inotersen therapy of transthyretin amyloid cardiomyopathy","volume":"27","author":"Dasgupta","year":"2020","journal-title":"Amyloid"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/1\/ytaa426\/38710112\/ytaa426.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ehjcr\/article-pdf\/5\/1\/ytaa426\/38710112\/ytaa426.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T03:09:21Z","timestamp":1624244961000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaa426\/6077969"}},"subtitle":[],"editor":[{"given":"Jonathan M","family":"Behar","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Luca","family":"Arcari","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Albert","family":"Galyavich","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Christian Fielder","family":"Camm","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1,15]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaa426","relation":{},"ISSN":["2514-2119"],"issn-type":[{"type":"electronic","value":"2514-2119"}],"subject":[],"published-other":{"date-parts":[[2021,1]]},"published":{"date-parts":[[2021,1]]},"article-number":"ytaa426"}}