{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T09:10:14Z","timestamp":1759137014175,"version":"3.44.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T00:00:00Z","timestamp":1757116800000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Patients with mild phenotypes of chronic cardiomyopathies are often followed up over time, and there is a temptation to assume a change in symptom status or investigation results is due to the original pathology. The possibility of acquired pathology must be considered in these patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>We present a case of a middle-aged veteran endurance athlete followed up for a mild phenotype of apical hypertrophic cardiomyopathy originally picked up due to an asymptomatic abnormal electrocardiogram (ECG). He developed subtle symptoms and morphological changes in his investigations (ECG, echocardiography, exercise tolerance test (ETT), and magnetic resonance imaging (MRI)). Due to the previously quiescent phenotype, a diagnosis of coexistent amyloid light-chain (AL) cardiac amyloidosis secondary to IgA lambda multiple myeloma was made.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>This case underscores the importance of paying attention to subtle changes in symptoms and morphology when managing patients with mild phenotypes and athletes, and considering alternative pathology when these occur. Multimodality imaging is essential in the investigation of such patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf443","type":"journal-article","created":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T13:38:10Z","timestamp":1757165890000},"source":"Crossref","is-referenced-by-count":0,"title":["Cardiac AL amyloidosis in a veteran endurance athlete with pre-existing apical hypertrophic cardiomyopathy: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8843-2171","authenticated-orcid":false,"given":"Emmanuel","family":"Androulakis","sequence":"first","affiliation":[{"name":"Kings College Hospital NHS Foundation Trust , Cardiac Unit, Denmark Hill, London SE5 9RS ,","place":["UK"]},{"name":"King's College London, School of Biomedical Engineering & Imaging , London WC2R 2LS ,","place":["UK"]},{"name":"City St George's, University of London, Cranmer Terrace , London SW17 0RE ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1035-0525","authenticated-orcid":false,"given":"Szymon","family":"Musiol","sequence":"additional","affiliation":[{"name":"Royal United Hospitals NHS Foundation Trust, Cardiology Department , Combe Park, Bath BA1 3NG ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0616-2353","authenticated-orcid":false,"given":"Michael","family":"Papadakis","sequence":"additional","affiliation":[{"name":"St George's University Hospitals NHS Foundation Trust, Cardiology Clinical Academic Group , Blackshaw Road, London SW17 0QT ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8962-3524","authenticated-orcid":false,"given":"Maria Teresa","family":"Tome Esteban","sequence":"additional","affiliation":[{"name":"St George's University Hospitals NHS Foundation Trust, Cardiology Clinical Academic Group , Blackshaw Road, London SW17 0QT ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,6]]},"reference":[{"key":"2025092904415964500_ytaf443-B1","first-page":"501","article-title":"Improved diagnostic criteria for apical hypertrophic cardiomyopathy","volume":"17","author":"Hughes","year":"2024","journal-title":"Cardiovasc Imaging"},{"key":"2025092904415964500_ytaf443-B2","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1161\/CIRCGENETICS.110.958835","article-title":"Sarcomere protein gene mutations in patients with apical hypertrophic cardiomyopathy","volume":"4","author":"Gruner","year":"2011","journal-title":"Circ Cardiovasc Genet"},{"key":"2025092904415964500_ytaf443-B3","first-page":"427","article-title":"AL amyloidosis for cardiologists: awareness, diagnosis, and future prospects: JACC: CardioOncology State-of-the-Art Review","volume":"4","author":"Wechalekar","year":"2022","journal-title":"Cardio Oncol"},{"key":"2025092904415964500_ytaf443-B4","doi-asserted-by":"crossref","first-page":"2863","DOI":"10.1200\/JCO.2015.61.2267","article-title":"Revised international staging system for multiple myeloma: a report from international myeloma working group","volume":"33","author":"Palumbo","year":"2015","journal-title":"J Clin Oncol"},{"key":"2025092904415964500_ytaf443-B5","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1182\/blood-2011-11-390658","article-title":"Trisomies in multiple myeloma: impact on survival in patients with high-risk cytogenetics","volume":"119","author":"Kumar","year":"2012","journal-title":"Blood"},{"key":"2025092904415964500_ytaf443-B6","doi-asserted-by":"crossref","first-page":"3503","DOI":"10.1093\/eurheartj\/ehad194","article-title":"2023 ESC guidelines for the management of cardiomyopathies: developed by the task force on the management of cardiomyopathies of the European Society of Cardiology (ESC)","volume":"44","author":"Arbelo","year":"2023","journal-title":"Eur Heart J"},{"key":"2025092904415964500_ytaf443-B7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease: the Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur Heart J"}],"container-title":["European Heart Journal - 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