Multimodality imaging can shift the clinical approach and prognosis of a patient: from heart failure and angina to cardiac amyloidosis

Contact address: Roxana Cristina Rimbas, Department of Cardiology, Emergency University Hospital, „Carol Davila” University of Medicine 169 Splaiul Independentei, 050098, Bucharest, Romania. E-mail: roxana.rimbas@umfcd.ro 1 Department of Cardiology and Cardiovascular Surgery, Emergency University Hospital, Bucharest, Romania 2 „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 3 Department of Radiology, Emergency University Hospital, Bucharest, Romania 4 Department of Hematology, Colentina Clinical Hospital, Bucharest, Romania 5 Department of Pathology, Colentina Clinical Hospital, Bucharest, Romannia INTRODUCTION AL (light chain) amyloidosis is a serious heterogeneous disease with a wide spectrum of non-specifi c clinical manifestations and a poor prognosis if left untreated1. The prognosis is mainly determined by the presence and extent of cardiac involvement, a condition called cardiac amyloidosis (CA), as well as the response to therapy2. Over the last years there has been remarkable progress in the diagnosis of cardiac amyloidosis, with a large body of emerging evidence for the clinical utility of various imaging modalities in achieving the diagnosis. However, the diagnosis of cardiac amyloidosis (CA) is often challenging, it relies on clinical awareness of and suspicion for the disease, and requires integration of data from a number of imaging modalities with clinical and serum biomarkers. Once the diagnosis of CA is established, a comprehensive approach (serial imaging with echocardiography and cardiac magnetic resonance), in addition to clinical status and serum biomarkers, including NTproBNP and troponin, is recommended for risk stratifi cation, prognosis and for monitoring cardiac disease progression and response to therapy1. Timely chemotherapy and stem cell transplantation can lead to a signifi cant clinical improvement, and regression of amyloid myocardial infi ltration with a better prognosis3.