title: Abnormal stress echocardiography findings in cardiac amyloidosis.
abstract: BACKGROUND
  Cardiac involvement in immunoglobulin light chain (amyloid light chain, AL) amyloidosis is characterized by myocardial interstitial deposition but can also cause obstructive deposits in the coronary microvasculature.
  
  
  METHODS
  We retrospectively identified 20 patients who underwent stress echocardiography within 1 year prior to the histologic diagnosis of AL amyloidosis. Only patients with cardiac amyloidosis and no known obstructive coronary disease were included.
  
  
  RESULTS
  Stress echocardiograms (13 exercise; 7 dobutamine) were performed for evaluation of dyspnea and/or chest pain. Stress-induced wall motion abnormalities (WMAs) occurred in 11 patients (55%), 4 of whom had normal left ventricular wall thickness. Coronary angiogram was performed in 9 of 11 patients and demonstrated no or mild epicardial coronary artery disease. Seven (54%) patients had an abnormal exercise blood pressure which occurred with similar likelihood between those with and without stress-induced WMAs.
  
  
  CONCLUSIONS
  Stress-induced WMAs and abnormal exercise blood pressure may occur in patients with cardiac AL amyloidosis despite the absence of significant epicardial coronary artery disease. This finding should raise the possibility of cardiac amyloidosis even in the absence of significant myocardial thickening.
authors.affiliation: a Division of Cardiovascular Disease .
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Ong
authors.affiliation: a Division of Cardiovascular Disease .
authors.forename: J Wells
authors.initials: JW
authors.lastname: Askew
authors.affiliation: b Division of Hematology , and.
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.affiliation: c Division of Anatomic Pathology , Mayo Clinic , Rochester , MN , USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Maleszewski
authors.affiliation: a Division of Cardiovascular Disease .
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Klarich
authors.affiliation: a Division of Cardiovascular Disease .
authors.forename: Nandan S
authors.initials: NS
authors.lastname: Anavekar
authors.affiliation: a Division of Cardiovascular Disease .
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Mulvagh
authors.affiliation: a Division of Cardiovascular Disease .
authors.forename: Martha
authors.initials: M
authors.lastname: Grogan
mesh_terms: D000368:Aged; D000682:Amyloid / Q000737:chemistry* / Q000648:ultrastructure; D000686:Amyloidosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality; D001794:Blood Pressure; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000401:mortality; D002637:Chest Pain / Q000503:physiopathology; D017023:Coronary Angiography; D004417:Dyspnea / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test; D005260:Female; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000737:chemistry / Q000648:ultrastructure; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000737:chemistry* / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000682:Amyloid; D007147:Immunoglobulin Light Chains
keywords: AL amyloidosis; cardiac amyloidosis; echocardiography; stress echocardiography