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Figure 1
ECG image showing sinus rhythm, right atrial enlargement, low amplitude QRS complexes in limb leads, q wave in DIII with flatten T waves in inferior leads, and poor R wave progression in V1–V3.
Figure 2
Transthoracic echocardiographic images for left ventricle showing A: severe concentric left ventricular hypertrophy (IVS=17 mm, PWT =16 mm, RWT =0.8, LV mass =157 g/m2) B: biatrial dilatation (LA volume = 63 ml/m2; RA volume = 54 ml/m2) C and D: restrictive filling pattern (E/A=3, E=97 cm/sec, E’ lateral = 4 cm/sec E/E’=25). IVS: interventricular septum; PWT: posterior wall thickness; RWT: relative wall thickness; LV: left ventricle; LA: left atrium; RA: right atrium. E=peak of early filling velocity; A=peak of late atrial filling velocity; E’lateral = lateral mitral annular peak early diastolic velocity.
Figure 3
Transthoracic echocardiographic images for right ventricle before and after chemotherapy and stem cell transplantation. A and B (before treatment): altered longitudinal systolic function (TAPSE = 8 mm, S’= 5 cm/sec) at initial diagnosis; C and D (after treatment): improvement in longitudinal systolic (TAPSE = 15.5 mm, S’= 9 cm/sec) at 6 months follow up. TAPSE: tricuspid annular plane systolic excursion; s’= peak systolic velocity.
Figure 4
Transthoracic echocardiographic images before and after chemotherapy and stem cell transplantation. A and B (before treatment) images. A: Bull’s eye plot image showing significantly reduced GLS (−8.4 %) with severe altered deformation mainly at the basal and midventricular segments and relatively preserved at the apex, with a typical apical sparing strain pattern or „cherry-on-top” pattern. B: severe tricuspid regurgitation on Colour Doppler images. C and D (after treatment) images. C: Bull’s eye plot image showing an improvement in GLS (−11%) predominantly on the lateral and anterior wall. D: significantly regression of tricuspid regurgitation to mild by Colour Doppler images. GLS: global longitudinal strain.
Figure 5
Cardiac magnetic resonance images showing A and B diffuse subendocardial LGE at the base and mid-ventricle in the left ventricle (yellow arrows). C no LGE of the apex. LGE: late-gadolinium enhancement.
Figure 6
Cardiac magnetic resonance images showing A. an increase in right ventricle wall thickness (8 mm). B no LGE of the right ventricle. LGE: late-gadolinium enhancement.
Figure 7
Rectal pad biopsy images showing A. homogenous extracellular fibrils positive for Congo red staining localized in the vascular walls (black arrows); B. These fibrils are positive for green birefringence, specific for amyloid deposits (yellow arrows).