Regression of Cardiac Amyloidosis After Stem Cell Transplantation Assessed by Cardiovascular Magnetic Resonance Imaging
2014; Lippincott Williams & Wilkins; Volume: 129; Issue: 22 Linguagem: Inglês
10.1161/circulationaha.114.009135
ISSN1524-4539
AutoresVikram Brahmanandam, Sloane McGraw, Omer Mirza, Ankit A. Desai, Afshin Farzaneh‐Far,
Tópico(s)Eosinophilic Disorders and Syndromes
ResumoHomeCirculationVol. 129, No. 22Regression of Cardiac Amyloidosis After Stem Cell Transplantation Assessed by Cardiovascular Magnetic Resonance Imaging Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBRegression of Cardiac Amyloidosis After Stem Cell Transplantation Assessed by Cardiovascular Magnetic Resonance Imaging Vikram Brahmanandam, MD, Sloane McGraw, DO, Omer Mirza, MD, Ankit A. Desai, MD and Afshin Farzaneh-Far, MD, PhD Vikram BrahmanandamVikram Brahmanandam From the Section of Cardiology (V.B., S.M., A.A.D., A.F.-F.) and the Department of Medicine (O.M.), University of Illinois at Chicago, Chicago, IL; and the Division of Cardiology, Duke University Medical Center, Durham, NC (A.F.-F.). , Sloane McGrawSloane McGraw From the Section of Cardiology (V.B., S.M., A.A.D., A.F.-F.) and the Department of Medicine (O.M.), University of Illinois at Chicago, Chicago, IL; and the Division of Cardiology, Duke University Medical Center, Durham, NC (A.F.-F.). , Omer MirzaOmer Mirza From the Section of Cardiology (V.B., S.M., A.A.D., A.F.-F.) and the Department of Medicine (O.M.), University of Illinois at Chicago, Chicago, IL; and the Division of Cardiology, Duke University Medical Center, Durham, NC (A.F.-F.). , Ankit A. DesaiAnkit A. Desai From the Section of Cardiology (V.B., S.M., A.A.D., A.F.-F.) and the Department of Medicine (O.M.), University of Illinois at Chicago, Chicago, IL; and the Division of Cardiology, Duke University Medical Center, Durham, NC (A.F.-F.). and Afshin Farzaneh-FarAfshin Farzaneh-Far From the Section of Cardiology (V.B., S.M., A.A.D., A.F.-F.) and the Department of Medicine (O.M.), University of Illinois at Chicago, Chicago, IL; and the Division of Cardiology, Duke University Medical Center, Durham, NC (A.F.-F.). Originally published3 Jun 2014https://doi.org/10.1161/CIRCULATIONAHA.114.009135Circulation. 2014;129:2326–2328IntroductionA previously fit 52-year-old man presented with severe progressive exertional dyspnea. He was in heart-failure with an elevated jugular-venous-pressure, edema, and increased plasma-NTpro-BNP levels of 4285 μg/mL (upper limit of normal <900 μg/mL). His ECG demonstrated sinus-rhythm with low limb and chest lead voltages (Figure 1). He had significant proteinuria with renal and bone marrow biopsies confirming light-chain amyloidosis. Cardiac magnetic resonance imaging revealed concentric left-ventricular hypertrophy with an ejection fraction of 65%, left-ventricular end-diastolic volume of 146 mL, left-ventricular end-systolic volume of 51 mL, left-ventricular mass of 245 g, and left-atrial volume of 144 mL (Figure 2, Movie I in the online-only Data Supplement). Late gadolinium-enhanced imaging showed extensive diffuse subendocardial hyperenhancement in both ventricles (Figures 3 and 4, arrows), consistent with amyloid infiltration. He subsequently underwent successful autologous stem cell transplantation.Download figureDownload PowerPointFigure 1. ECG showing sinus rhythm with low QRS voltages (<5 mm in the limb leads and 5 mm in leads I, III, aVR, aVL).Download figureDownload PowerPointFigure 6. Post stem cell transplant cine imaging in the 4-chamber view, showing an ejection fraction of 69% with concentric left-ventricular hypertrophy. The left atrium has reduced in size.Download figureDownload PowerPointFigure 7. Post stem cell transplant late gadolinium enhancement imaging in the 4-chamber view, showing significant regression of the subendocardial hyperenhacement.Download figureDownload PowerPointFigure 8. Post stem cell transplant late gadolinium enhancement imaging in the 3-chamber view, showing significant regression of the subendocardial hyperenhacement.Prognosis for patients with light-chain amyloid and cardiac infiltration has historically been dismal, and extensive cardiac involvement has generally been regarded as a contraindication to stem cell transplantation.1–3 This case suggests that stem cell transplantation can lead to regression of cardiac amyloid and may be considered in selected patients.Sources of FundingDr Brahmanandam was supported by National Institutes of Health grant T32HL072742.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.114.009135/-/DC1.Correspondence to Afshin Farzaneh-Far, MD, PhD, FACC, Section of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S Wood St (MC 715), Chicago, IL 60612. E-mail [email protected]References1. 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Falk R, Alexander K, Liao R and Dorbala S (2016) AL (Light-Chain) Cardiac Amyloidosis, Journal of the American College of Cardiology, 10.1016/j.jacc.2016.06.053, 68:12, (1323-1341), Online publication date: 1-Sep-2016. Behbahan I, Keating A and Gale R (2015) Bone Marrow Therapies for Chronic Heart Disease, Stem Cells, 10.1002/stem.2080, 33:11, (3212-3227), Online publication date: 1-Nov-2015. June 3, 2014Vol 129, Issue 22 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.114.009135PMID: 24891627 Originally publishedJune 3, 2014 PDF download Advertisement SubjectsComputerized Tomography (CT)Congenital Heart Disease
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