A: Two dimensional echocardiogram in a patient with amyloidosis showing thick ventricles, dilated atria, thick interventricular septum and a pericardial effusion. Left ventricular systolic function is depressed.
B: Strain echocardiography showing relatively preserved longitudinal strain in the apex (red) compared to the mid and basal myocardial segments. More negative values on the color scale depicts regions with normal longitudinal strain.
Tc-99m pyrophosphate (PYP) scintigraphy:
Tc-99m PYP is a bone scan agent. It is normally not taken up by the myocardium. (Left Panel). Avid myocardial uptake is diagnostic of cardiac ATTR amyloidosis (Right Panel).