2026 年 90 巻 1 号 p. 139-
An 87-year-old man was admitted for catheter ablation (CA) of atrial fibrillation (AF), 2 years after he had undergone transcatheter aortic valve replacement (TAVR). Pre-TAVR computed tomography (CT) had revealed diffuse late enhancement (LE) predominantly in the basal left ventricular myocardium (LVM) (Figure A) and an elevated global LV extracellular volume fraction (ECV) of 33.3% (Figure B).
Late enhancement (LE; arrows) of left ventricular myocardium (LVM) (A) and an elevated LV extracellular volume fraction (ECV) were detected on computed tomography (CT) (B). Echocardiography demonstrated LV hypertrophy (C). Diffuse LE on LVM (D, arrows), and a further rise in LV-ECV detected on CT (E). Tc-99 m pyrophosphate scintigraphy demonstrated higher uptake in the IVS and basal lateral LVM (F, arrows).
Echocardiography demonstrated LVM hypertrophy (Figure C). Pre-CA CT showed larger bright LE, predominantly in the basal interventricular septum (IVS) and inferior to the lateral LVM (Figure D), and a further rise in global LV-ECV to 44.3% (Figure E). A late-phase scan was performed 6 min after contrast injection (515 or 471 mgI/kg) using Revolution APEX (GE Healthcare, Waukesha, WI, USA) at a tube voltage of 70 kV. The slice thickness of the LE was 10 mm. A myocardial biopsy suggested amyloid deposition, and the serum immunofixation electrophoresis test was negative. Tc-99 m pyrophosphate scintigraphy demonstrated higher uptake in the IVS and basal lateral LVM (Figure F), leading to a diagnosis of wild-type ATTR amyloidosis. Because of the immediacy of the diagnosis, disease-specific therapy has not begun. We conclude that CT-ECV was useful for diagnosing cardiac amyloidosis.1
This work was supported by the JSPS KAKENHI (JP23K11891).
Y.K. is a member of Circulation Journal’s Editorial Team.
