Purpose: The relative apical sparing pattern of longitudinal strain (RASP), as determined by a Bull’s eye map, aids in diagnosing cardiac amyloidosis (CA). Despite the challenges involved in estimation, longitudinal strain (LS) values of the apex and other regions are needed for comparison and estimation. Moreover, quantitative evaluation methods for RASP can be confusing to determine. Therefore, our aim is to investigate the significant evaluation method of RASP in patients with CA.

Methods: This study included 176 cases (mean age: 68±14 years, 129 males) with suspected CA who underwent transthoracic echocardiography and LS analysis. We identified 20 cases with CA and compared the detection sensitivity, specificity, and positive predictive value of A and B methods. Method A calculated the average apical LS divided by the sum of average basal LS and average mid LS. Method B involved the average apical septal LS divided by the average basal septal LS. For Method B, we determined the cutoff value for CA positivity and evaluated its accuracy.

Results: In Method B, the cutoff value for apical sparing by ROC analysis was 2.0. The sensitivity, specificity, and positive predictive value for diagnosing CA were 65%, 81%, and 31% for Method A and 90%, 73%, and 30% for Method B, respectively.

Conclusions: Echocardiography, as the gatekeeper, is crucial for detecting suspected cases of CA with high sensitivity, leading to prompt treatment. Our findings suggests that Method B is a suitable screening test for CA.

Bilateral ruptured Baker’s cysts are a rare cause of acute lower extremity swelling accompanied by pain. The differential diagnoses for lower leg swelling with pain include various musculoskeletal and vascular pathologies such as deep venous thrombosis. Ultrasound imaging plays a crucial role in the swift and accurate detection of such diseases. Herein, we report a case of bilateral ruptured Baker’s cysts in a patient with rheumatoid arthritis presenting with bilateral lower extremity swelling and pain. The diagnosis was confirmed via ultrasound, and successful management was achieved with medication.