PMID- 25794983 OWN - NLM STAT- MEDLINE DCOM- 20170502 LR - 20181113 IS - 1615-2573 (Electronic) IS - 0910-8327 (Linking) VI - 31 IP - 6 DP - 2016 Jun TI - Late gadolinium enhancement in cardiac amyloidosis: attributable both to interstitial amyloid deposition and subendocardial fibrosis caused by ischemia. PG - 990-5 LID - 10.1007/s00380-015-0658-0 [doi] AB - Gadolinium contrast agents used for late gadolinium enhancement (LGE) distribute in the extracellular space. Global diffuse myocardial LGE pronounced in the subendocardial layers is common in cardiac amyloidosis. However, the pathophysiological basis of these findings has not been sufficiently explained. A 64-year-old man was admitted to our hospital with leg edema and nocturnal dyspnea. Bence Jones protein was positive in the urine, and an endomyocardial and skin biopsy showed light-chain (AL) amyloidosis. He died of ventricular fibrillation 3 months later. 9 days before death, the patient was examined by cardiac magnetic resonance (CMR) imaging on a 3-T system. We acquired LGE data at 2, 5, 10, and 20 min after the injection of gadolinium contrast agents, with a fixed inversion time of 350 ms. Myocardial LGE developed sequentially. The myocardium was diffusely enhanced at 2 min, except for the subendocardium, but LGE had extended to almost the entire left ventricle at 5 min and predominantly localized to the subendocardial region at 10 and 20 min. An autopsy revealed massive and diffused amyloid deposits in perimyocytes throughout the myocardium. Old and recent ischemic findings, such as replacement fibrosis and coagulative myocyte necrosis, were evident in the subendocardium. In the intramural coronary arteries, mild amyloid deposits were present within the subepicardial to the mid layer of the left ventricle, but no stenotic lesions were evident. However, capillaries were obstructed by amyloid deposits in the subendocardium. In conclusion, the late phase of dynamic LGE (at 10 and 20 min) visualized in the subendocardium corresponded to the interstitial amyloid deposition and subendocardial fibrosis caused by ischemia in our patient. FAU - Hashimura, Hiromi AU - Hashimura H AD - Department of Pathology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, Japan. AD - Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan. FAU - Ishibashi-Ueda, Hatsue AU - Ishibashi-Ueda H AD - Department of Pathology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, Japan. hueda@hsp.ncvc.go.jp. FAU - Yonemoto, Yumiko AU - Yonemoto Y AD - Department of Pathology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, Japan. FAU - Ohta-Ogo, Keiko AU - Ohta-Ogo K AD - Department of Pathology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, Japan. FAU - Matsuyama, Taka-Aki AU - Matsuyama TA AD - Department of Pathology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, Japan. FAU - Ikeda, Yoshihiko AU - Ikeda Y AD - Department of Pathology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, Japan. FAU - Morita, Yoshiaki AU - Morita Y AD - Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan. FAU - Yamada, Naoaki AU - Yamada N AD - Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan. FAU - Yasui, Hiroki AU - Yasui H AD - Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan. FAU - Naito, Hiroaki AU - Naito H AD - Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan. LA - eng PT - Case Reports PT - Journal Article DEP - 20150321 PL - Japan TA - Heart Vessels JT - Heart and vessels JID - 8511258 RN - 0 (Amyloid) RN - 0 (Contrast Media) RN - K2I13DR72L (Gadolinium DTPA) SB - IM MH - Amyloid/*analysis MH - Amyloidosis/*diagnostic imaging/metabolism/pathology/physiopathology MH - Autopsy MH - Cardiomyopathies/*diagnostic imaging/metabolism/pathology/physiopathology MH - Contrast Media/*administration & dosage MH - Coronary Artery Disease/*diagnostic imaging/metabolism/pathology/physiopathology MH - Coronary Circulation MH - Coronary Vessels/chemistry/*diagnostic imaging/pathology/physiopathology MH - Fatal Outcome MH - Fibrosis MH - Gadolinium DTPA/*administration & dosage MH - Humans MH - *Magnetic Resonance Imaging MH - Male MH - Middle Aged MH - Myocardial Perfusion Imaging/*methods MH - *Myocardium/chemistry/pathology MH - Predictive Value of Tests OTO - NOTNLM OT - Cardiac amyloidosis OT - Late gadolinium enhancement OT - Magnetic resonance imaging OT - Pathology EDAT- 2015/03/22 06:00 MHDA- 2017/05/04 06:00 CRDT- 2015/03/22 06:00 PHST- 2014/01/22 00:00 [received] PHST- 2015/03/06 00:00 [accepted] PHST- 2015/03/22 06:00 [entrez] PHST- 2015/03/22 06:00 [pubmed] PHST- 2017/05/04 06:00 [medline] AID - 10.1007/s00380-015-0658-0 [pii] AID - 10.1007/s00380-015-0658-0 [doi] PST - ppublish SO - Heart Vessels. 2016 Jun;31(6):990-5. doi: 10.1007/s00380-015-0658-0. Epub 2015 Mar 21.