Cardiac amyloidosis in a patient with multiple myeloma: A case report and review of literature

Sedaghat, David; Zakir, Ramzan M.; Choe, Jin; Klapholz, Marc; Sarić, Muhamed

doi:10.1002/jcu.20552

Cited by 22 publications

(22 citation statements)

References 26 publications

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“…39 Further improvement in sensitivity is achieved by testing with the quantitative serum free light chains assay which has a higher sensitivity compared to immunofixation. 40 The kappa/lambda free light chain ratio obtained in this test helps in establishing the diagnosis, especially in cases with co-existing renal impairment.…”

Section: Discussionmentioning

confidence: 99%

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Stiff Heart Syndrome

Bhupathi

Chalasani²,

Rokey³

2010

Clinical Medicine & Research

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Section: Discussionmentioning

confidence: 99%

“…39 In the period known as the "colchicine era" (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987), the mainstay of treatment was monotherapy with colchicine. 52 Subsequently, the MPC trial results led to the use of melphalan, prednisone and colchicine as a combined regimen.…”

Section: Discussionmentioning

confidence: 99%

Stiff Heart Syndrome

Bhupathi

Chalasani²,

Rokey³

2010

Clinical Medicine & Research

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“…The early detection of cardiac amyloidosis can improve outcomes. However, diagnosis is difficult because signs and symptoms are similar to other cardiomyopathies [30,32].…”

Section: Amyloidosismentioning

confidence: 97%

“…Approximately 10 % of patients with multiple myeloma have concomitant amyloidosis and it often involves the heart, kidney, and nerves [28,29]. The prognosis for multiple myeloma with concomitant amyloidosis is poor and heart involvement is often associated with a rapidly progressive course and high mortality rate [28,30,31]. The early detection of cardiac amyloidosis can improve outcomes.…”

Section: Amyloidosismentioning

confidence: 98%

“…Endocardial deposition is associated with valvular thickening and is observed as intramural depositions within the small intramural vessels of the conduction system [30,32,33]. The initial stages of cardiac amyloidosis manifest as congestive heart failure and its late stages are described as restrictive cardiomyopathy with severe left ventricular diastolic dysfunction [30]. Electrocardiography (ECG) and echocardiography are performed as primary examinations when cardiac amyloidosis is suspected.…”

Section: Amyloidosismentioning

confidence: 99%

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CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review

Kim

Jung

Kim

et al. 2015

Int J Cardiovasc Imaging

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Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment.

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Immunoglobulin light chain amyloidosis: 2011 update on diagnosis, risk‐stratification, and management

Gertz

2011

American J Hematol

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Immunoglobulin (Ig) light chain amyloidosis is a clonal but nonproliferative plasma cell disorder in which fragments of an Ig light chain are deposited in tissues. The clinical features depend on the organs involved but can include restrictive cardiomyopathy, nephrotic syndrome, hepatic failure, and peripheral/autonomic neuropathy. Tissue biopsy stained with Congo red demonstrating amyloid deposits with apple‐green birefringence is required for diagnosis. Invasive organ biopsy is not required because amyloid deposits can be found in bone marrow biopsy or subcutaneous fat aspirate in 85% of patients. N‐terminal pro–brain natriuretic peptide and serum troponin T values are used to classify patients into three groups of approximately equal size; median survivals are 26.4, 10.5, and 3.5 months, respectively. All patients with a visceral amyloid syndrome require therapy to prevent deposition of amyloid in other viscera and to prevent progressive organ failure of involved sites. Stem cell transplant (SCT) is a preferred technique, but only 20% of patients are eligible. Requirements for safe SCT include mild or no cardiac involvement, troponin T value <0.06 ng/mL, age younger than 70 years, <3 organs involved, and serum creatinine value ≤1.7 mg/dL. Nontransplant candidates can be offered melphalan‐dexamethasone. Pomalidomide appears to have activity, as do other combinations of chemotherapy with agents such as cyclophosphamide‐thalidomide‐dexamethasone, bortezomib‐dexamethasone, and melphalan‐prednisone‐lenalidomide. Late diagnosis remains a major obstacle to initiating effective therapy when organ dysfunction is still recoverable. Recognizing the presenting syndromes is necessary for improvement in survival. Am. J. Hematol. 86:181–186, 2011. © 2011 Wiley‐Liss, Inc.

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Cardiac amyloidosis in a patient with multiple myeloma: A case report and review of literature

Cited by 22 publications

References 26 publications

Stiff Heart Syndrome

Stiff Heart Syndrome

CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review

Immunoglobulin light chain amyloidosis: 2011 update on diagnosis, risk‐stratification, and management

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