Embolic Infarction Associated with Cardiac Amyloidosis

Abstract

Embolic cerebral infarction due to cardiac amyloidosis is rare. We report two patients with amyloidosis who developed cerebral infarcts. These embolic infarcts were probably related to cardiac involvement of amyloidosis, which was based on results of myocardial biopsy (Patient 1), and kidney biopsy and characteristic echocardiographic features including granular sparkling, restrictive cardiomyopathy and the presence of mural thrombus (Patient 2). Diffuse amyloid infiltration of the heart may have lead to impairment of myocardial function and subsequent mural thrombosis. Cardiomyopathy due to cardiac amyloidosis should be recognized as one of the causes of cardioembolic infarction.

Cerebral embolism secondary to cardiac amyloidosis: A case report and literature review

“…However, 4 of whose (including our case) medical history and electrocardiogram showing no evidence of atrial fibrillation, revealed intra-cardiac thrombus ( 13 , 15 , 16 ). 2 patients were proved by TEE ( 13 , 16 ), 1 by autopsy ( 16 ), and the other was not elaborated. As to the present case, he was found to have intra-cardiac thrombus by both TEE and CMR.…”

“…Prognosis of CA is generally poor. For patients with AL amyloidosis, the median survival is 6 months after appearance of congestive heart failure ( 13 , 23 ), however, patients with senile systemic amyloidosis and heart failure live with longer survival of 5 years ( 24 ). Cardiac troponins and NT-proBNP are important prognostic indicators in CA, and also allow for monitoring progression of disease or efficacy of therapy ( 25 ).…”

“…Case reports were included, and reports without adequate details or full text were excluded. A total of 7 articles with reference information on 9 patients (including our patient in the present study) qualified for the literature review and served as the study population for the purpose of analysis ( Table I ) ( 13 – 19 ).…”

“…In addition to the routine treatment of heart failure, 4 patients ( 13 , 16 , 19 ), including the present case, were prescribed with immunosuppressive therapy, and one patient underwent liver transplantation ( 16 ). 5 patients ( 13 , 14 , 18 ) and the present case received anticoagulation therapy, 4 of whom survived ( 13 , 14 , 18 ), 1 of whom died of heart failure (our case), 1 of whom had recurrent stroke but was still alive ( 14 ) at the time of press. Oppositely, 3 of the 4 patients ( 15 – 17 , 19 ) without anticoagulation therapy died of heart and kidney failure ( 15 ), disseminated intravascular coagulation ( 16 ) and multiple myeloma ( 19 ) respectively.…”

Brain embolic infarction associated with cardiac amyloidosis in a patient with multiple myeloma: a bone marrow-heart-brain crosstalk

“…Immunoglobulin amyloid light chain amyloidosis may occur as a primary disease or in association with multiple myeloma or other plasma cell dyscrasia [1]. The heart is affected in over 50% of cases [2] but cerebral embolism in relation to cardiac amyloidosis has rarely been reported [1,3]. Herein, we report a patient with multiple myeloma who suffered from embolic infarction associated with cardiac amyloidosis diagnosed based on the kidney biopsy, echocardiographic and cardiac magnetic resonance imaging (MRI) results.…”