Left ventricular hypertrophy: diagnostics pitfalls

Area of Science:

• Cardiology
• Cardiovascular Diseases
• Cardiac Imaging

Background:

• Isolated left ventricular hypertrophy (LVH) is often presumed to be hypertrophic cardiomyopathy (HCM).
• However, other conditions, such as cardiac amyloidosis, can mimic HCM, presenting diagnostic challenges.
• Accurate differentiation is critical due to distinct prognoses and therapeutic strategies.

Purpose of the Study:

• To highlight the diagnostic challenges in differentiating cardiac amyloidosis from hypertrophic cardiomyopathy (HCM) when isolated left ventricular hypertrophy is present.
• To emphasize the limitations of non-invasive cardiac investigations in distinguishing between these two conditions.
• To underscore the definitive role of endomyocardial biopsy (EMB) in diagnosing cardiac amyloidosis.

Main Methods:

• Review of a clinical case presenting with isolated left ventricular hypertrophy.
• Evaluation of non-invasive cardiac investigations (e.g., echocardiography, cardiac MRI).
• Consideration of endomyocardial biopsy (EMB) for definitive diagnosis.

Main Results:

• Non-invasive cardiac investigations were inconclusive in differentiating between hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis.
• Endomyocardial biopsy (EMB) confirmed cardiac involvement secondary to systemic amyloidosis.
• The case involved multiorgan failure, complicating the diagnostic and therapeutic pathway.

Conclusions:

• Cardiac amyloidosis poses a significant diagnostic challenge, often mimicking hypertrophic cardiomyopathy (HCM).
• Endomyocardial biopsy (EMB) remains the gold standard for confirming cardiac amyloidosis.
• A multidisciplinary approach is essential for accurate diagnosis and tailored treatment planning in complex cardiac cases.