Apical Sparing Pattern of Longitudinal Strain and Positive Bone Scintigraphy in Metastatic Myocardial Calcification

Area of Science:

• Cardiology
• Medical Imaging
• Pathology

Background:

• Transthyretin cardiac amyloidosis (ATTR-CM) is a progressive disease.
• Specific imaging patterns, including apical sparing of longitudinal strain and positive bone scintigraphy, are key diagnostic markers for ATTR-CM.

Observation:

• A young woman presented with imaging findings suggestive of ATTR-CM: apical sparing of longitudinal strain and positive bone scintigraphy.
• Autopsy revealed metastatic myocardial calcification as the underlying cause.

Findings:

• The study highlights a case where metastatic myocardial calcification mimicked the diagnostic imaging features of transthyretin cardiac amyloidosis.
• This challenges the specificity of apical sparing and bone scintigraphy in certain clinical contexts.

Implications:

• Diagnostic criteria for cardiac amyloidosis may need refinement to account for alternative conditions.
• Further research is needed to differentiate metastatic myocardial calcification from ATTR-CM using non-invasive imaging.