**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was done. Co-authors will be added in a separate section.**
Vinayak Hegde MD, FACC

**Main Body of the Abstract**
Background: Non invasive imaging modalities including cardiac MRI (CMR), Technetium pyrophosphate (PYP), PET scan have revolutionized the diagnosis of cardiac amyloidosis. Myocardial biopsy is not  widely available, and not routinely performed. We present a patient where this paradigm is questioned.
Case: 76 year old white male with a history of rheumatoid arthritis, Type 2 Diabetes, bilateral carpal tunnel syndrome, lumbar stenosis, presented with progressive dyspnea, weight gain, leg edema. Electrocardiography  revealed normal voltage, sinus rhythm. Echocardiography after aggressive iv diuresis revealed a normal sized left ventricle, moderate left ventricular hypertrophy, borderline left atrial filling pressures, biatrial dilatation. Suspicion was raised for cardiac amyloidosis. Serology revealed a normal hemogram,  kappa/Lambda ratio, negative M protein. Tc-PYP scan was negative for transthyretin (TTR) amyloid. CMR revealed diffuse myocardial late gadolinium enhancement ( LGE), difficulty nulling myocardium, elevated native myocardial T1 value at 990 msec , and extracellular volume ( ECV) at 31%. The CMR suggested cardiac amyloid, and a buccal mucosa biopsy that followed , was positive for light chain ( AL) amyloid. A bone marrow biopsy was however negative for AL amyloidosis. Given the discrepant findings, light chain amyloid therapy was withheld, and a myocardial biopsy was performed. The myocardial biopsy was reported as endocardial fibroelastosis.
Conclusion: Current diagnostic parameters on noninvasive imaging such as LGE, ECV are supportive, but not specific for cardiac amyloidosis. Our case highlights the value of myocardial biopsy for distinguishing cardiac amyloidosis from other mimicking clinical entities, thus avoiding inappropriate initiation of amyloid therapies in such patients.



Diagnosing Cardiac Amyloid: Can we ditch the bioptome yet? PA50 (#31)

We invite you to attend the XIX International Symposium on Amyloidosis to be held in Rochester, MN.

This symposium is organized as a hybrid meeting (with the focus on in-person) held from Sunday, May 26 through Thursday, May 30, 2024.

Together with the ISA Board and members of Mayo Clinic, a very attractive scientific hybrid program is being planned. The program will cover a variety of types of systemic amyloidosis: ATTR (hereditary and wild-type), AL (light-chain), AA and less frequent forms. There will be key lectures, specific symposia including those company sponsored, oral presentations and poster sessions of accepted abstracts.

COURSE DESCRIPTION
This program will provide a comprehensive review of state-of-the-art education in systemic amyloidosis: basic science, pathophysiology, diagnosis, current and emerging treatments. Scientific presentations will include competitive oral and poster abstracts. The rapid evolution of scientific discovery and expanding treatment options has created tremendous interest in the field and this meeting will fill and important gap in educating scientists and clinicians.