**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.**
Jennifer Marsidi, Rush University, Chicago, IL

**Main Body of the Abstract**
Despite the use of multimodal testing, the diagnosis of cardiac amyloidosis can be challenging and requires a high index of suspicion. We present a rare case of cardiac amyloidosis without significantly increased left ventricular (LV) wall thickness which was identified on endomyocardial biopsy during left ventricular device (LVAD) implantation.
A 77-year-old male presented to our center from an outside hospital with initial diagnosis of ischemic cardiomyopathy following percutaneous coronary intervention to the left circumflex artery (Lcx). Initial cardiac magnetic resonance imaging (cMRI) demonstrated scar in the Lcx territory without increased LV wall thickness. Electrocardiogram with normal voltage, sinus rhythm and premature ventricular contractions. The patient progressed to end-stage heart failure, and LVAD was placed. Prior to implantation, echocardiogram demonstrated a mildly thickened LV wall at 11mm with average global longitudinal strain of -2% and relative apical strain of 0.56, not suggestive of amyloid.
Apical core biopsy during LVAD implant suggestive of amyloid light chain amyloid, however subsequent testing was negative for monoclonal protein. Biopsy was sent for laser microdissection with liquid chromatography-mass spectrometry (LC-MS) identifying transthyretin amyloidosis. The patient was started on Tafamidis and his diagnosis informed genetic counseling for his family.
This patient’s presentation was non-classical on multiple tests: echocardiogram, electrocardiogram and cMRI. At 11mm, his LV was less than current AHA/ACC/HFSA guideline of 14mm when considering amyloidosis. This patient did have other indications of amyloidosis including bilateral carpal tunnel syndrome and history of ventricular tachycardia. This case highlights the complexity of identifying cardiac amyloidosis despite contemporary diagnostics.



Left Ventricular Assist Device Therapy in ATTR Cardiac Amyloid PB47 (#541)

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.