Heart failure secondary to amyloidosis AL: diagnosis and treatment

EUGENIA LLOVERAS; SANTAIGO DE COTTO; EUGENIA VILLANUEVA; MARCELINA CARRETERO; MARIA LOURDES POSADAS MARTINEZ; ELSA M NUCIFORA; ADELA AGUIRRE

MEDICINA (BUENOS AIRES)

MEDICINA (BUENOS AIRES)

Lugar: Buenos Aires; Año: 2023

0025-7680

Case Reports Medicina (B Aires). 2023;83(5):811-815.[Heart failure secondary to amyloidosis AL: diagnosis and treatment][Article in Spanish]Eugenia Pérez Lloveras 1, Santiago Decotto 2, Eugenia Villanueva 3, María Agustina Marco 1, Marcelina Carretero 1, María Lourdes Posadas-Martinez 4, Diego Pérez De Arenaza 3, Elsa Nucifora 5, María Adela Aguirre 1Affiliations expandPMID: 37870341Abstract in English, SpanishLight chain amyloidosis (AL) is a rare and underdiagnosed disease. The best treatment available is autologous bone marrow transplantation (BMT). Cardiac involvement is the main prognostic determinant in this pathology and sometimes an impediment to receive BMT. We present a clinical case of a 44-year-old who consulted for signs and symptoms of heart failure (HF) with elevated cardiac biomarkers. A transthoracic echocardiogram showed increased wall thickness with global hypokinesia and mildly impaired ejection fraction (50%). The patient was admitted to the coronary unit for treatment with diuretics and for etiological study of the condition. In view of the suspicion of infiltrative disease, a bone scintigraphy with pyrophosphate and free light chains in serum were requested. The bone scintigraphy was not suggestive of transthyretin amyloidosis and the free light chains showed a ratio of less than 0.26 with lambda predominance. A gum biopsy was performed and confirmed the diagnosis of AL amyloidosis. After diagnosis, specific chemotherapy treatment with Cyclophosphamide, Bortezomib and Dexamethasone (CYBORD scheme) and Daratumumab was started. He evolved with refractory HF so it was decided to admit him to the cardiac transplantation list, receiving the same soon after, with good evolution. This allowed the patient to restart the chemotherapy regimen and finally receive BMT, with good evolution.Keywords: AL amyloidosis; autologous bone marrow transplantation; cardiac transplantation; heart failure.