Relative Left Ventricular Apical Sparing of Longitudinal Strain in Cardiac Amyloidosis: Is it Just Amyloid Infiltration?

Cardiac amyloidosis (CA) is a rare and phenotypically heterogeneous disease, with pathophysiological clinical and morphological variability. From an imaging point of view, CA is one of the cardiomyopathies with a hypertrophic phenotype and is frequently misdiagnosed on echocardiography as sarcomeric or idiopathic hypertrophic cardiomyopathy. However, there are morphological and functional features that could unravel the underlying myocardial infiltration, and relative apical sparing of longitudinal strain (LS) impairment is among the most specific and almost invariably reported findings.