Fig. 4

Cardiac MRI showed evidence of restricted cardiomyopathy suggestive of cardiac amyloidosis. The left and right atrium were high-normal in size (LA area: 19cm², LA area index: 11 cm²/m², RA area: 22cm², RA area index: 12 cm²/m²), and the LAS was hypertrophied. LV hypertrophy (maximal septal thickness 14 mm in the inferoseptal area) and a mild reduced LV systolic function (LV ejection fraction: 46%, and LV end-diastolic volume:100 ml) could be seen. Mild RVH and mild reduced RV systolic dysfunction could also be detected (RV ejection fraction: 43% and RV end-diastolic volume: 100 ml). Moreover, mild mitral regurgitation, mild tricuspid regurgitation, and mild mitral thickness were demonstrated in the valvular evaluation. The main pulmonary artery was mildly dilated (13 mm). Moderate left-sided pleural effusion was obvious, with evidence of mild pericardial effusion (anterior LV side: 6 mm and inferior LV side: 9 mm) without any compressive effect on the LV or RV. In the gadolinium phase, diffuse subendocardial to transmural enhancement is achieved throughout LV and RV and bilateral walls and enhancement of inter-atrial septum and atrioventricular valves