Cardiac amyloidosis: combined use of two-dimensional echocardiography and electrocardiography in noninvasive screening before biopsy.

Cardiac amyloidosis (CA) presenting with intractable congestive heart failure, electrocardiographic (ECG) normal or low voltage, and conduction or rhythm disturbances, is rapidly fatal. During life, CA often mimics other cardiomyopathies so that definitive diagnosis depends on demonstration of amyloid on myocardial biopsy. On two-dimensional echocardiography (2-D echo), nonspecific features, such as increased ventricular wall thicknesses, predominant diastolic dysfunction, and diffuse myocardial "sparkling," are consistently found in CA. The combined presence of these 2-D echo features and normal or low voltage on ECG is highly suggestive of CA, allows differentiation from other cardiomyopathies, and might be useful in noninvasive screening before myocardial biopsy.