Cardiac Amyloidosis and Suspected Coronary Disease: What Would You Do Next?

Perfusion images (top) and myocardial blood flow – QPET (bottom) from Coronary Microvascular Dysfunction Due to Cardiac Amyloidosis – Multimodality Approach to Diagnosis, by Tamara Naneishvili, MD, Andrew Crean, MD, and Parthiban Arumugam, MB BS, FASNC, of the University of Manchester and Nuclear Medicine Centre, Manchester University NHS Foundation Trust, in the UK. 

An 80-year-old man with chest pain and known ATTR cardiac amyloidosis, diagnosed by bone scintigraphy, undergoes rest/stress myocardial perfusion imaging to evaluate for possible ischemia. The study reveals transient ischemic dilation, very high coronary calcium, reduced ejection fraction at stress, and very mildly abnormal myocardial blood flow reserve.

What should be the next step? Medical therapy, coronary CT angiography (CCTA), cardiac catheterization, or stress echocardiography?

Nov 2026 PET case authors

The case, authored by Tamara Naneishvili, MD, Andrew Crean, MD, and Parthiban Arumugam, MB BS, FASNC, explores the diagnostic challenges of evaluating potential coronary disease in a patient with cardiac amyloidosis.

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