ABC | Volume 114, Nº4, Suplement, April 2020

Case Report Nunes et al. Syncope in Val122Ile amyloidosis Arq Bras Cardiol 2020; 114(4Suppl.1):1-3 Figure 2 – Transthoracic echocardiogram showing pseudonormal mitral Doppler pattern (type II diastolic dysfunction), tricuspid regurgitation peak velocity >2.8 m/s and biatrial enlargement with indexed LA volume of 87 mL/m 2 . Parasternal longitudinal apical-4 chamber projections showing increased myocardial brightness, interatrial septum and valve thickening, and LVH. Global Longitudinal Strain showing typical amyloidosis pattern – “relative preservation of the apical regions” and longitudinal strain reduction in the basal and middle myocardial segments. 1. Nativi-Nicolau J, Maurer MS. Amyloidosis cardiomyopathy. Curr Opin Cardiol. 2018;33(5):571–9. 2. Ando Y, Coelho T, Berk JL, Waddington Cruz M, Ericzon B-G, Ikeda S-I, et al. Guideline of transthyretin-related hereditary amyloidosis for clinicians. Orphanet J Rare Dis. 2013 Feb 20;8:31. 3. Brignole M, Moya A, de Lange FJ, Deharo J-C, Elliott PM, Fanciulli A, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883–948. 4. Elliott P. Addressing common questions encountered in the diagnosis and management of cardiac amyloidosis. Circulation. 2017;135(14):1357–77. 5. Maurer MS, Hanna M, Grogan M, Dispenzieri A, Witteles R, Drachman B, et al. Genotype and Phenotype of Transthyretin Cardiac Amyloidosis. J Am Coll Cardiol. 2016;68(2):161–72. 6. BanypersadSM,MoonJC,WhelanC,HawkinsPN,WechalekarAD.Updates in Cardiac Amyloidosis: A Review. J AmHeart Assoc. 2012;(2):1–13. 7. Martinez-NaharroA,TreibelTA,Abdel-GadirA,BulluckH,ZumboG,Knight DS, et al. Magnetic Resonance in Transthyretin Cardiac Amyloidosis. J Am Coll Cardiol. 2017;70(4):466–77. 8. Phelan D, Thavendiranathan P, Popovic Z, Collier P, Griffin B, Thomas JD, et al. Application of a ParametricDisplay of Two-Dimensional Speckle-Tracking Longitudinal Strain to Improve the Etiologic Diagnosis of Mild to Moderate Left Ventricular Hypertrophy. J Am Soc Echocardiogr. 2014; 27(8):888–95. 9. Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation. 2016;133(24):2404–12. 10. Marin-AcevedoJA,Sanchez-AlvarezC,AlsaadAA,PagánRJ.CaseReportRecurrent syncope,aclue inamyloidcardiomyopathy.CaseRepMed.2018Jan28:1-6. References This is an open-access article distributed under the terms of the Creative Commons Attribution License ATTR is an underdiagnosed cause of HFpEF, although TTR deposits are identified in up to 30% of elderly patients referred for autopsy. 1,2,5 Syncope, although uncommon in the presentation of this phenotype, may be the first symptom of this disease. Author contributions Conception and design of the research and Acquisition of data: Nunes NSV, Mesquita CT, Mesquita ET; Analysis and interpretation of the data: Nunes NSV, Carvalho JPM, Costa FS, Nacif MS, Dominato J, Mesquita CT, Mesquita ET; Writing of the manuscript: Nunes NSV, Carvalho JPM, Costa FS, Nacif MS, Dominato J; Critical revision of the manuscript for intellectual content: Mesquita CT, Mesquita ET. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 3