Breathlessness and a thick heart in a 79-year-old man
History
79-year-old man with 18 months of exertional breathlessness and ankle swelling. Bilateral carpal tunnel release 6 years ago; lumbar spinal stenosis. Echocardiogram: left ventricular wall thickness 16 mm, LVEF 55%, reduced longitudinal strain with relative apical sparing. NT-proBNP 3,400 ng/L; high-sensitivity troponin T mildly raised; eGFR 58 mL/min/1.73 m². Referred for bone scintigraphy: cardiac amyloidosis?
Step 1 · Planar images
On the 3-h planar images the myocardium is intensely avid, more than the ribs, and uptake in the rest of the skeleton is markedly reduced. What is the Perugini grade?