Reversible Restrictive Cardiomyopathy Due to Light-Chain Deposition Disease  Motoyuki Nakamura, MD, Mamoru Satoh, MD, Shugo Kowada, MD, Hidetoshi Satoh, MD, Atsushi Tashiro, MD, Fumitoshi Sato, MD, Tomoyuki Masuda, MD, Katsuhiko Hiramori, MD  Mayo Clinic Proceedings  Volume 77, Issue 2, Pages 193-196 (February 2002) DOI: 10.4065/77.2.193 Copyright © 2002 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Standard 12-lead electrocardiogram before (A, September 1998) and 3 years after (B, July 2001) therapy. ST-T changes in I, aVL, and V3 through V6 observed in October 1998 (A) were completely eliminated after remission of multiple myeloma in July 2001 (B). Mayo Clinic Proceedings 2002 77, 193-196DOI: (10.4065/77.2.193) Copyright © 2002 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Left ventricular geometric and functional changes before (A, September 1998) and 3 years after (B, July 2001) therapy. Long-axis view of 2-dimensional echocardiography (top), M-mode echocardiography (middle), and spectral tracing of pulsed Doppler left ventricular inflow velocity (bottom). Left ventricular wall thickness was normalized (septum, from 17 to 9 mm; posterior wall, from 18 to 10 mm) with disappearance of granular sparkling texture (top and middle) and improvement in diastolic function (early-to-atrial peak transmitral velocity ratio from 3.38 to 0.96; deceleration time, from 105 to 235 milliseconds) (bottom). Mayo Clinic Proceedings 2002 77, 193-196DOI: (10.4065/77.2.193) Copyright © 2002 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Histological section of right endomyocardial biopsy specimen (original magnification x250). Light microscopy showed deposition of eosinophilic fibrillar substances in the interstitium (top). These substances were negative for Congo red staining and showed no apple green birefringence on polarized microscopy. Immunohistochemical studies revealed positive staining of the substances for κ light chain around the myocardial cells and the interstitium (arrows) (bottom). Mayo Clinic Proceedings 2002 77, 193-196DOI: (10.4065/77.2.193) Copyright © 2002 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 4 Electron microscopy showed electron dense deposits with a granular and fibrillar appearance in the interstitium (original magnification x20,000). Mayo Clinic Proceedings 2002 77, 193-196DOI: (10.4065/77.2.193) Copyright © 2002 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 5 Serial changes in an echocardiographic diastolic functional marker (E/A), with left ventricular posterior wall (PW) thickness and interventricular septum (IVS) thickness. Mayo Clinic Proceedings 2002 77, 193-196DOI: (10.4065/77.2.193) Copyright © 2002 Mayo Foundation for Medical Education and Research Terms and Conditions