Case Report: Contrast adenosine stress echocardiography revealing microvascular dysfunction in cardiac AL amyloidosis

Cardiac amyloidosis (CA) is a rare but increasingly recognized cause of restrictive cardiomyopathy. Noninvasive assessment of coronary microvascular dysfunction in CA can facilitate earlier diagnosis and improve disease monitoring. We present a case of light-chain (AL) cardiac amyloidosis manifesting as exertional angina with non-obstructive epicardial coronary arteries, in which contrast adenosine stress echocardiography combined with Doppler-derived coronary flow velocity reserve (CFVR) measurement revealed impaired myocardial perfusion and reduced CFVR. The findings were consistent with cardiac magnetic resonance (CMR) and laboratory results, confirming the diagnosis of CA. This case demonstrates the clinical application of contrast adenosine stress echocardiography as a practical adjunct to advanced imaging modalities for evaluating microvascular dysfunction in CA.