Introducere. Amiloidoza cu lanţuri uşoare (AL) este o afecţiune hematologică rară cu impact cardiovascular major unde implicarea cordului determină un prognostic nefavorabil. Manifestările cardiovasculare pot mima alte patologii, necesitând o vigilenţă clinică crescută pentru diagnostic precoce şi iniţierea tratamentului. Scop. Evidenţierea particularităţilor cardiovasculare în amiloidoza cu lanţuri uşoare (AL) prin analiza clinică şi imagistică a două cazuri confirmate histologic şi imunologic. Material şi metode. Studiu retrospectiv observaţional care a inclus doi pacienţi internaţi în Institutul de Cardiologie în anul 2025. Au fost analizate date clinice, ECG, EchoCG, NT-proBNP şi investigaţii histologice şi imunologice. Diagnosticul a fost confirmat prin biopsia gingiei şi identificarea lanţurilor uşoare prin electroforeza proteinelor serice. Rezultate. Vârsta medie a pacienţilor a fost 62 ani. Clinic s-au caracterizat prin dispnee severă, edeme periferice, parestezii periferice şi scădere ponderală marcată. ECG: microvoltaj precordial neconcordat cu hipertrofia VS. Ecocardiografie: HVS>14,6 mm, disfuncţie diastolică restrictivă, dilatare atrială bilaterală, prezenţa lichidului pericardic şi pleural. Date de laborator NT-proBNP: 12.828 pg/mL şi 23.410 pg/mL. Biopsia mucoasei bucale a evidenţiat depozite de amiloid în ţesutul conjunctiv subepitelial. Electroforeza proteinelor a confirmat lanţuri uşoare şi pacienţii au fost direcţionaţi către tratament hematologic specializat. Concluzii. Respectarea criteriilor etapizat a evidenţiat afectarea cardiovasculară severă ca manifestare centrală în amiloidoza AL. Confirmarea diagnosticului prin investigaţii paraclinice şi histolog-ice a permis direcţionarea rapidă spre tratament specific, susţinând importanţa depistării precoce.
Introduction. Light chain (AL) amyloidosis is a rare hematologic disorder with major cardiovascular impact, where cardiac involvement often results in a poor prognosis. Its clinical manifestations may closely mimic other conditions, requiring high clinical vigilance for early diagnosis and timely treatment. Objective. Highlighting key cardiovascular features and clinical manifestations in AL amyloidosis through detailed clinical, imaging, and histopathological analysis of two confirmed cases. Material and methods. Retrospective study that included two patients hospitalized at the IMSP Institute of Cardiology in the year 2025. Clinical data, ECG, EchoCG, NT-proBNP, as well as histological and immunological investigations, were analyzed. The diagnosis was confirmed through gum biopsy and the identification of light chains via serum protein electrophoresis. Results. The average age of the patients was 62 years. Clinically, they were characterized by dyspnea, peripheral edema, peripheral paresthesias, and significant weight loss. ECG: precordial microvoltages inconsistent with left ventricular hypertrophy. Echocardiography: LV wall thickness >14.6 mm, restrictive diastolic dysfunction, bilateral atrial dilation, presence of pericardial and pleural fluid. Laboratory data: NT-proBNP levels of 12,828 pg/mL and 23,410 pg/ mL. Buccal mucosa biopsy revealed amyloid deposits. Protein electrophoresis confirmed the presence of light chains, and the patients were referred for specialized hematologic treatment. Conclusion. Adherence to the staged criteria highlighted severe cardiovascular involvement as a central manifestation in AL amyloidosis. Confirmation of the diagnosis through paraclinical and histological investigations allowed for rapid referral to treatment, emphasizing the importance of early detection.
