The apical sparing pattern of global longitudinal strain (GLS) is a characteristic echocardiographic finding in cardiac amyloidosis. This pattern appears as a relative preservation of longitudinal strain in the apical segments compared to markedly reduced strain in basal and mid-ventricular segments, resulting in a "cherry on top" bullseye plot appearance.

This distinctive pattern helps differentiate amyloidosis from other causes of left ventricular hypertrophy and dysfunction, such as hypertensive heart disease, hypertrophic cardiomyopathy, or athlete’s heart, which generally show more uniform or different regional strain impairments.

This diagnostic feature has been validated in numerous studies and is included in the ASE guidelines on strain imaging and the "Textbook of Clinical Echocardiography," providing a sensitive and specific noninvasive marker for amyloid infiltration of the myocardium【12:ASE Strain Imaging Guidelines†p.130-140】【16:Textbook of Clinical Echocardiography, 6e†p.320-325】.