Detection of increased left ventricular filling pressure by pulsed tissue Doppler in cardiac amyloidosis.
OBJECTIVE
The aim of this study was to evaluate the incremental diagnostic role of tissue Doppler in primary cardiac amyloidosis (CA).


METHODS
Eleven patients with CA at diagnosis and 11 healthy controls, matched for sex and age, underwent standard Doppler echocardiography and pulsed tissue Doppler of the left ventricular (LV) lateral annulus, in the apical four-chamber view. The ratio of early transmitral flow velocity to early diastolic mitral annular velocity (E/E(m) ratio) was derived as an index of LV filling pressure.


RESULTS
The two groups were comparable for body mass index, blood pressure, heart rate and standard Doppler diastolic measurements. Patients with CA had a significantly higher sum of wall thickness (SWT) and LV mass, a lower E(m) peak velocity (P < 0.002) and a higher E/E(m) ratio (P < 0.001) than controls. By dividing CA patients according to the transmitral E/A ratio, patients with an E/A ratio < 1 (abnormal relaxation) (n = 5) and patients with an E/A ratio > 1 (likely pseudonormal/restrictive pattern) (n = 6) did not show any difference in the E/E(m) ratio (14.5 + or - 7.1 vs. 15.1 + or - 6.4, P = NS). In the overall population, the E/E(m) ratio was related to SWT (r = 0.84, P < 0.0001) and LV mass index (r = 0.72, P < 0.0001). After adjusting for age and heart rate by separate multivariate models, SWT (beta = 0.78, P < 0.0001; cumulative r(2) = 0.63, SE = 3.38, P < 0.0001) and LV mass index (beta = 0.71, P < 0.0001; cumulative r(2) = 0.53, SE = 3.80, P < 0.002) were both independently associated with the E/E(m) ratio.


CONCLUSIONS
Pulsed tissue Doppler is able to detect early myocardial diastolic impairment in CA. The E/E(m) ratio is very useful in diagnosing increased LV filling pressure, regardless of the transmitral pattern, and may, therefore, be helpful in the clinical management of these patients.
Innelli
Pasquale
P
Cardioangiology Unit, Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy.
Galderisi
Maurizio
M
Catalano
Lucio
L
Martorelli
Maria Carmen
MC
Olibet
Marinella
M
Pardo
Moira
M
Rotoli
Bruno
B
de Divitiis
Oreste
O
D000368:Aged; D000686:Amyloidosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000704:Analysis of Variance; D015331:Cohort Studies; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D011336:Probability; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology