title: Detection of increased left ventricular filling pressure by pulsed tissue Doppler in cardiac amyloidosis.
abstract: 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.
authors.affiliation: Cardioangiology Unit, Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Innelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.forename: Lucio
authors.initials: L
authors.lastname: Catalano
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Martorelli
authors.forename: Marinella
authors.initials: M
authors.lastname: Olibet
authors.forename: Moira
authors.initials: M
authors.lastname: Pardo
authors.forename: Bruno
authors.initials: B
authors.lastname: Rotoli
authors.forename: Oreste
authors.initials: O
authors.lastname: de Divitiis
mesh_terms: 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