title: Characteristics of left ventricular rotational mechanics in patients with systemic amyloidosis, systemic hypertension and normal left ventricular mass.
abstract: BACKGROUND
  Recently, two-dimensional (2D) speckle-tracking echocardiography has enabled assessment of a particular behaviour of left ventricular (LV) motion defined as twisting/untwisting. The aim of our study is to evaluate whether in early stage of hypertension and systemic amyloidosis, subclinical alteration of LV twist and untwist is already present even if no LV hypertrophy is evidenced.
  
  
  METHODS
  Forty-seven patients with light chain immunoglobulin amyloidosis (AL) entered the study and were classified having cardiac amyloidosis (CA) or not (NCA) if the mean value of LV wall thickness was ≥12 mm or not. Twenty-two consecutive patients with history of arterial essential hypertension (Hyp Group) and no sign of LV hypertrophy were enrolled. A total of 26 asymptomatic healthy subjects, age-matched, were analysed as control group. All three groups of patients and healthy subjects underwent traditional and 2D speckle-tracking echocardiography evaluation. LV diameters, volumes, wall thickness, mass, ejection fraction, E/A and E/E' ratio were evaluated.
  
  
  RESULTS
  Twisting and untwisting rates were significantly increased in NCA and Hyp group when compared with CA and control group. Moreover, despite similar LV mass and diastolic dysfunction degree, untwisting rate peak was significantly delayed in NCA when compared with Hyp group. In patients with CA, untwisting rate delay was similar to patients with NCA.
  
  
  CONCLUSIONS
  Our results show that amyloidosis and systemic hypertension produce both LV twist and untwist rate enhancement before LV hypertrophy is developed. In patients with amyloidosis irrespectively of LV infiltration degree, a significant LV untwisting rate peak delay occurs suggesting that different aetiology of cardiac involvement could differently affect LV untwisting rate.
authors.affiliation: Heart and Vessels Department, University of Florence, Florence, Italy. cappellifrancesco@inwind.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Cappelli
authors.forename: Maria C
authors.initials: MC
authors.lastname: Porciani
authors.forename: Franco
authors.initials: F
authors.lastname: Bergesio
authors.forename: Federico
authors.initials: F
authors.lastname: Perfetto
authors.forename: Francesco
authors.initials: F
authors.lastname: De Antoniis
authors.forename: Ardian
authors.initials: A
authors.lastname: Cania
authors.forename: Francesca
authors.initials: F
authors.lastname: Tronconi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ricceri
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D007558:Italy; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012399:Rotation; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left