Journal of the American Society of Echocardiography
Original articleDetection of Left Ventricular Systolic Dysfunction in Cardiac Amyloidosis with Strain Rate Echocardiography
Section snippets
Study Population
This study was approved by the institutional review board of the Mayo Clinic. The study population consisted of 103 patients with primary AL consecutively selected from patients undergoing evaluation in the Divisions of Cardiovascular Diseases and Hematology at the Mayo Clinic, Rochester Minnesota, from February 2004 to October 2005. The diagnosis of primary AL was made by either subcutaneous fat biopsy or involved organ biopsy that demonstrated typical Congo red birefringence under polarized
Clinical Characteristics
The characteristics of the subjects enrolled are shown in Table 1. Patients with advanced-CA were aged 66 ± 7 years and 67% were male, whereas patients with AL-normal-wall-thickness were aged 60 ± 10 years and 47% were male (P = .01, .04, respectively). Two patients in the AL-normal-wall-thickness group and five patients in the advanced-CA group had pleural effusion. Five patients in the AL-normal-wall-thickness group and nine patients in the advanced-CA group had pericardial effusions.
Discussion
Death in AL is most commonly from cardiac causes, mainly because of progressive congestive cardiomyopathy. High-dose melphalan followed by PBSCT is presently considered the most effective treatment for patients with AL.18 Cardiac involvement remains one of the most important prognostic factors, although patients with overt CA are not usually referred to high-dose melphalan or PBSCT, 42% of the treatment-related deaths are from cardiac causes.19 Therefore, in patients with systemic AL for whom
Conclusions
In this study, we confirmed that longitudinal sS and sSR are more sensitive than sTVI and that they are the most effective echocardiographic modalities to detect impairment of LV systolic function in patients with systemic AL and cardiac involvement. We believe DMI should be applied to all patients with systemic AL as they are undergoing standard echocardiography evaluation, which should also include measurement of the mitral annular E’ velocity. The DMI evaluation should include calculation of
Acknowledgments
The authors thank Drs. Cataliotti and Bursi for their greatly appreciated support and comments.
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This study was supported in part by a grant from the American Heart Association Heartland Affiliate (Grant No. 0620073Z).