Diagnosis of cardiac amyloidosis based on the myocardial velocity profile in the hypertrophied left ventricular wall

• Published in: The American journal of cardiology Vol. 93; no. 7; pp. 864 - 869
• Main Authors: Oki, Takashi, Tanaka, Hideji, Yamada, Hirotsugu, Tabata, Tomotsugu, Oishi, Yoshifumi, Ishimoto, Takeo, Nagase, Norio, Shinohara, Hisanori, Sakabe, Koichi, Fukuda, Nobuo
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2004; Elsevier; Elsevier Limited
• Subjects: Adult; Amyloidosis; Amyloidosis - diagnostic imaging; Amyloidosis - physiopathology; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiomyopathy, Hypertrophic - complications; Cardiomyopathy, Hypertrophic - diagnostic imaging; Cardiomyopathy, Hypertrophic - physiopathology; Coronary vessels; Diagnosis, Differential; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Female; Heart; Heart Diseases - diagnostic imaging; Heart Diseases - physiopathology; Humans; Hypertension - complications; Hypertension - diagnostic imaging; Hypertension - physiopathology; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Male; Medical research; Medical sciences; Metabolic diseases; Middle Aged; Myocardial Contraction - physiology; Other metabolic disorders; Ultrasonic imaging; Heart; Wall; Metabolic diseases; Enzymopathy; Phlebology; Velocity; Profile; Protein; Left ventricle; Myocardium; Amyloidosis; Circulatory system; Diagnosis; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2003.12.025

The myocardial velocity profile (MVP), derived from color-coded tissue Doppler imaging (TDI), can identify transmural heterogeneity based on the physiology and pathology of the myocardium. This study sought to clarify whether the MVP can differentiate cardiac amyloidosis from other causes of left ventricular hypertrophy. We recorded the MVP and determined its myocardial velocity gradient (MVG) in the ventricular septum and left ventricular posterior wall using color-coded TDI in 10 patients with cardiac amyloidosis, in 25 patients with hypertensive hypertrophied left ventricular wall, in 25 patients with asymmetric septal hypertrophy of hypertrophic cardiomyopathy, and in 20 clinically normal controls. End-diastolic ventricular septal thickness was similar among the cardiac amyloidosis, hypertension, and hypertrophic cardiomyopathy groups. Percent systolic thickening of the ventricular septum and left ventricular posterior wall calculated from M-mode left ventricular echocardiograms was lower in the cardiac amyloidosis group than in the hypertension, hypertrophic cardiomyopathy, or control group. Peak MVGs during systole and early diastole were lowest in the cardiac amyloidosis group, followed, in order, by the control, hypertension, and hypertrophic cardiomyopathy groups. The systolic and early diastolic MVPs in the ventricular septum and left ventricular posterior wall showed a characteristic serrated pattern in all patients with cardiac amyloidosis, but not in any other patient groups. In conclusion, MVPs in the ventricular septum and left ventricular posterior wall show a distinctive serrated pattern that may be related to amyloid deposition in the myocardium. Myocardial tissue characterization using color-coded TDI provides diagnostic information in patients with cardiac amyloidosis.