Prognostic significance of Doppler measures of diastolic function in cardiac amyloidosis : a Doppler echocardiography study

• Published in: Circulation (New York, N.Y.) Vol. 83; no. 3; pp. 808 - 816
• Main Authors: KLEIN, A. L, HATLE, L. K, TABLIERCIO, C. P, OH, J. K, KYLE, R. A, GERTZ, M. A, BAILEY, K. R, SEWARD, J. B, TAJIK, A. J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.1991
• Subjects: Amyloidosis - diagnostic imaging; Amyloidosis - mortality; Biological and medical sciences; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - mortality; Echocardiography, Doppler; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Prognosis; Proportional Hazards Models; Prospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Survival Analysis; Time Factors; Ventricular Function, Left - physiology; Doppler ultrasound study; Sonography; Human; Echocardiography; Prognosis; Diastole; Cardiomyopathy; Cardiovascular disease; Exploration; Follow up study; Systemic disease; Complication; Amyloidosis; Left ventricle performance
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.83.3.808

We have previously characterized the left ventricular diastolic filling abnormalities in cardiac amyloidosis by Doppler methods. The various filling patterns were shown to be related to the degree of cardiac amyloid infiltration. The purpose of this study was to determine the value of Doppler diastolic filling variables for assessing prognosis in cardiac amyloidosis. We performed pulsed-wave Doppler studies of the left ventricular inflow and obtained clinical follow-up data in 63 consecutive patients with biopsy-proven systemic amyloidosis. All patients had typical echocardiographic features of cardiac involvement. The patients were subdivided into two groups according to deceleration time: Group 1 (33 patients) had a deceleration time of 150 msec or less, indicative of restrictive physiology, and group 2 (30 patients) had a deceleration time of more than 150 msec. Of the 63 patients, 32 (51%) died during a mean follow-up period of 18 +/- 12 months. Of these deaths, 25 (78%) were cardiac deaths, and 19 of the 25 patients (76%) were from group 1. The 1-year probability of survival in group 1 was significantly less than that in group 2 (49% versus 92%, p less than 0.001). Bivariate analysis revealed that the combination of the Doppler variables of shortened deceleration time and increased early diastolic filling velocity to atrial filling velocity ratio were stronger predictors of cardiac death than were the two-dimensional echocardiographic variables of mean left ventricular wall thickness and fractional shortening. Doppler-derived left ventricular diastolic filling variables are important predictors of survival in cardiac amyloidosis.