Atrial Systolic Failure in Primary Amyloidosis

Intracardiac Thrombosis, Embolism and Anticoagulation Therapy in Patients with Cardiac Amyloidosis – Inspiration from a Case Observation

“…LV diastolic dysfunction and low LAA emptying velocity, in addition to AF, were independently associated with intracardiac thrombosis. The Mayo autopsy and TEE studies and prior study support the hypothesis that the combination of systolic and diastolic ventricular dysfunction and chronic amyloid infiltrate in the atria lead to atrial mechanical dysfunction, 17,24 atrial enlargement, and blood stasis. 23,27 Such atrial electrical-mechanical dissociation at least partially explains why some cardiac amyloid patients developed atrial thrombosis while in sinus rhythm.…”

“…Furthermore, the LV diastolic function and atrial mechanical activity were more impaired. Reduced atrial contractility secondary to amyloid infiltration has been reported 17,24 and LV diastolic function is typically impaired before systolic function. 25 The combination of systolic and diastolic ventricular dysfunction, chronic amyloid infiltrate in the atria, and direct toxic effect on myocardium 26 could lead to atrial mechanical dysfunction, atrial enlargement, and blood stasis.…”

“…23,27 Such atrial electrical-mechanical dissociation may partially explain why many cardiac amyloidosis patients developed atrial thrombosis while in sinus rhythm. 17,24,28 It is possible that endomyocardial damage and endothelial dysfunction from amyloid depositions may be responsible. 29,30 Hypercoagulability may also contribute.…”

“…23,27 Such atrial electrical-mechanical dissociation at least partially explains why some cardiac amyloid patients developed atrial thrombosis while in sinus rhythm. 17,24,28 …”

Treatment of End Stage Heart Failure Related to Cardiac Amyloidosis

“…Trans-mitral Doppler and tissue Doppler frequently suggests elevated left ventricular filling pressure [52], [53]. A decreased transmitral A wave can be due to the direct effect of atrial infiltration and not only the restrictive physiology therefore a normal E wave deceleration time with small A wave can be encountered [54] [55]. Pericardial effusion is common.…”