'Hypersynchronisation' by tissue velocity imaging in patients with cardiac amyloidosis

Bellavia, Diego; Pellikka, Patricia A.; Abraham, Theodore P.; Al-Zahrani, Ghormallah B.; Dispenzieri, Angela; Oh, Jae K.; Espinosa, Raúl E.; Scott, Christopher G.; Miyazaki, Chinami; Miller, Fletcher A.

doi:10.1136/hrt.2007.140343

Cited by 27 publications

(26 citation statements)

References 15 publications

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“…7 This observation is similar to that of Migrino et al, 17 who used a longer follow-up period (median, 29 months) and a multivariate survival analysis that included biomarkers as well as clinical and standard echocardiographic variables. Ejection time ≤ 240 ms, NYHA class III or IV, and alkaline phosphatase levels were the only independent predictors of mortality in their group of patients with AL amyloidosis.…”

Section: Discussionsupporting

confidence: 82%

“…Plasma BNP, NT-proBNP, and troponin T levels were measured as previously described. 7 To pool the data of the monoclonal kappa and lambda patients, the clonal free light chain was considered the “involved” immunoglobulin free light chain for the purpose of the analyses. Immunoglobulin clonal free light chain quantitation was carried out as previously described.…”

Section: Methodsmentioning

confidence: 99%

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Independent Predictors of Survival in Primary Systemic (AL) Amyloidosis, Including Cardiac Biomarkers and Left Ventricular Strain Imaging: An Observational Cohort Study

Bellavia

Pellikka

Al-Zahrani

et al. 2010

Journal of the American Society of Echocardiography

103

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Background The prognostic value of Doppler myocardial imaging, including myocardial velocity imaging, strain, and strain rate imaging, in patients with primary (AL) amyloidosis is uncertain. The aim of this longitudinal study was to identify independent predictors of survival, comparing clinical data, hematologic and cardiac biomarkers, and standard echocardiographic and Doppler myocardial imaging measures in a cohort of patients with AL amyloidosis. Methods A total of 249 consecutive patients with AL amyloidosis were prospectively enrolled. The primary end point was all-cause mortality, and during a median follow-up period of 18 months, 75 patients (30%) died. Clinical and electrocardiographic data, biomarkers (brain natriuretic peptide and cardiac troponin T) and standard echocardiographic and longitudinal systolic and diastolic Doppler myocardial imaging measurements for 16 left ventricular segments were tested as potential independent predictors of survival. Results Age (hazard ratio [HR], 1.03; P = .03), New York Heart Association class III or IV (HR, 2.47; P = .01), the presence of pleural effusion (HR, 1.79; P = .08), brain natriuretic peptide level (HR, 1.29; P = .01), ejection time (HR, 0.99; P = .13), and peak longitudinal systolic strain of the basal anteroseptal segment (HR, 1.05; P = .02) were independent predictors in the final model. Conclusions Multivariate survival analysis identified independent predictors of clinical outcome in patients with AL amyloidosis: New York Heart Association class III or IV, presence of pleural effusion, brain natriuretic peptide level > 493 pg/mL, ejection time < 273 ms, and peak longitudinal systolic basal anteroseptal strain less negative than or equal to −7.5% defined a high-risk group of patients.

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Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Independent Predictors of Survival in Primary Systemic (AL) Amyloidosis, Including Cardiac Biomarkers and Left Ventricular Strain Imaging: An Observational Cohort Study

Bellavia

Pellikka

Al-Zahrani

et al. 2010

Journal of the American Society of Echocardiography

103

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“…Echocardiography is an important noninvasive tool to assess cardiac involvement with classic findings of ventricular thickening and diastolic dysfunction with often preserved left ventricular ejection fraction 6-8. However, early systolic dysfunction is increasingly recognized with more sensitive techniques such as strain imaging 9, 10 and regional systolic dyssynchrony or hypersynchrony has recently been reported in AL subjects 11, 12. Prior retrospective studies of AL patients demonstrated prognostic value for echocardiography-derived abnormal deceleration time, ratio of peak early mitral inflow to late mitral inflow velocity (E/A ratio) as well as the Tei index that incorporates ejection time and isovolumetric relaxation/contraction time 13, 14.…”

mentioning

confidence: 99%

“…Prior retrospective studies of AL patients demonstrated prognostic value for echocardiography-derived abnormal deceleration time, ratio of peak early mitral inflow to late mitral inflow velocity (E/A ratio) as well as the Tei index that incorporates ejection time and isovolumetric relaxation/contraction time 13, 14. Recently, with a median follow up of 13 months, Bellavia and colleagues reported that the most important echocardiographic predictor of mortality was reduced left ventricular systolic ejection time (ET) although the underlying mechanistic basis behind the increased risk remains unknown 11. We hypothesized that standard echocardiographic structural, systolic and diastolic measures can identify AL patients at risk of dying on long-term follow up.…”

mentioning

confidence: 99%

Left Ventricular Ejection Time on Echocardiography Predicts Long-Term Mortality in Light Chain Amyloidosis

Migrino

Mareedu

Eastwood

et al. 2009

Journal of the American Society of Echocardiography

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Light chain amyloidosis (AL) is associated with high mortality. The aim was to identify echocardiographic parameters that predict AL long-term mortality.Methods/Results-42 biopsy-proven AL subjects (43% females; 61±12 years) had echocardiography and followed 29±16 (median 29.4) months. Standard echocardiographic and clinical parameters and heart failure (HF) class were tested using univariate/multivariable Cox proportional hazard regression analyses to identify markers of mortality. 23 subjects died with 1-year mortality of 44%. Univariate predictors of mortality were HF class (p<0.001), left ventricular systolic ejection time (ET, p=0.002), alkaline phosphatase (p<0.001), aspartate and alanine aminotransferase (p=0.003 each). On multivariable analysis, only HF Class (hazards ratio, 95% confidence interval, p-value: 4.86, 1.58-14.9, p=0.006), ET (10 ms increase, 0.87, 0.78-0.97, p=0.01) and alkaline phosphatase (10 U/L increase, 1.04, 1.01-1.06, p=0.01) were prognostic. ET≤240 ms had sensitivity/specificity of 61/90% in predicting 1-year mortality and 73/90% in predicting 1-year cardiac mortality.Conclusions-AL amyloidosis was associated with high long-term mortality. Among echocardiographic and clinical parameters, only ET and alkaline phosphatase had incremental value to HF class in predicting mortality. This may be useful to identify high-risk patients.Light chain or primary amyloidosis (AL) is a plasma cell dyscrasia with monoclonal production and extracellular deposition of immunoglobulin light chains in multiple organs [1][2][3] . The accumulation of fibrillar amyloid deposits in the heart, kidneys, liver and nervous system leads to organ failure and death. It is associated with poor prognosis with median survival reduced to 4 months in patients with heart failure 4, 5 . The early identification of high risk patients is important for risk stratification. Echocardiography is an important noninvasive tool to assess cardiac involvement with classic findings of ventricular thickening and diastolic dysfunction with often preserved left ventricular ejection fraction [6][7][8] . However, early systolic dysfunction is increasingly recognized with more sensitive techniques such as strain imaging 9, 10 and regional systolic dyssynchrony or hypersynchrony has recently been reported in AL subjects Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 11,12 . Prior retrospective studies of AL patients demonstrated prognostic value for echocardiography-derived abnormal deceleration time, ratio of peak early mitral inflow to late mitral inflow velocity (E/A ratio) as well as th...

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“…This can easily be assessed by heart rate variability (HRV) studies [4], [5], [6]. Although autonomic disturbances are a well-established mechanism for reduced HRV [7], we hypothesize that cardiac function disturbances by themselves may have an additional impact on HRV -in a way similar to what was previously found in dilated cardiomyopathy [8] [9]. The aim of this study was, therefore, to assess the elationship between LV function and HRV in a cohort of Swedish patients with FAP.…”

Section: Introductionmentioning

confidence: 62%

Left ventricular dyssynchrony is associated with reduced heart rate variability in familial amyloidotic polyneuropathy

Zhao

Hörnsten

Lindqvist

et al. 2012

International Journal of Cardiology

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Suhr, O. et al. (2012) "Left ventricular dyssynchrony is associated with reduced heart rate variability in familial amyloidotic polyneuropathy" International Journal of Cardiology, 155 (2) Methods: Twenty-nine FAP patients and 29 healthy controls were studied using Doppler echocardiography. Patients' and controls' HRV was studied using power spectral analysis from 24-hour Holter ECG recordings. Results:In FAP patients, all HRV parameters were lower (p<0.01 for all) than in controls.Echocardiography showed normal LV systolic function in patients. Relative filling time (FT/RR) was shorter (p<0.01) and total isovolumic time (t-IVT) was longer (p<0.01) in patients than in controls. E/Em was higher (p<0.01), as was Tei index (p=0.02) as compared to controls. T-IVT and Tei index correlated with stroke volume (SV) (r=-0.54, p<0.05 and r=-0.44, p<0.05, respectively) in patients.HRV was reduced in 9/29 (31%) patients, who had shorter FT/RR (p<0.01), longer t-IVT (p<0.01), higher Tei index (p=0.05), A wave (p<0.01) and E/Em (p<0.05) than in subjects without reduced HRV. FT/RR and t-IVT correlated with HRV spectral parameters (p<0.05 for all). The correlation between t-IVT and SV was stronger in patients with reduced HRV (r=-0.80, p<0.01) than in those without. QRS duration was not different in the two subgroups of patients Conclusions:In a subset of patients with FAP, HRV was significantly reduced and appeared to be associated with shortened LV filling time and prolonged t-IVT, which reflect ventricular dyssynchrony, despite normal QRS. Thus, in addition to autonomic 2 disturbances in FAP, ventricular dyssynchrony is another factor associated with reduced HRV. Correction of such disturbed ventricular function by cardiac resynchronization therapy may control patients' symptom.

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'Hypersynchronisation' by tissue velocity imaging in patients with cardiac amyloidosis

Abstract: The regional timing of systolic motion measured by TVI was abnormally synchronised in the patients with advanced-CA. ET reduction plays a prominent part in this process and should be considered an essential parameter for assessment of patients with cardiac amyloidosis.

Cited by 27 publications

References 15 publications

Independent Predictors of Survival in Primary Systemic (AL) Amyloidosis, Including Cardiac Biomarkers and Left Ventricular Strain Imaging: An Observational Cohort Study

Independent Predictors of Survival in Primary Systemic (AL) Amyloidosis, Including Cardiac Biomarkers and Left Ventricular Strain Imaging: An Observational Cohort Study

Left Ventricular Ejection Time on Echocardiography Predicts Long-Term Mortality in Light Chain Amyloidosis

Left ventricular dyssynchrony is associated with reduced heart rate variability in familial amyloidotic polyneuropathy

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