Circulation, Vol 83, 808-816, Copyright © 1991 by American Heart Association
AL Klein, LK Hatle, CP Taliercio, JK Oh, RA Kyle, MA Gertz, KR Bailey, JB Seward and AJ Tajik
BACKGROUND. 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. METHODS AND RESULTS. 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. CONCLUSIONS. Doppler-derived left
ventricular diastolic filling variables are important predictors of
survival in cardiac amyloidosis.
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Prognostic significance of Doppler measures of diastolic function in cardiac amyloidosis. A Doppler echocardiography study
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905.
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