Copyright © 2005, The European Society of Cardiology
Pulsed tissue Doppler and strain imaging discloses early signs of infiltrative cardiac disease: A study on patients with familial amyloidotic polyneuropathy
aDepartment of Public Health and Clinical Medicine, Heart Centre, Umeå University, S-90185 Umeå, Sweden
bDepartment of Cardiology, Heart Centre, Umeå University, S-90185 Umeå, Sweden
cDepartment of Clinical Physiology, Heart Centre, Umeå University, S-90185 Umeå, Sweden
dInstitution of Surgery and perioperative sciences, Heart Centre, Umeå University, S-90185 Umeå, Sweden
Received 7 December 2004; received in revised form 17 February 2005; accepted after revision 6 March 2005.
* Corresponding author. Tel.: +46907856980; fax: +4690137633. per.lindqvist{at}medicin.umu.se
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Abstract |
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Background Familial amyloidotic polyneuropathy (FAP) is a hereditary systemic amyloidosis with cardiac involvement. As early identification of the cardiac involvement is of major clinical interest we performed this study to test the hypothesis that tissue Doppler imaging (TDI) and strain imaging (SI) might disclose cardiac involvement in patients with early stages of FAP.
Methods Twenty-two patients with FAP and 36 healthy controls were studied. Standard M-mode and Doppler echocardiography were performed. TDI and SI were used to assess the regional longitudinal left ventricular (LV) lateral and septal and right ventricular (RV) wall functions. All time intervals were corrected for heart rate by dividing with R–R interval and presented as percentage.
Results We found that patients in comparison with controls had increased LV and RV wall thickness and by using TDI a prolonged isovolumic relaxation time (IVRt) at the septal segment (15.0±7.0 vs 10.7±4.1%, p<0.05) and prolonged isovolumic contraction time (IVCt) at LV lateral (12.8±4.3 vs 10.1±3.3%, p<0.05), septal (12.5±3.5 vs 8.9±1.9%, p<0.001) and RV free wall segments (12.0±3.6 vs 8.3±2.1%, p<0.001). Strain was reduced at LV lateral basal segment (–4.6±14.0 vs –20.2+9.1, p<0.001), RV free wall mid segment (–16.2±12.8 vs –29.4±15.2) as well as both septal segments (–4.1±11.7 vs –16.2±9.0%, p<0.001, –8.8±11.5 vs –19.4±8.4%, p<0.001 for septal basal and mid-segment). Even in the absence of septal hypertrophy the septal strain was reduced and the regional IVCt was prolonged.
Conclusions This is the first clinical study using TDI and strain in patients with FAP showing functional abnormalities before any morphological echocardiographic abnormalities were present. Both the left and right heart functions are involved and the disease should therefore be regarded as biventricular.
Keywords: Amyloid; Cardiomyopathy; Echocardiography; Heart failure; Strain; Infiltration
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