Doppler Myocardial Imaging Compared to Standard Two-Dimensional and Doppler Echocardiography for Assessment of Diastolic Function in Patients With Systemic Amyloidosis

Background and Aims: Cardiac amyloidosis (AL) is characterized by early impairment of diastolic function with preservation of systolic function, as assessed by standard measures, until very late in the disease process> Role of diastolic color Doppler myocardial imaging (cDMI), that is diastolic color Doppler myocardial velocity imaging (MVI) and strain rate imaging (SRI), to assess distolic dysfunction in this population remains unclear. Methods: 238 patients with biopsy proven systemic primary (AL) amyloidosis and 39 age and sex-matched controls have been enrolled. Left ventricular diastolic cDMI measures were compared in patients and healthy subjects, to test if such diastolic dysfunction occurs before longitudinal left ventricular systolic dysfunction. Results: Compared to Diastolic longitudinal, radial, and circumferential DMI, standard pulsed wave tissue Doppler imaging (PW-TDI) of the mitral annulus was the most accurate technique to detect early diastolic dysfunction in patients with AL. However, systolic longitudinal peak cDMI measures outperformed all of the diastolic measures, including PW-TDI, in separating patients with systemic AL, but no evidence of cardiac involvement on standard 2D and Doppler evaluation, from controls. Conclusions: Even when compared to diastolic cDMI measurements, standard PW-TDI of the mitral annulus was the most accurate diastolic measure to detect early left ventricular dysfunction in patients with AL amyloidosis. However, no diastolic measure approached the accuracy of longitudinal systolic cDMI measurements in identifying ventricular dysfunction in AL patients with normal standard 2D and Doppler examinations, compared to controls.