Serial Doppler echocardiographic follow-up of left ventricular diastolic function in cardiac amyloidosis

A spectrum of left ventricular diastolic filling abnormalities noted on Doppler echocardiography has been demonstrated in patients with cardiac amyloidosis. To determine how these filling abnormalities evolve over time and the significance of any change, serial pulsed wave Doppler studies of left ventricular inflow were performed over 12.6 ± 4.9 months in 41 consecutive patients (36 men and 15 women. mean age 59 ± 11 years) with typical two-dimensional echocardiographic features of cardiac involvement. The measurements were peak left ventricular inflow in early diastole (E) and atrial contraction (A) velocities, E A ratio. deceleration time and isovolumetric relaxation time. Patients were classified by mean left ventricular wall thickness into an early group (<15 mm) of 24 patients and an advanced group (≥15 mm) of 17 patients. The total group showed an increased E A ratio (1.7 ± 0.9 versus 1.4 ± 0.9, p = 0.009) and decreased deceleration time (164 ± 57 versus 174 ± 51 ms. p = 0.11) at follow up compared with baseline study. The early group showed significant changes in the E A ratio (1.6 ± 1.0 versus 1.2 ± 0.7, p = 0.001) between the two studies. Seven patients (29%) in the early group showed a change from an abnormal relaxation or "normal" pattern to one of restriction, coincident with increased symptoms in six of these patients. Fifteen (88%) of the 17 patients in the advanced group did not show significant changes in the measures during the follow-up study, but these patients already showed a restrictive pattern. Thus, significant changes in serial left ventricular flow velocity variables occur during short-term follow-up evaluation, predominantly in the early group with cardiac amyloidosis.