© 2007 European Society of Cardiology
Importance of the echocardiographic evaluation of right ventricular function in patients with AL amyloidosis
a Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo and University of Pavia 27100 Pavia, Italy
b Department of Internal Medicine, Fondazione IRCCS Policlinico S. Matteo and University of Pavia 27100 Pavia, Italy
c Centre for Amyloidosis, Department of Biochemistry, Fondazione IRCCS Policlinico S. Matteo and University of Pavia 27100 Pavia, Italy
d Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia 27100 Pavia, Italy
* Corresponding author. Divisione di Cardiologia, Policlinico S. Matteo, Piazzale Golgi 1, 27100 Pavia, Italy. Tel.: +39 0382 503 718; fax: +39 0382 501884. E-mail address: s.ghio{at}smatteo.pv.it
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Abstract |
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Background: Patients with AL amyloidosis often present with signs of congestive heart failure.
Aim: This study was prospectively designed to assess the significance of RV dysfunction in AL amyloidosis.
Methods and results: Seventy-four patients with biopsy proven AL amyloidosis underwent a thorough echocardiographic evaluation. A tricuspid annular plane systolic excursion (TAPSE) <17 mm was taken as marker of RV dysfunction. Plasma NT-proBNP determinations were performed in all cases. RV function was normal in 60 patients and reduced in 14 patients. Patients with RV dysfunction had thicker left ventricular (LV) walls (p<0.01), lower LV end-diastolic volumes (p<0.01), lower LV ejection fraction (p<0.01) and more frequently a restrictive LV filling pattern (p<0.01). RV dimensions and RV free wall thickness were not significantly different in the two groups. A thick interventricular septum and a reduced TAPSE were associated with high NT-proBNP levels (both p<0.01). Seven patients died during a median follow-up period of 19 months; TAPSE <17 mm was the only echocardiographic parameter associated with poor survival.
Conclusion: In patients with AL amyloidosis, RV dysfunction is associated with more severe involvement of the left ventricle, higher plasma levels of NT-proBNP and with poor prognosis.
Key Words: Amyloid • Prognosis • Right ventricle • Echocardiography
Received August 7, 2006; Revised February 9, 2007; Accepted May 8, 2007
1 Giovanni Palladini is partly supported by an investigator fellowship from Collegio Ghislieri, Pavia.
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