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Reduced trans-mitral A-wave velocity predicts the presence of wild-type transthyretin amyloidosis in elderly patients with left ventricular hypertrophy

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Abstract

Wild-type transthyretin amyloidosis (ATTRwt) is often overlooked in elderly patients with left ventricular hypertrophy (LVH). Impaired atrial function, in addition to ventricular diastolic dysfunction, is one of the hallmarks of cardiac amyloidosis. Here, we assessed the hypothesis that atrial function evaluated by A-velocity in pulse Doppler echocardiography is useful to differentiate ATTRwt in elderly patients with LVH. We analyzed 133 consecutive patients who underwent tissue biopsy to rule out infiltrative cardiomyopathy in our institute. We excluded patients younger than 50 years, without LVH (LV thickness was less than 12 mm), with other types of cardiac amyloidosis and patients with chronic atrial fibrillation, and analyzed remaining 51 patients (ATTRwt: 16, non-ATTRwt: 35). ATTRwt patients were significantly older and had advanced heart failure compared with non-ATTRwt group. In echocardiography, E/A, E/e′, and relative wall thickness was significantly higher in ATTRwt group than non-ATTRwt group. A-velocity was significantly decreased in ATTRWT group compared with non-ATTRwt group (40.8 ± 20.8 vs. 78.7 ± 28.2 cm/s, p = 0.0001). Multivariate logistic analysis using eight forced inclusion models identified trans-mitral Doppler A-wave velocity was more significant factor of cardiac amyloidosis in ATTRwt. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for A-wave velocity in discrimination between ATTRwt and non-ATTRwt were 0.86 (CI 0.76–0.96, p < 0.001). The cut-off value was 62.5 cm/s, and it yielded the best combination of sensitivity (69.7%) and specificity (87.5%) for prediction of amyloidosis. We concluded that reduced A-velocity predicts the presence of ATTRwt in elderly patients with LVH in sinus rhythm.

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References

  1. Tanskanen M, Peuralinna T, Polvikoski T, Notkola IL, Sulkava R, Hardy J, Myllykangas L (2008) Senile systemic amyloidosis affects 25% of the very aged and associates with genetic variation in alpha2-macroglobulin and τ: a population-based autopsy study. Ann Med 40:232–239

    Article  CAS  PubMed  Google Scholar 

  2. Rahman JE, Helou EF, Gelzer-Bell R, Thompson RE, Kuo C, Rodriguez ER, Kasper EK (2004) Noninvasive diagnosis of biopsy-proven cardiac amyloidosis. J Am Coll Cardiol 43:410–415

    Article  PubMed  Google Scholar 

  3. Plehn JF, Southworth J, Cornwell GG III (1992) Atrial systolic failure in primary amyloidosis. N Engl J Med 327:1570–1573

    Article  CAS  PubMed  Google Scholar 

  4. Dubrey S, Pollak A, Skinner M, Falk RH (1995) Atrial thrombi occurring during sinus rhythm in cardiac amyloidosis: evidence for atrial electromechanical dissociation. Br Heart J 74:541–544

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Kwong RY, Heydari B, Abbasi S, Steel K, Al-Mallah M, Wu H, Falk RH (2015) Characterization of cardiac amyloidosis by atrial late gadolinium enhancement using contrast-enhanced cardiac magnetic resonance imaging and correlation with left atrial conduit and contractile function. Am J Cardiol 116:622–629

    Article  PubMed  PubMed Central  Google Scholar 

  6. Migrino RQ, Harmann L, Christenson R, Hari P (2014) Clinical and imaging predictors of 1-year and long-term mortality in light chain (AL) amyloidosis: a 5-year follow-up study. Heart Vessels 29:793–800

    Article  PubMed  Google Scholar 

  7. Hashimura H, Ishibashi UH, Yonemoto Y, Ohta OK, Matsuyama TA, Ikeda Y, Morita Y, Yamada N, Yasui H, Naito H (2016) Late gadolinium enhancement in cardiac amyloidosis: attributable both to interstitial amyloid deposition and subendocardial fibrosis caused by ischemia. Heart Vessels 31:990–995

    Article  PubMed  Google Scholar 

  8. Modesto KM, Dispenzieri A, Cauduro SA, Lacy M, Khandheria BK, Pellikka PA, Gertz M (2005) Left atrial myopathy in cardiac amyloidosis: implications of novel echocardiographic techniques. Eur Heart J 26:173–179

    Article  PubMed  Google Scholar 

  9. Moyssawtkis I, Triposkiadis F, Pantazopoulos NJ, Kyriakidis M, Nihoyannopoulos P (2004) Left atrial systolic function in primary and familial amyloidosis: assessment from left atrial volume change. Clin Cardiol 27:528–532

    Article  Google Scholar 

  10. Murphy L, Falk RH (2000) Left atrial kinetic energy in AL amyloidosis: can it detect early dysfunction? Am J Cardiol 86:244–246

    Article  CAS  PubMed  Google Scholar 

  11. Manning WJ, Silverman DI, Katz SE, Riley MF, Doherty RM, Munson JT, Douglas PS (1995) Temporal dependence of the return of atrial mechanical function on the mode of cardioversion of atrial fibrillation to sinus rhythm. Am J Cardiol 75:624–626

    Article  CAS  PubMed  Google Scholar 

  12. Leung DY, Boyd A, Ng AA, Chi C, Thomas L (2008) Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 156:1056–1064

    Article  PubMed  Google Scholar 

  13. Klein AL, Hatle LK, Taliercio C, Oh JK, Kyle RA, Gertz MA, Tajik AJ (1991) Prognostic significance of Doppler measures of diastolic function in cardiac amyloidosis. A Doppler echocardiography study. Circulation 83:808–816

    Article  CAS  PubMed  Google Scholar 

  14. Klein AL, Hatle LK, Taliercio CP, Taylor CL, Kyle RA, Bailey KR, Tajik AJ (1990) Serial Doppler echocardiographic follow-up of left ventricular diastolic function in cardiac amyloidosis. J Am Coll Cardiol 16:1135–1141

    Article  CAS  PubMed  Google Scholar 

  15. Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Bailey KR, Seward JB (1994) Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc 69:212–224

    Article  CAS  PubMed  Google Scholar 

  16. Yu CM, Sanderson JE, Marwick TH, Oh JK (2007) Tissue Doppler imaging: a new prognosticator for cardiovascular diseases. J Am Coll Cardiol 49:1903–1914

    Article  PubMed  Google Scholar 

  17. Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’for medical statistics. Bone Marrow Transplant 48:452–458

    Article  CAS  PubMed  Google Scholar 

  18. Falk RH (2005) Diagnosis and management of the cardiac amyloidoses. Circulation 112:2047–2060

    Article  PubMed  Google Scholar 

  19. Selvanayagam JB, Hawkins PN, Paul B, Myerson SG, Neubauer S (2007) Evaluation and management of the cardiac amyloidosis. J Am Coll Cardiol 50:2101–2110

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Satoru Yamamura, Yasuhiro Izumiya, Toshifumi Ishida, Yoshiro Onoue, Yuichi Kimura, Shinsuke Hanatani, Satoshi Araki, Koichiro Fujisue, Daisuke Sueta, Hisanori Kanazawa, Seiji Takashio, Hiroki Usuku, Koichi Sugamura, Kenji Sakamoto, Eiichiro Yamamoto, Megumi Yamamuro, Hisayo Yasuda, Sunao Kojima, Koichi Kaikita, Seiji Hokimoto, Hisao Ogawa & Kenichi Tsujita

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  1. Satoru Yamamura
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  2. Yasuhiro Izumiya
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Corresponding author

Correspondence to Yasuhiro Izumiya.

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This study was approved by the ethics committee of Kumamoto University Hospital and was populated in accordance with the Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

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The authors have declared no conflicts of interest.

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Yamamura, S., Izumiya, Y., Ishida, T. et al. Reduced trans-mitral A-wave velocity predicts the presence of wild-type transthyretin amyloidosis in elderly patients with left ventricular hypertrophy. Heart Vessels 32, 708–713 (2017). https://doi.org/10.1007/s00380-016-0925-8

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  • DOI: https://doi.org/10.1007/s00380-016-0925-8

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