Cardiac amyloidosis echocardiography
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Cardiac amyloidosis Microchapters |
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Cardiac amyloidosis echocardiography On the Web |
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American Roentgen Ray Society Images of Cardiac amyloidosis echocardiography |
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Risk calculators and risk factors for Cardiac amyloidosis echocardiography |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]: Aarti Narayan, M.B.B.S [3]; Cafer Zorkun, M.D., Ph.D. [4]
Overview
Transthoracic echocardiography is most commonly used in the initial evaluation of cardiac amyloidosis. The most common echocardiographic finding is thickening of the left ventricle. Echocardiographic findings strongly correlate with the degree of cardiac dysfunction and disease progression with mildly or moderately increased wall thickness in the early asymptomatic phase and severe thickening and hypokinesia of the left ventricular posterior wall and interventricular septum in clinically apparent cardiac dysfunction.
Echocardiography
Findings on echocardiography include:[1][2][3][4]
- Thickening of the left ventricle
- Granular or sparkling appearance of the myocardium secondary to amyloid deposition in the myocardium. This finding is especially seen best with two dimentional echocardiography as hyperrefractile myocardial echoes.[5]
- Thickening of interventricular septum
- Diastolic dysfunction
- Normal or reduced LV cavity
- Pericardial effusion is often present but is usually small
- Right ventricular hypertrophy[6]
- Left atrial enlargement
- Thickened AV valves
- Right ventricular dilatation (poor prognostic marker indicating right heart failure and with a median survival of only 4 months)[6][6]
- Dynamic left ventricular outflow tract obstruction[7]
- Dissociation between short and long axis systolic function[8][5]
- Intracardiac thrombus: Occurrence of intracardiac thrombi is frequent in patients with cardiac amyloidosis especially in the AL type. Atrial fibrillation, poor left ventricular diastolic function and atrial mechanical dysfunction have been shown to be associated with increased risk for developing intracardiac thrombi. [9]
The combination of increased thickness of the left ventricular posterior wall and interventricular septum with a low voltage electrocardiographic pattern is highly specific for cardiac amyloidosis. In an echocardiographic study conducted in 54 patients (30 with AA type cardiac amyloidosis and 24 with AL type amyloidosis) it was found that this finding is more often seen in the AL type cardiac amyloidosis.
Videos
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References
- ↑ Siqueira-Filho AG, Cunha CL, Tajik AJ, Seward JB, Schattenberg TT, Giuliani ER (1981). "M-mode and two-dimensional echocardiographic features in cardiac amyloidosis". Circulation. 63 (1): 188–96. PMID 7438392. Unknown parameter
|month=ignored (help) - ↑ Nishikawa H, Nishiyama S, Nishimura S; et al. (1988). "Echocardiographic findings in nine patients with cardiac amyloidosis: their correlation with necropsy findings". Journal of Cardiology. 18 (1): 121–33. PMID 3221306. Unknown parameter
|month=ignored (help) - ↑ Hamer JP, Janssen S, van Rijswijk MH, Lie KI (1992). "Amyloid cardiomyopathy in systemic non-hereditary amyloidosis. Clinical, echocardiographic and electrocardiographic findings in 30 patients with AA and 24 patients with AL amyloidosis". European Heart Journal. 13 (5): 623–7. PMID 1618203. Unknown parameter
|month=ignored (help) - ↑ Klein AL, Hatle LK, Taliercio CP; et al. (1990). "Serial Doppler echocardiographic follow-up of left ventricular diastolic function in cardiac amyloidosis". Journal of the American College of Cardiology. 16 (5): 1135–41. PMID 2229760. Unknown parameter
|month=ignored (help) - ↑ 5.0 5.1 Selvanayagam JB, Hawkins PN, Paul B, Myerson SG, Neubauer S (2007). "Evaluation and management of the cardiac amyloidosis". Journal of the American College of Cardiology. 50 (22): 2101–10. doi:10.1016/j.jacc.2007.08.028. PMID 18036445. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 6.2 Patel AR, Dubrey SW, Mendes LA; et al. (1997). "Right ventricular dilation in primary amyloidosis: an independent predictor of survival". The American Journal of Cardiology. 80 (4): 486–92. PMID 9285663. Unknown parameter
|month=ignored (help) - ↑ Philippakis AA, Falk RH (2012). "Cardiac amyloidosis mimicking hypertrophic cardiomyopathy with obstruction: treatment with disopyramide". Circulation. 125 (14): 1821–4. doi:10.1161/CIRCULATIONAHA.111.064246. PMID 22492950. Unknown parameter
|month=ignored (help) - ↑ Koyama J, Ray-Sequin PA, Falk RH (2003). "Longitudinal myocardial function assessed by tissue velocity, strain, and strain rate tissue Doppler echocardiography in patients with AL (primary) cardiac amyloidosis". Circulation. 107 (19): 2446–52. doi:10.1161/01.CIR.0000068313.67758.4F. PMID 12743000. Unknown parameter
|month=ignored (help) - ↑ Feng D, Syed IS, Martinez M; et al. (2009). "Intracardiac thrombosis and anticoagulation therapy in cardiac amyloidosis". Circulation. 119 (18): 2490–7. doi:10.1161/CIRCULATIONAHA.108.785014. PMID 19414641. Unknown parameter
|month=ignored (help)