Doppler echocardiographic assessments of left ventricular diastolic filling in patients with amyloid heart disease.

Twenty-eight patients with amyloid heart disease, 9 with primary and 19 with familial amyloidosis, were examined by Doppler echocardiography to characterize transmitral flow velocity patterns and to assess restrictive ventricular hemodynamics. Six of the 28 patients had restrictive ventricular physiology, and the remaining 22 did not. Patients with a restrictive filling process had marked ventricular wall thickening with depressed fractional shortening. The transmitral flow velocity patterns in patients with restriction were characteristically manifested by the increased peak flow velocity and shortening of rapid diastolic filling, which was associated with a reduced flow velocity in atrial systole. In the 22 patients without restriction, the left ventricular filling patterns were subclassified as 1) filling patterns with the prolonged isovolumic relaxation time and reduced early diastolic filling, as well as enhanced atrial contribution to ventricular filling (16 patients with mild echocardiographic abnormalities), 2) normal filling patterns with normal echocardiograms (4 patients), and 3) normal filling patterns, with moderate ventricular wall thickening (2 patients). These findings suggested that restrictive ventricular hemodynamics can be characterized by the transmitral velocity pattern and that patterns of left ventricular diastolic filling are markedly varied depending on the magnitude of myocardial amyloid deposition in patients with amyloid heart disease.