Federico Cacciapuoti1. 1. Department of Internal Medicine and Geriatry, Second University of Naples, Piazza L. Miraglia 2, 80100, Naples, Italy, fulviocacciapuoti@gmail.com.
Abstract
INTRODUCTION: The diagnosis of cardiac amyloidosis (CA) is usually performed by endomyocardial biopsy; however, possible sampling errors and procedural risks such as cardiac tamponade, malignant arrhythmias and bleeding risk, limit its use. Therefore, a non-invasive diagnostic method appears to be necessary. MATERIALS AND METHODS: Echocardiography plays an important role in this need. Conventional two-dimensional echocardiography appears able to detect some specific and distinguishing signs of cardiac amyloid infiltration. RESULTS AND CONCLUSIONS: Of these, thickened right and left ventricular (LV) myocardium, normal or small LV cavity size in contrast to enlarged biatrial cavities, diffuse hyper-refractile 'granular sparkling' appearance and 'mismatch' ECG/ECHO are the most specific findings. The magnitude of cyclic variation recorded with integrated backscatter reflects structural changes in the myocardium. In patients with CA, this magnitude is reduced because myocardial amyloid infiltration is characterized by a reduction of number of "contractile" fibers. Other informations concerning LV dysfunction CA-related can be obtained by Tei index. Finally, new echocardiographic imaging modalities, such as tissue Doppler, Doppler-based strain, speckle tracking imaging and three-dimensional echocardiography, can provide some findings regarding the preclinical stages of LV dysfunction when other echocardiographic measurements are showing normal; however, these are unable to provide a non-invasive diagnosis of cardiac amyloidosis.
INTRODUCTION: The diagnosis of cardiac amyloidosis (CA) is usually performed by endomyocardial biopsy; however, possible sampling errors and procedural risks such as cardiac tamponade, malignant arrhythmias and bleeding risk, limit its use. Therefore, a non-invasive diagnostic method appears to be necessary. MATERIALS AND METHODS: Echocardiography plays an important role in this need. Conventional two-dimensional echocardiography appears able to detect some specific and distinguishing signs of cardiac amyloid infiltration. RESULTS AND CONCLUSIONS: Of these, thickened right and left ventricular (LV) myocardium, normal or small LV cavity size in contrast to enlarged biatrial cavities, diffuse hyper-refractile 'granular sparkling' appearance and 'mismatch' ECG/ECHO are the most specific findings. The magnitude of cyclic variation recorded with integrated backscatter reflects structural changes in the myocardium. In patients with CA, this magnitude is reduced because myocardial amyloid infiltration is characterized by a reduction of number of "contractile" fibers. Other informations concerning LV dysfunction CA-related can be obtained by Tei index. Finally, new echocardiographic imaging modalities, such as tissue Doppler, Doppler-based strain, speckle tracking imaging and three-dimensional echocardiography, can provide some findings regarding the preclinical stages of LV dysfunction when other echocardiographic measurements are showing normal; however, these are unable to provide a non-invasive diagnosis of cardiac amyloidosis.
Authors: Dermot Phelan; Patrick Collier; Paaladinesh Thavendiranathan; Zoran B Popović; Mazen Hanna; Juan Carlos Plana; Thomas H Marwick; James D Thomas Journal: Heart Date: 2012-08-03 Impact factor: 5.994
Authors: A L Klein; L K Hatle; D J Burstow; J B Seward; R A Kyle; K R Bailey; T F Luscher; M A Gertz; A J Tajik Journal: J Am Coll Cardiol Date: 1989-04 Impact factor: 24.094
Authors: Angelos G Rigopoulos; Muhammad Ali; Elena Abate; Abdel-Rahman Torky; Marios Matiakis; Mammad Mammadov; Hannes Melnyk; Alexander Vogt; Renato de Vecchis; Boris Bigalke; Walter Wohlgemuth; Sophie Mavrogeni; Michel Noutsias Journal: Heart Fail Rev Date: 2019-07 Impact factor: 4.214