Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
Amyloid. 2009;16(2):63-70. doi: 10.1080/13506120902879681.
Using traditional echocardiography, the diagnosis of cardiac amyloidosis (CA) is often only possible in advanced stage when recommended therapies may have adverse effects. The aim of our study was to evaluate whether additional information can be derived from Tissue and strain Doppler imaging (TDI and SDI). Forty patients with systemic amyloidosis and 24 healthy subjects underwent traditional, tissue and strain Doppler echocardiography. Patients were classified having CA if mean wall thickness (mT), was half of the sum septum and posterior wall thickness, was > or =12 mm. The following parameters were evaluated: peak early diastolic velocity (Em) as index of ventricular relaxation, mitral E-wave to Em ratio (E/Em) as index of left ventricular (LV) filling pressure and mean LV strain peak curves (mSt) as global long-axis contraction index. In non cardiac amyloidosis (NCA), both Em and mSt were lower than in age matched controls (p < 0.01, p < 0.05, respectively) and higher than in CA (p < 0.01 and p < 0.01, respectively). Both Em and mSt were related to mT (p < 0.001). A significant (p < 0.01) nonlinear relation was observed between plasma terminal of pro B-natriuretic peptide and mT, Em, E/Em and mSt. TDI and SDI are able to detect amyloid myocardial involvement in such an early stage that cannot be evidenced by using traditional echocardiography.
使用传统超声心动图，心脏淀粉样变性（CA）的诊断通常仅在推荐治疗可能产生不良反应的晚期阶段才有可能。我们的研究目的是评估组织和应变多普勒成像（TDI 和 SDI）是否可以提供更多信息。40 例系统性淀粉样变性患者和 24 例健康受试者接受了传统、组织和应变多普勒超声心动图检查。如果平均壁厚度（mT）是间隔和后壁厚度之和的一半，大于或等于 12mm，则将患者分类为 CA。评估以下参数：舒张早期峰值速度（Em）作为心室松弛指数，二尖瓣 E 波与 Em 比值（E/Em）作为左心室（LV）充盈压指数和平均 LV 应变峰值曲线（mSt）作为整体长轴收缩指数。在非心脏淀粉样变性（NCA）中，Em 和 mSt 均低于年龄匹配的对照组（p<0.01，p<0.05，分别），高于 CA（p<0.01 和 p<0.01，分别）。Em 和 mSt 均与 mT 相关（p<0.001）。血浆脑钠肽前体末端与 mT、Em、E/Em 和 mSt 之间观察到显著（p<0.01）非线性关系。TDI 和 SDI 能够在传统超声心动图无法证实的早期阶段检测到淀粉样心肌受累。
