DOPPLER INDEX COMBINING SYSTOLIC AND DIASTOLIC MYOCARDIAL PERFORMANCE- CLINICAL-VALUE IN CARDIAC AMYLOIDOSIS

Objectives. This study was designed to determine the clinical value of a Doppler-derived index of combined systolic and diastolic myocardial performance in tile assessment of cardiac amyloidosis. Background Car diac amyloidosis is an infiltrative disease with diastolic and systoli c dysfunction. Therefore, the index of myocardial performance combinin g systolic and diastolic time intervals could be a useful predictor of clinical outcome in cardiac amyloidosis. Methods. The study included 45 patients with biopsy-proved amyloidosis and 45 age matched normal s ubjects, All patients had typical echocardiographic features of amyloi d cardiac involvement, A Doppler-derived index, defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divid ed by ejection time, was measured from left ventricular outflow and mi tral inflow Doppler velocity profiles recorded during routine echocard iography. The index as well as conventional systolic or diastolic echo cardiographic/Doppler variables were related to subsequent outcome. Re sults. The isovolumetric contraction and relaxation times were prolong ed and ejection time was shortened (p < 0.001) in patients with amyloi dosis compared with that in normal subjects, resulting in a marked inc rease of the index from normal values (p < 0.001), In the amyloid grou p the index was highest in patients with a low stroke index or with bo th shortened mitral deceleration time and lower ejection fraction, By univariate analysis, New York Heart Association functional class, the index, ejection fraction and mitral deceleration time were significant predictors of outcome, However, by multivariate stepwise regression a nalysis, functional class and the index were the only independent pred ictors of survival. Conclusions. The Doppler-derived index of combined systolic and diastolic myocardial performance correlates with global cardiac dysfunction and is a useful predictor of clinical outcome in p atients with cardiac amyloidosis.