LEFT-VENTRICULAR FILLING DISTURBANCES IN CARDIAC AMYLOIDOSIS - STUDY OF ATRIAL SOUND AND DIASTOLIC INFLOW VELOCITIES

Cardiac amyloidosis is characterized by left-ventricular filling defec ts at a relatively early stage. To investigate such defects more preci sely, we studied atrial sound and left-ventricular inflow velocity pat terns in 12 patients with cardiac amyloidosis (mean age 60.9 +/- 12.5 years). Twelve age-matched cases with hypertrophic cardiomyopathy (HCM ) served as controls. We recorded the amplitude of the atrial sound by low-frequency phonocardiography and measured the height of the A wave of apexcardiogram (ACG-A wave) as well as its ratio to the total ampl itude of the ACG. Using pulsed Doppler echocardiography, we measured t he rapid filling wave (E) and the atrial filling wave (A) and calculat ed the ratio of A to E. In the amyloidosis group, the atrial sound was weaker and the ACG-A wave was significantly smaller than in the HCM g roup (p < 0.001; 12.4 +/- 3.9 vs. 22.4 +/- 5.6%). As concerns the left -ventricular inflow velocity patterns, both the E wave (41.7 +/- 16.0 vs. 56.4 +/- 12.1 cm/s; p < 0.02) and the A wave (40.5 +/- 13.4 vs. 58 .1 +/- 13.0 cm/s; p < 0.006) were smaller than in the HCM group. The A /E was 1.0 +/- 0.34 in the amyloidosis group and 1.1 +/- 0.3 in the HC M group (NS). We conclude that disturbed left-ventricular filling, esp ecially in the atrial filling period, decreases the amplitude of both atrial sound and ACG-A wave in cardiac amyloidosis.