Duration of pulmonary venous atrial reversal flow velocity and mitral inflow a wave: New measure of Severity of cardiac amyloidosis

Transmitral Doppler now patterns of patients with cardiac amyloidosis evolv e from an early impaired relaxation to an advanced restrictive pattern. Thi s reflects increasing severity of diastolic dysfunction and hence left vent ricular filling pressures. The duration of the pulmonary venous atrial reve rsal now was recently shown to exceed that of the mitral inflow A wave in p atients with left ventricular end-diastolic pressure greater than 15 mm Hg. The objective of this study was to assess the utility of this index as a m easure of the severity of cardiac amyloidosis. Comprehensive transthoracic 2-dimensional and pulsed-wave Doppler echocardiograms of the pulmonary veno us and transmitral flows were made of 23 patients (10 women) with biopsy-pr oven diagnosis of primary systemic amyloidosis and of 49 subjects as age-ma tched normal controls. The amyloidosis group was divided into nonrestrictiv e and restrictive subgroups on the basis of the patients' transmitral inflo w deceleration time (> 150 and less than or equal to 150 ms, respectively). The durations of the pulmonary venous atrial reversal and mitral inflow A wave were measured, and the differences between the flow durations were com pared with the control and published data in the nonrestrictive and restric tive groups. The mean duration of the pulmonary venous atrial reversal was significantly longer in the amyloid than the control group (P < .01). The m ean duration of the mitral inflow A wave was significantly shorter in the r estrictive group than both the nonrestrictive and the control groups (P < . 05). The duration of the pulmonary venous atrial reversal exceeded that of the mitral inflow A wave in all patients with cardiac amyloidosis. The diff erence in duration between pulmonary venous atrial reversal and mitral infl ow A wave was significantly greater in the amyloidosis group compared with the normal group, and this index varied significantly within the amyloid gr oup between the abnormal relaxation and the restrictive groups. The differe nce in the duration between the pulmonary venous atrial reversal and the mi tral Inflow A wave is a reliable index of diastolic function and can be use d to assess the severity of cardiac amyloidosis.