Reduced trans-mitral A-wave velocity predicts the presence of wild-type transthyretin amyloidosis in elderly patients with left ventricular hypertrophy

• Published in: Heart and vessels 2017-06, Vol.32 (6), p.708-713
• Main Authors: Yamamura, Satoru, Izumiya, Yasuhiro, Ishida, Toshifumi, Onoue, Yoshiro, Kimura, Yuichi, Hanatani, Shinsuke, Araki, Satoshi, Fujisue, Koichiro, Sueta, Daisuke, Kanazawa, Hisanori, Takashio, Seiji, Usuku, Hiroki, Sugamura, Koichi, Sakamoto, Kenji, Yamamoto, Eiichiro, Yamamuro, Megumi, Yasuda, Hisayo, Kojima, Sunao, Kaikita, Koichi, Hokimoto, Seiji, Ogawa, Hisao, Tsujita, Kenichi
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial - complications; Amyloid Neuropathies, Familial - diagnostic imaging; Amyloid Neuropathies, Familial - pathology; Amyloidosis; Biomedical Engineering and Bioengineering; Biopsy; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Cardiomyopathy; Doppler effect; Echocardiography; Echocardiography, Doppler; Electrocardiography; Female; Fibrillation; Geriatrics; Heart; Heart diseases; Heart Failure - diagnostic imaging; Heart Failure - etiology; Heart Failure - physiopathology; Heart Ventricles - physiopathology; Humans; Hypertrophy; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Japan - epidemiology; Kaplan-Meier Estimate; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Older people; Original Article; Patients; Pulse Wave Analysis; Retrospective Studies; Rhythm; ROC Curve; Sinus; Transthyretin; Vascular Surgery; Velocity; Ventricle; Wall thickness; Wave velocity
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-016-0925-8

Wild-type transthyretin amyloidosis (ATTRwt) is often overlooked in elderly patients with left ventricular hypertrophy (LVH). Impaired atrial function, in addition to ventricular diastolic dysfunction, is one of the hallmarks of cardiac amyloidosis. Here, we assessed the hypothesis that atrial function evaluated by A-velocity in pulse Doppler echocardiography is useful to differentiate ATTRwt in elderly patients with LVH. We analyzed 133 consecutive patients who underwent tissue biopsy to rule out infiltrative cardiomyopathy in our institute. We excluded patients younger than 50 years, without LVH (LV thickness was less than 12 mm), with other types of cardiac amyloidosis and patients with chronic atrial fibrillation, and analyzed remaining 51 patients (ATTRwt: 16, non-ATTRwt: 35). ATTRwt patients were significantly older and had advanced heart failure compared with non-ATTRwt group. In echocardiography, E/A, E/e′, and relative wall thickness was significantly higher in ATTRwt group than non-ATTRwt group. A-velocity was significantly decreased in ATTRWT group compared with non-ATTRwt group (40.8 ± 20.8 vs. 78.7 ± 28.2 cm/s, p  = 0.0001). Multivariate logistic analysis using eight forced inclusion models identified trans-mitral Doppler A-wave velocity was more significant factor of cardiac amyloidosis in ATTRwt. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for A-wave velocity in discrimination between ATTRwt and non-ATTRwt were 0.86 (CI 0.76–0.96, p