Detection of early systolic dysfunction with strain rate imaging in a patient with light chain cardiomyopathy

• Published in: Clinical research in cardiology 2005-02, Vol.94 (2), p.133-136
• Main Authors: Niedeggen, A, Breithardt, O A, Franke, A
• Format: Article
• Language: English
• Subjects: Amyloid; Amyloidosis; Amyloidosis - diagnostic imaging; Amyloidosis - pathology; Amyloidosis - physiopathology; Biopsy; Brain natriuretic peptide; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - pathology; Cardiomyopathies - physiopathology; Cardiomyopathy; Congestive heart failure; Deformation; Diagnosis, Differential; Diastole - physiology; Doppler effect; Echocardiography; Echocardiography, Doppler; Echocardiography, Doppler, Color; Endocardium - pathology; Heart Failure - diagnostic imaging; Heart Failure - pathology; Heart Failure - physiopathology; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - pathology; Hypertrophy, Left Ventricular - physiopathology; Image Processing, Computer-Assisted; Immunoglobulin Light Chains - blood; Male; Medical imaging; Middle Aged; Multiple Myeloma - diagnostic imaging; Multiple Myeloma - pathology; Multiple Myeloma - physiopathology; Muscle contraction; Myocardial Contraction - physiology; Myocardium - pathology; Natriuretic Peptide, Brain - blood; Neuroimaging; Strain rate; Systole - physiology; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - pathology; Ventricular Dysfunction, Right - physiopathology
• ISSN: 0300-5860; 1861-0684; 1435-1285; 1861-0692
• DOI: 10.1007/s00392-005-0175-8

Congestive heart failure (CHF) in cardiac amyloidosis has been attributed to the development of diastolic dysfunction, because severe CHF symptoms have been observed despite a normal or only mildly reduced LV ejection fraction (EF). An early impairment of longitudinal systolic function has been described by means of tissue Doppler-derived myocardial deformation imaging ('strain rate imaging', SRI). Our patient presented with signs of CHF and significantly increased brain-natriuretic peptide (BNP) levels. Conventional measures of systolic contractile function were within the normal range and mitral inflow Doppler showed only moderate diastolic dysfunction. Histopathological examination by endomyocardial biopsy revealed interstitial deposition of amyloid fibers. Quantitative assessment of myocardial velocities (TDI) and deformation properties (Strain) from the apical view demonstrated a significant impairement of systolic longitudinal myocardial function. In patients with isolated diastolic dysfunction detected by conventional Doppler echocardiography, the quantitative assessment of myocardial strain and strain rate can be helpful in the early detection of systolic dysfunction.