Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis

Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.

OBJECTIVES: This study was designed to determine the clinical value of a Doppler-derived index of combined systolic and diastolic myocardial performance in the assessment of cardiac amyloidosis. BACKGROUND: Cardiac amyloidosis is an infiltrative disease with diastolic and systolic dysfunction. Therefore, the index of myocardial performance combining 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 subjects. All patients had typical echocardiographic features of amyloid cardiac involvement. A Doppler-derived index, defined as the sum of isovolumetric contraction time and isovolumetric relaxation time divided by ejection time, was measured from left ventricular outflow and mitral inflow Doppler velocity profiles recorded during routine echocardiography. The index as well as conventional systolic or diastolic echocardiographic/Doppler variables were related to subsequent outcome. RESULTS: The isovolumetric contraction and relaxation times were prolonged and ejection time was shortened (p < 0.001) in patients with amyloidosis compared with that in normal subjects, resulting in a marked increase of the index from normal values (p < 0.001). In the amyloid group the index was highest in patients with a low stroke index or with both 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 analysis, functional class and the index were the only independent predictors 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 patients with cardiac amyloidosis.

This article has been cited by other articles:

				A. K. Reddy, D. Amador-Noguez, G. J. Darlington, B. A. Scholz, L. H. Michael, C. J. Hartley, M. L. Entman, and G. E. Taffet Cardiac Function in Young and Old Little Mice J. Gerontol. A Biol. Sci. Med. Sci., December 1, 2007; 62(12): 1319 - 1325. [Abstract] [Full Text] [PDF]

				A. Romero-Corral, V. K. Somers, P. A. Pellikka, E. J. Olson, K. R. Bailey, J. Korinek, M. Orban, J. Sierra-Johnson, M. Kato, R. S. Amin, et al. Decreased Right and Left Ventricular Myocardial Performance in Obstructive Sleep Apnea Chest, December 1, 2007; 132(6): 1863 - 1870. [Abstract] [Full Text] [PDF]

				J. E.A.K. Bamfo, N. A. Kametas, K. H. Nicolaides, and J. B. Chambers Maternal left ventricular diastolic and systolic long-axis function during normal pregnancy Eur J Echocardiogr, October 1, 2007; 8(5): 360 - 368. [Abstract] [Full Text] [PDF]

				P. Pattoneri, G. Pela, E. Montanari, I. Pesci, P. Moruzzi, and A. Borghetti Evaluation of the myocardial performance index for early detection of mitoxantrone-induced cardiotoxicity in patients with multiple sclerosis Eur J Echocardiogr, March 1, 2007; 8(2): 144 - 150. [Abstract] [Full Text] [PDF]

				Y. Su, N. Wu, and J. Tian Evaluation of Cardiac Global Function Using the Myocardial Performance Index by Tissue Doppler Echocardiography in Patients With Uremia. J. Ultrasound Med., December 1, 2006; 25(12): 1563 - 1569. [Abstract] [Full Text] [PDF]

				E. C. Rojo, J. L. Rodrigo, L. Perez de Isla, C. Almeria, N. Gonzalo, A. Aubele, R. Cinza, J. Zamorano, and C. Macaya Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index Eur J Echocardiogr, October 1, 2006; 7(5): 356 - 364. [Abstract] [Full Text] [PDF]

				M. Cannesson, D. Jacques, M. R. Pinsky, and J. Gorcsan III Effects of modulation of left ventricular contractile state and loading conditions on tissue Doppler myocardial performance index Am J Physiol Heart Circ Physiol, May 1, 2006; 290(5): H1952 - H1959. [Abstract] [Full Text] [PDF]

				P. Dilaveris, A. Pantazis, G. Giannopoulos, A. Synetos, J. Gialafos, and C. Stefanadis Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick? Europace, January 1, 2006; 8(5): 352 - 357. [Abstract] [Full Text] [PDF]

				A. Schaefer, G. P. Meyer, D. Hilfiker-Kleiner, B. Brand, H. Drexler, and G. Klein Evaluation of Tissue Doppler Tei index for global left ventricular function in mice after myocardial infarction: Comparison with Pulsed Doppler Tei index Eur J Echocardiogr, October 1, 2005; 6(5): 367 - 375. [Abstract] [Full Text] [PDF]

				J. Arnlov, E. Ingelsson, U. Riserus, B. Andren, and L. Lind Myocardial performance index, a Doppler-derived index of global left ventricular function, predicts congestive heart failure in elderly men Eur. Heart J., December 2, 2004; 25(24): 2220 - 2225. [Abstract] [Full Text] [PDF]

				M. M.H. Cheung, J. F. Smallhorn, A. N. Redington, and M. Vogel The effects of changes in loading conditions and modulation of inotropic state on the myocardial performance index: comparison with conductance catheter measurements Eur. Heart J., December 2, 2004; 25(24): 2238 - 2242. [Abstract] [Full Text] [PDF]

				A. Dispenzieri, M. A. Gertz, R. A. Kyle, M. Q. Lacy, M. F. Burritt, T. M. Therneau, P. R. Greipp, T. E. Witzig, J. A. Lust, S. V. Rajkumar, et al. Serum Cardiac Troponins and N-Terminal Pro-Brain Natriuretic Peptide: A Staging System for Primary Systemic Amyloidosis J. Clin. Oncol., September 15, 2004; 22(18): 3751 - 3757. [Abstract] [Full Text] [PDF]

				C J McMahon, S F Nagueh, R S Eapen, W J Dreyer, I Finkelshtyn, X Cao, B W Eidem, L I Bezold, S W Denfield, J A Towbin, et al. Echocardiographic predictors of adverse clinical events in children with dilated cardiomyopathy: a prospective clinical study Heart, August 1, 2004; 90(8): 908 - 915. [Abstract] [Full Text] [PDF]

				H. I. Karvounis, I. G. Nouskas, T. M. Farmakis, K. M. Vrogistinos, C. E. Papadopoulos, T. A. Zaglavara, G. E. Parharidis, and G. E. Louridas Evaluation of a Doppler-Derived Index Combining Systolic and Diastolic Left Ventricular Function in Acute Myocardial Infarction Angiology, January 1, 2004; 55(1): 21 - 28. [Abstract] [PDF]

				N. H. Andersen, S. H. Poulsen, K. Helleberg, P. Ivarsen, S. T. Knudsen, and C. E. Mogensen Impact of Essential Hypertension and Diabetes Mellitus on Left Ventricular Systolic and Diastolic Performance Eur J Echocardiogr, December 1, 2003; 4(4): 306 - 312. [Abstract] [Full Text] [PDF]

				E. Schwammenthal, Y. Adler, K. Amichai, A. Sagie, S. Behar, H. Hod, and M. S. Feinberg Prognostic Value of Global Myocardial Performance Indices in Acute Myocardial Infarction: Comparison to Measures of Systolic and Diastolic Left Ventricular Function Chest, November 1, 2003; 124(5): 1645 - 1651. [Abstract] [Full Text] [PDF]

				J. L. Berk, J. Keane, D. C. Seldin, V. Sanchorawala, J. Koyama, L. M. Dember, and R. H. Falk Persistent Pleural Effusions in Primary Systemic Amyloidosis: Etiology and Prognosis Chest, September 1, 2003; 124(3): 969 - 977. [Abstract] [Full Text] [PDF]

				M. Swaminathan, B. G. Phillips-Bute, and J. P. Mathew An Assessment of Two Different Methods of Left Ventricular Ejection Time Measurement by Transesophageal Echocardiography Anesth. Analg., September 1, 2003; 97(3): 642 - 647. [Abstract] [Full Text] [PDF]

				K. Ozdemir, B. B. Altunkeser, A. Icli, H. Ozdil, and H. Gok New Parameters in Identification of Right Ventricular Myocardial Infarction and Proximal Right Coronary Artery Lesion Chest, July 1, 2003; 124(1): 219 - 226. [Abstract] [Full Text] [PDF]

				J. Koyama, P. A. Ray-Sequin, and R. H. Falk Prognostic Significance of Ultrasound Myocardial Tissue Characterization in Patients With Cardiac Amyloidosis Circulation, July 30, 2002; 106(5): 556 - 561. [Abstract] [Full Text] [PDF]

				F. I. Parthenakis, M. K. Kanakaraki, E. M. Kanoupakis, E. I. Skalidis, G. F. Diakakis, O. K. Filippou, and P. E. Vardas Value of Doppler Index Combining Systolic and Diastolic Myocardial Performance in Predicting Cardiopulmonary Exercise Capacity in Patients With Congestive Heart Failure* : Effects of Dobutamine Chest, June 1, 2002; 121(6): 1935 - 1941. [Abstract] [Full Text] [PDF]

				T. Menzel, T. Kramm, S. Mohr-Kahaly, E. Mayer, H. Oelert, and J. Meyer Assessment of cardiac performance using Tei indices in patients undergoing pulmonary thromboendarterectomy Ann. Thorac. Surg., March 1, 2002; 73(3): 762 - 766. [Abstract] [Full Text] [PDF]

				M. V. T. Tantengco, R. L. Thomas, and P. P. Karpawich Left ventricular dysfunction after long-term right ventricular apical pacing in the young J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2093 - 2100. [Abstract] [Full Text] [PDF]

				C Bruch, A Schmermund, D Marin, M Katz, T Bartel, J Schaar, and R Erbel Tei-Index in patients with mild-to-moderate congestive heart failure Eur. Heart J., November 2, 2000; 21(22): 1888 - 1895. [Abstract] [PDF]

				T. G. DiSalvo, M. E. King, and R. N. Smith Case 3-2000- A 66-Year-Old Woman with Diabetes, Coronary Disease, Orthostatic Hypotension, and the Nephrotic Syndrome N. Engl. J. Med., January 27, 2000; 342(4): 264 - 273. [Full Text] [PDF]

				D.L. Brutsaert Diagnosing primary diastolic heart failure Eur. Heart J., January 2, 2000; 21(2): 94 - 96. [PDF]