Cardiac Imaging

Echo Clues: When to Suspect Amyloidosis

cardiac amyloidosis echo

Aortic stenosis and cardiac amyloidosis cause similar functional and morphological changes in the heart, and discerning between the two conditions can be difficult. But in this European Heart Journal meta-analysis, researchers brought to light key differences in a large number of conventional echo criteria that can predict the presence of cardiac amyloidosis (CA) in aortic stenosis (AS) patients. 

The authors reviewed observational data from 1,449 patients (160 AS-CA and 1,289 AS-only) and found that the following features were significantly higher in patients with AS-CA compared with AS-only patients:

  • interventricular septal thickness (standardized mean difference: 0.74)
  • relative wall thickness (SMD: 0.74) 
  • posterior wall thickness (SMD: 0.74
  • LV mass index (SMD: 1.62)
  • E/A ratio (SMD: 4.18)
  • LA dimension (SMD: 0.73)

In contrast, these attributes were significantly lower in AS-CA patients:

  • myocardial contraction fraction (SMD: −2.88)
  • average mitral annular S′ (SMD: −1.14)
  • tricuspid annular plane systolic excursion (SMD: −0.36)
  • tricuspid annular S′ (SMD: −0.77)

The Takeaway

As the study’s editorial put it, the authors have revealed a “fundamental principle.” Routine echocardiographic parameters may prove to be “the key” to spotting cardiac amyloidosis in the presence of aortic stenosis. 

Get twice-weekly insights on the biggest stories shaping cardiology.

You might also like

You might also like..

Select All

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Cardiac Wire Team

You're all set!