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Updated: Jul 5, 2026
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
'Hypersynchronisation' by tissue velocity imaging in patients with cardiac amyloidosis
D Bellavia1, P A Pellikka, T P Abraham
1Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Insights
Cardiac amyloidosis (CA) patients, particularly those with advanced disease, exhibit reduced intraventricular dyssynchrony. Decreased ejection time (ET) is a key factor and a significant predictor of survival in CA patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Electrophysiology
Background:
- Mechanical dyssynchrony is observed in various cardiomyopathies.
- Its presence and significance in cardiac amyloidosis (CA) remain largely uncharacterized.
- Tissue velocity imaging (TVI) is a tool for assessing cardiac mechanics.
Purpose of the Study:
- To evaluate mechanical dyssynchrony in patients with primary amyloidosis using TVI.
- To determine the utility of TVI-derived dyssynchrony parameters for risk stratification in CA.
- To investigate the relationship between dyssynchrony and survival in CA.
Main Methods:
- 121 patients with primary amyloidosis and 37 controls were studied.
- Patients were stratified into advanced-CA and no-advanced-CA groups based on LV wall thickness and diastolic dysfunction.
- Dyssynchrony was assessed using TVI, including atrioventricular, interventricular, and intraventricular (longitudinal and radial) parameters.
Main Results:
- Contrary to hypothesis, advanced-CA patients showed reduced intraventricular dyssynchrony (Ts-SD) compared to controls and no-advanced-CA groups.
- Reduced ejection time (ET) was identified as the primary cause for decreased intraventricular dyssynchrony.
- ET was the strongest independent predictor of all-cause mortality (HR=0.98, p<0.001).
Conclusions:
- Patients with advanced cardiac amyloidosis exhibit abnormally synchronized regional systolic motion.
- Reduced ejection time is a critical factor in the altered mechanics of advanced CA.
- Ejection time should be considered a vital parameter for assessing survival in cardiac amyloidosis patients.
Objective:
It is unknown if some patients with cardiac amyloidosis (CA) have mechanical dyssynchrony, as has been demonstrated in patients with ischaemic and dilated cardiomyopathies. The aim of this study was to assess mechanical dyssynchrony in patients with CA using tissue velocity imaging (TVI) and to define its usefulness for risk stratification.
Design And Patients:
We included 121 patients with primary amyloidosis and 37 age-matched and sex-matched controls. Patients were divided into two groups: 60 with advanced-CA and 61 with no-advanced-CA, according to left ventricular (LV) wall thickness and diastolic dysfunction. Dyssynchrony assessment included: (1) atrioventricular dyssynchrony (dys), (2) interventricular dys, (3) intraventricular dys assessed longitudinally, using the standard deviation of time to systolic peak velocity (Ts-SD) of the 12 basal and mid level LV segments, and (4) intraventricular dys assessed radially, using the difference in radial Ts between mid anteroseptal and mid posterior segments.
Outcome:
Primary end-point was all-cause death. During a median follow-up of 13 months there were 35 events among patients.
Results:
Contrary to the hypothesis, the intraventricular dys indices in advanced-CA patients were reduced compared to either the no-advanced-CA group or to controls (Ts-SD: 12.1 (9.0); 35.1 (18.6); 24.5 (14.1), respectively, p<0.001). This reduction was primarily the result of decreased ejection time (ET). Moreover, ET was the most significant predictor of survival (HR = 0.98, p<0.001).
Conclusions:
The regional timing of systolic motion measured by TVI was abnormally synchronised in the patients with advanced-CA. ET reduction plays a prominent part in this process and should be considered an essential parameter for assessment of patients with cardiac amyloidosis.
