Value of natriuretic peptides and tissue doppler imaging in the estimation of left ventricular filling pressure in patients with cardiac amyloidosis

Abstract

Estimation of ventricular filling pressures (VFP) is a determining factor in the follow-up of patients with cardiac amyloidosis (CA). Low VFP can lead to decreased cardiac output and symptoms of fatigue, with signs of hypotension and hypoperfusion. High VFP lead to shortness of breath and cardiac decompensation. Natriuretic peptides (NPs) and tissue Doppler imaging are daily used to monitor VFP in patients with CA. The aim of this study was to evaluate the value of NPs and Doppler parameters in estimating left VFP in patients with CA. Forty-six patients with biopsy verified light-chain (29), AA (1), Apoliporotein A2 (1) or bone scintigraphy proven transthyretin (15) CA were retrospectively included. All patients underwent transthoracic echocardiography, BNP (20) or NT-proBNP (26) measurement and right heart catheterization (RHC). Median BNP and NT-proBNP levels were 786 [from 37 to 3798] and 3796 [from 1178 to 49402] ng/L, respectively. Echocardiography demonstrated left atrial enlargement with a mean volume of 44 ± 14 mL and low tissue Doppler lateral e’ of 5 ± 1 cm.s-1. Median E/e’ ratio was 18 ± 8 and pulmonary capillary wedge pressure (PCWP) by RHC was 18 ± 7 mmHg. There was no correlation between BNP ( r = 0.308, P = 0187) or NT-proBNP ( r = -0.095, P = 0.646) levels and PCWP. There was a slight correlation between E/e’ ratio and PCWP ( r = 0.341, P = 0.041; Fig. 1 ). In patients with CA, NPs do not accurately estimate PCWP. Tissue Doppler–derived mitral E/e’ ratio is correlated with PCWP but the slight correlation requires to consider it carefully and to integrate others parameters to estimate intracardiac filling pressures.