Myocardial Mechanics and Valvular and Vascular Abnormalities in Cardiac Amyloidosis

Figures

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  Figure 1. Routine two-dimensional echocardiographic image from the apical 4-chamber view of a patient with cardiac amyloidosis with biventricular hypertrophy. Abbreviations. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

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  Figure 2. Three-dimensional (3D) speckle-tracking echocardiographic assessment of the left ventricular (LV) parameters. After 3D echocardiographic dataset acquisitions, apical 4-chamber (A) and 2-chamber (B) long-axis views and short-axis views at apical (C3), midventricular (C5), and basal (C7) LV levels were created using a special software. Together with a 3D virtual model of the LV (D), we calculated LV volumetric data and the LV ejection fraction (E) and apical (yellow arrow) and basal (dashed yellow arrow) LV rotations (F) together with curves representing time–LV global (white curve); and segmental (colored curves) radial (G), longitudinal (H), circumferential (J), area (K), and 3D (L) strain curves with curves representing time–LV volume changes (dashed white curve) are presented. Abbreviations. EDV = end-diastolic volume, ESV = end-systolic volume, EF = ejection fraction, MASS = LV muscle mass. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

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  Figure 3. Three-dimensional (3D) speckle-tracking echocardiographic assessment of the left atrial (LA) parameters. After 3D echocardiographic dataset acquisitions, apical 4-chamber (A) and 2-chamber (B) long-axis views and short-axis views at basal (C3) and midatrial (C5) and superior (C7) LA levels were created using a special software. Together with a 3D virtual model of the LA (D), we calculated LA volumetric data (E) and curves representing time–LA global (white curve), and segmental (colored curves) circumferential (F) strains changes together with curves representing time–LA volume changes (dashed white curve) are presented. Peak LA strains are represented by a yellow arrow, while LA strains at atrial contraction are represented by a dashed yellow arrow. Abbreviations. LV = left ventricle, LA = left atrium, RV = right ventricle, RA = right atrium, EDV = end-diastolic volume, ESV = end-systolic volume, EF = ejection fraction, MASS = LA muscle mass, Vmax = minimum end-systolic LA volume, VpreA = early diastolic LA volume before atrial contraction, Vmin = end-diastolic minimum LA volume.

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  Figure 4. Three-dimensional (3D) speckle-tracking echocardiography-derived two-dimensionally projected views of the tricuspid (TA) (left panel) and mitral annuli (MA) (right panel). After 3D echocardiographic dataset acquisitions, following adjustments on apical four-chamber (A) and two-chamber (B) long-axis views, TA/MA-optimized images are presented in C7 cross-sectional views (C7). The yellow arrows represent the TA/MA plane. Abbreviations: LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle, Area = TA/MA area, Circ = TA/MA perimeter.

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  Figure 5. Three-dimensional (3D) speckle-tracking echocardiographic assessment of the right atrial (RA) parameters. After 3D echocardiographic dataset acquisitions, apical 4-chamber (A) and 2-chamber (B) long-axis views and short- axis views at basal (C3) and midatrial (C5) and superior (C7) RA levels were created using a special software. Together with a 3D virtual model of the RA (D), calculated RA volumetric data (E) and curves representing time–RA global (white curve), and segmental (colored curves) circumferential (F) strain changes together with a curve representing time–RA volume changes (dashed white curve) are presented. Peak RA strains are represented by a yellow arrow, while RA strains at atrial contraction are represented by a dashed yellow arrow. Abbreviations. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle, EF = ejection fraction, EDV = end-diastolic volume, ESV = end-systolic volume, MASS = RA muscle mass, Vmax = minimum end-systolic RA volume, VpreA = early diastolic RA volume before atrial contraction, Vmin = end-diastolic minimum RA volume.