Doppler peak-plateau morphology in pulmonary regurgitation flow with respiratory changes of its profile revealing hemodynamic features of restrictive cardiomyopathy (original) (raw)

International Journal of Cardiology, 2012

Abstract

Restrictive cardiomyopathy due to myocardial deposition of amyloid protein usually presents as right-sided heart failure. Prognosis in such cases is poor, but patients who receive specific treatment for the underlying condition causing amyloidosis seem to have a slightly better outcome [1]. Early diagnosis of restrictive ventricular physiology and it ultimate cause may be important for patient prompt useful management. In deposition cardiomyopathies, ventricular ejection fraction is usually preserved and end-diastolic ventricular volumes are normal or reduced. Raised filling pressure is the main compensatory mechanism to maintain cardiac output in such cases [2]. Distinguishing between constriction and restriction is a common challenge in healthcare practice [3], since clinical presentation is usually similar, and even typical causes of myocardial restriction may provoke true pericardial constriction [4]. Pulmonary regurgitation Doppler flow morphology depends on the pressure gradient between pulmonary artery and right ventricle. Echocardiography is able to record pulmonary regurgitation signal in more than 80% of studies [5]. High right ventricular end-diastolic pressure due to restrictive physiology has been shown to produce a distinctive morphology in continuous-wave Doppler tracings of pulmonary regurgitation, with prognostic value in the setting of right ventricular infarction [5]. Gilman et al. pointed out the respiratory

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