Importance of the echocardiographic evaluation of right ventricular function in patients with AL amyloidosis

Background: Patients with AL amyloidosis often present with signs of congestive heart failure. Aim: This study was prospectively designed to assess the significance of RV dysfunction in AL amyloidosis. Methods and results: Seventy-four patients with biopsy proven AL amyloidosis underwent a thorough echocardiographic evaluation. A tricuspid annular plane systolic excursion (TAPSE) <17 mm was taken as marker of RV dysfunction. Plasma NT-proBNP determinations were performed in all cases. RV function was normal in 60 patients and reduced in 14 patients. Patients with RV dysfunction had thicker left ventricular (LV) walls (p <0.01), lower LV end-diastolic volumes (p <0.01), lower LV ejection fraction (p <0.01) and more frequently a restrictive LV filling pattern (p <0.01). RV dimensions and RV free wall thickness were not significantly different in the two groups. A thick interventricular septum and a reduced TAPSE were associated with high NT-proBNP levels (both p <0.01). Seven patients died during a median follow-up period of 19 months; TAPSE <17 mm was the only echocardiographic parameter associated with poor survival. Conclusion: In patients with AL amyloidosis, RV dysfunction is associated with more severe involvement of the left ventricle, higher plasma levels of NT-proBNP and with poor prognosis.