Figure 1.

Diastolic function in cardiac amyloidosis (CA): diastolic parameters tend to be markedly abnormal due to stiffening of the myocardium secondary to amyloid infiltration. Aside from the classical steep deceleration time, which is consistent with restrictive diastolic dysfunction, there are other parameters that are helpful. Tissue Doppler velocity at mitral annulus (E′) are usually <6 cm/s. Also, notice the significant blunting of the systolic component of the pulmonary vein flow, suggesting high filling pressures in the absence of significant mitral regurgitation. Typically, like any other restrictive cardiomyopathy, CA will present with biatrial enlargement, reflecting the chronically elevated filling ventricular pressures.