European Heart Journal Advance Access originally published online on April 12, 2007
European Heart Journal 2007 28(8):1019-1024; doi:10.1093/eurheartj/ehm066
Vascular abnormalities in primary amyloidosis
1 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
2 Division of Hematology, Mayo Clinic, Rochester, MN, USA
3 Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
Received 31 July 2006; revised 26 February 2007; accepted 8 March 2007; online publish-ahead-of-print 12 April 2007.
* Corresponding author: Johns Hopkins University, 600 North Wolfe Street, Carnegie 568, Baltimore, MD, USA. Tel: +1 410 955 6173; fax: +1 410 955 1509. E-mail address: Tabraha3{at}jhmi.edu
Aims: Primary amyloidosis (AL) is a systemic disease; however, there is limited information regarding the presence and character of vascular abnormalities.
Methods and results: Validated ultrasound techniques were used to prospectively determine carotid artery intimal–medial thickness (IMT) and brachial artery flow-mediated dilatation (FMD) in 59 consecutive AL patients and 17 age-similar, healthy, asymptomatic volunteers (CON). Carotid IMT was increased in AL when compared with CON (0.07 ± 0.02 vs. 0.04 ± 0.01 mm, P < 0.01). Similarly, brachial artery FMD was significantly lower in AL when compared with CON subjects (3 ± 7 vs. 12 ± 8%, P < 0.01). Multivariable analysis revealed that AL was associated with larger IMT and lower FMD after controlling for several confounding variables. However, within AL cases, there was not a significant association of cardiac vs. non-cardiac involvement with IMT or FMD (P = 0.1 and 0.2, respectively).
Conclusion: AL is associated with abnormal vascular morphology and endothelial dysfunction. Vascular abnormalities do not appear to be related to echocardiographic evidence of cardiac involvement.
Key Words: Amyloidosis • Intimal–medial thickness • Flow-mediated arterial dilatation • Endothelial function