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Abstract: 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. [Copyright &y& Elsevier]

Background. Elevated plasma levels of cytokines have been associated with an increased risk of congestive heart failure (CHF) even in people without history of myocardial infarction. Here we have tested the hypothesis that effective removal of pro-inflammatory cytokines in patients with advanced CHF unresponsive to diuretic treatment is associated with diuresis restoration and with a significant reduction of B-type natriuretic peptide (BNP) circulating levels. [ABSTRACT FROM PUBLISHER]

A response by Carmelo Libetta, Vincenzo Sepe, Manuela Zucchi et al to a letter to the editor about their article on intermittent haemodiafiltration in refractory congestive heart failure is presented.

A letter to the editor is presented in response to the article "Standard Hemodiafiltration Improves Diuretic Responsiveness in Advanced Congestive Heart Failure," by Carmelo Libetta, Vincenzo Sepe, Manuela Zucchi, Carlo Campana, and Antonio Dal Canton in the December 15, 2005 issue.