Abstract
Echocardiographic diagnosis of cardiac amyloidosis (CA) can be difficult to differentiate from increased left ventricular (LV) wall thickness from hypertensive heart disease. The aim of this study was to evaluate left atrial (LA) function and deformation using strain and strain rate (SR) imaging in cardiac amyloidosis. We reviewed 44 cases of CA confirmed by tissue biopsy or a combination of clinical and cardiac imaging data. Cases were classified according two subgroups: amyloid light chain (AL) or amyloid transthyretin (ATTR). These subjects underwent 2D-Speckle tracking echocardiographic derived (STE) LA strain analysis. These were compared to 25 hypertensive (HT) patients with increased LV wall thickness. The three phases of LA function were evaluated using strain and strain rate parameters. Despite a similar increase in LV wall thickness, all LA strain parameters were significantly reduced in the AL cohort compared to the HT cohort (reservoir strain/LAs: 11.0 vs. 24.8%, p < 0.05). The ATTR cohort had significantly thicker LV walls and higher atrial fibrillation burden compared to AL and HT patients but similar reduction in LA strain values compared to AL group. A reservoir strain (S-LAs) cut off value of 20% was 86.4% sensitive and 88.6% specific for detecting CA compared to HT heart disease in this cohort. LA strain parameters were able to identify LA dysfunction in all types of CA. LA function in CA is significantly worse compared with hypertensive patients despite similar increase in LV wall thickness. In combination with other clinical and imaging features, LA strain may provide incremental value in differentiating cardiac amyloidosis from increased wall thickness secondary to hypertension.
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References
Nochioka K, Quarta CC, Claggett B, Roca GQ, Rapezzi C, Falk RH, Solomon SD (2017) Left atrial structure and function in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 18(10):1128–1137
Falk RH, Dubrey SW (2010) Amyloid heart disease. Prog Cardiovasc Dis 52(4):347–361
Mohty D, Damy T, Cosnay P, Echahidi N, Casset-Senon D, Virot P, Jaccard A (2013) Cardiac amyloidosis: updates in diagnosis and management. Arch Cardiovasc Dis 106(10):528–540
Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A, Wechalekar AD, Berk JL et al (2016) Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 133(24):2404–2412
Shukla A, Wong D, Humphries JA, Fitzgerald BT, Newbigin K, Bashford J, Scalia GM (2017) Transthyretin cardiac amyloidosis: a noninvasive multimodality approach to diagnosis using transthoracic echocardiography, 99m-Tc-labeled phosphate bone scanning, and cardiac magnetic resonance imaging. CASE (Philadelphia, PA) 1(2):49–53
Lee SP, Park JB, Kim HK, Kim YJ, Grogan M, Sohn DW (2019) Contemporary imaging diagnosis of cardiac amyloidosis. J Cardiovasc Imaging 27(1):1–10
Fitzgerald BT, Bashford J, Newbigin K, Scalia GM (2017) Regression of cardiac amyloidosis following stem cell transplantation: a comparison between echocardiography and cardiac magnetic resonance imaging in long-term survivors. Int J Cardiol Heart Vasculature 14:53–57
Alexander KM, Evangelisti A, Witteles RM (2019) Emerging therapies for transthyretin cardiac amyloidosis. Curr Treat Options Cardiovasc Med 21(8):40
Maurer MS, Schwartz JH, Gundapaneni B, Elliott PM, Merlini G, Waddington-Cruz M, Kristen AV, Grogan M et al (2018) Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 379(11):1007–1016
Scalia GM, Scalia IG, Kierle R, Beaumont R, Cross DB, Feenstra J, Burstow DJ, Fitzgerald BT et al (2016) ePLAR - The echocardiographic pulmonary to left atrial ratio - A novel non-invasive parameter to differentiate pre-capillary and post-capillary pulmonary hypertension. Int J Cardiol 212:379–386
Rausch K, Shiino K, Putrino A, Lam AK, Scalia GM, Chan J (2019) Reproducibility of global left atrial strain and strain rate between novice and expert using multi-vendor analysis software. Int J Cardiovasc Imaging 35(3):419–426
Rausch K, Shiino K, Putrino A, Lam AK, Scalia GM, Chan J (2018) Reproducibility of global left atrial strain and strain rate between novice and expert using multi-vendor analysis software. Int J Cardiovasc Imaging 35:419
Mohty D, Petitalot V, Magne J, Fadel BM, Boulogne C, Rouabhia D, ElHamel C, Lavergne D et al (2018) Left atrial function in patients with light chain amyloidosis: a transthoracic 3D speckle tracking imaging study. J Cardiol 71(4):419–427
de Gregorio C, Dattilo G, Casale M, Terrizzi A, Donato R, Di Bella G (2016) Left atrial morphology, size and function in patients with transthyretin cardiac amyloidosis and primary hypertrophic cardiomyopathy- comparative strain imaging study. Circul J 80(8):1830–1837
Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM (2017) LA Strain for categorization of LV diastolic dysfunction. JACC Cardiovasc Imaging 10(7):735–743
Buss SJ, Emami M, Mereles D, Korosoglou G, Kristen AV, Voss A, Schellberg D, Zugck C et al (2012) Longitudinal left ventricular function for prediction of survival in systemic light-chain amyloidosis: incremental value compared with clinical and biochemical markers. J Am Coll Cardiol 60(12):1067–1076
Koyama J, Falk RH (2010) Prognostic significance of strain Doppler imaging in light-chain amyloidosis. JACC Cardiovasc Imaging 3(4):333–342
Fitzgerald BT, Bashford J, Scalia GM (2017) Regression of the anatomic cardiac features of amyloid light chain cardiac amyloidosis accompanied by normalization of global longitudinal strain. CASE (Philadelphia, PA) 1(2):46–48
Mohty D, Pibarot P, Dumesnil JG, Darodes N, Lavergne D, Echahidi N, Virot P, Bordessoule D et al (2011) Left atrial size is an independent predictor of overall survival in patients with primary systemic amyloidosis. Arch Cardiovasc Dis 104(12):611–618
Tuzovic M, Kobayashi Y, Wheeler M, Barrett C, Liedtke M, Lafayette R, Schrier S, Haddad F et al (2017) Functional cardiac recovery and hematologic response to chemotherapy in patients with light-chain amyloidosis (from the Stanford University Amyloidosis Registry). Am J Cardiol 120(8):1381–1386
Sanchis K, Cariou E, Colombat M, Ribes D, Huart A, Cintas P, Fournier P, Rollin A et al (2019) Atrial fibrillation and subtype of atrial fibrillation in cardiac amyloidosis: clinical and echocardiographic features, impact on mortality. Amyloid 26(3):128–138
Inaba Y, Yuda S, Kobayashi N, Hashimoto A, Uno K, Nakata T, Tsuchihashi K, Miura T et al (2005) Strain rate imaging for noninvasive functional quantification of the left atrium: comparative studies in controls and patients with atrial fibrillation. J Am Soc Echocardiogr 18(7):729–736
Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L, Addetia K, Caballero L et al (2018) Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 19(6):630–638
Pathan F, D'Elia N, Nolan MT, Marwick TH, Negishi K (2017) Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr 30(1):59–70.e8
Liao JN, Chao TF, Kuo JY, Sung KT, Tsai JP, Lo CI, Lai YH, Su CH et al (2017) Age, sex, and blood pressure-related influences on reference values of left atrial deformation and mechanics from a large-scale Asian population. Circ Cardiovasc Imaging 10(10):e006077
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KR—concept and design, data collection, primary author of manuscript. GMS—concept and design, critical revision of article. KS—interobserver variability data collection. NE—data collection, critical revision of article. AL—concept and design, drafting article, critical revision of article. DGP—concept and design, critical revision of article. JC—concept and design, oversight of data collection, statistical analysis, drafting article, critical revision of article.
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Appendices
Appendix
Data including study vendor, year of study and strain values for the amyloid and hypertensive cohorts
Disease state | Vendor | Year of study | Reservoir strain (S-LAs | Conduit strain (S-LAe) | Contractile strain (S-LAa) |
|---|---|---|---|---|---|
AL | GE | 2017 | 11.87 | ||
AL | Phillips | 2018 | 7.94 | 4.895 | 3.045 |
AL | Phillips | 2016 | 8.77 | 5.85 | 2.92 |
AL | Phillips | 2010 | 22.955 | 7.75 | 15.205 |
AL | Phillips | 2015 | 6.795 | 3.11 | 3.685 |
AL | Phillips | 2015 | 9.09 | 4.87 | 4.22 |
AL | Phillips | 2011 | 7.44 | 4.455 | 2.985 |
AL | GE | 2017 | 2.245 | 1.385 | 0.86 |
AL | Phillips | 2017 | 27.655 | 16.285 | 11.37 |
AL | GE | 2015 | 12.64 | 4.805 | 7.835 |
AL | GE | 2017 | 3.65 | ||
ATTR | GE | 2015 | 12.64 | 4.805 | 7.835 |
ATTR | GE | 2017 | 3.65 | ||
ATTR | GE | 2018 | 6.245 | 3.995 | 2.25 |
ATTR | Phillips | 2016 | 3.27 | 2.73 | 0.535 |
ATTR | GE | 2016 | 5.46 | 3.58 | 1.88 |
ATTR | GE | 2017 | 10.21 | ||
ATTR | Phillips | 2019 | 5.00 | ||
ATTR | GE | 2018 | 4.13 | ||
ATTR | GE | 2017 | 5.57 | ||
ATTR | GE | 2017 | 15.84 | 5.40 | 10.45 |
ATTR | GE | 2017 | 15.87 | 6.53 | 9.34 |
ATTR | GE | 2018 | 6.10 | ||
ATTR | Phillips | 2014 | 19.51 | ||
ATTR | Phillips | 2018 | 10.78 | 8.18 | 2.60 |
ATTR | GE | 2017 | 6.60 | ||
ATTR | Phillips | 2018 | 7.71 | ||
ATTR | Phillips | 2017 | 3.73 | ||
ATTR | GE | 2019 | 6.22 | ||
ATTR | Phillips | 2015 | 10.08 | ||
ATTR | Phillips | 2015 | 25.70 | 15.47 | 10.24 |
ATTR | GE | 2015 | 9.95 | 3.41 | 6.54 |
ATTR | GE | 2016 | 5.70 | 4.63 | 1.07 |
ATTR | GE | 2015 | 7.30 | ||
ATTR | GE | 2014 | 5.21 | ||
ATTR | GE | 2015 | 6.10 | ||
ATTR | GE | 2017 | 4.82 | ||
ATTR | GE | 2013 | 7.34 | ||
ATTR | Phillips | 2010 | 20.71 | 6.92 | 13.79 |
ATTR | HP7500 | 2004 | 2.49 | ||
ATTR | Phillips | 2017 | 6.30 | 4.61 | 1.69 |
ATTR | Phillips | 2018 | 28.70 | 4.94 | 15.77 |
ATTR | Phillips | 2016 | 9.18 | ||
ATTR | Siemens | 2016 | 2.37 | ||
ATTR | Phillips | 2017 | 8.34 | 5.48 | 2.86 |
ATTR | GE | 2015 | 32.64 | 15.91 | 13.65 |
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Rausch, K., Scalia, G.M., Sato, K. et al. Left atrial strain imaging differentiates cardiac amyloidosis and hypertensive heart disease. Int J Cardiovasc Imaging 37, 81–90 (2021). https://doi.org/10.1007/s10554-020-01948-9
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DOI: https://doi.org/10.1007/s10554-020-01948-9