Causes and Consequences of Longitudinal LV Dysfunction Assessed by 2D Strain Echocardiography in Cardiac Amyloidosis

Ternacle, Julien; Bodez, Diane; Guellich, Aziz; Audureau, Étienne; Rappeneau, Stéphane; Lim, Pascal; Radu, Costin; Guendouz, Soulef; Couëtil, Jean‐Paul; Benhaiem, N; Hittinger, Luc; Dubois‐Randé, Jean‐Luc; Planté‐Bordeneuve, Violaine; Mohty, Dania; Deux, Jean-François; Damy, Thibaud

doi:10.1016/j.jcmg.2015.05.014

Cited by 160 publications

(138 citation statements)

References 38 publications

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“…We hypothesize that increased values of EFSR in patients with CA can be attributed to the reduced longitudinal deformation in EF, which is, in part, compensated by the preserved LV twist and the smaller (per level) percentile reduction of global circumferential strain as it was observed by us and others. 10,28 These deformation characteristics would be also compatible with the observed double gradient of CA (apex-to-base 8,24 and subepicardium to subendocardium), which indicates toward a stronger impairment of the subendocardial (right-handed helix) fibers.…”

Section: Deformation Indices and Diagnosis Of Ca: Why Efsr?supporting

confidence: 70%

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Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis

Pagourelias

Mirea

Duchenne

et al. 2017

Circ: Cardiovascular Imaging

228

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Background— A plethora of echo parameters has been suggested for distinguishing cardiac amyloidosis (CA) from other causes of myocardial thickening with, however, scarce data on their head-to-head comparison. This study aimed at comparing the diagnostic accuracy of various deformation and conventional echo parameters in differentiating CA from other hypertrophic substrates, especially in the gray zone of mild hypertrophy (maximum wall thickness ≤16 mm) or normal ejection fraction (EF). Methods and Results— We included 100 subjects, of which 40 were patients with newly diagnosed, biopsy-proven CA (65.5±10.8 years, 65% male, 62.5% amyloidosis light chain [AL] type), 40 patients with hypertrophic cardiomyopathy matched for demographics and maximum wall thickness (60.1±14.8 years, 85% male), and 20 hypertensives with prominent myocardial remodeling. Quantifiable conventional morphological and functional parameters along with multidimensional strain and strain-derived ratios indices, previously suggested to diagnose CA, were analyzed. EF global longitudinal strain ratio showed the best performance to discriminate CA (area under the curve, 0.95; 95% confidence intervals, 0.89–0.98; P <0.00005). Traditional echo indices showed overall low sensitivities and high specificities (among them myocardial contraction fraction ratio had the highest area under the curve, 0.80; 95% confidence intervals, 0.7–0.87; P <0.0001). In the challenging subgroups (maximum wall thickness ≤16 mm and EF>55%), EF global longitudinal strain ratio remained the best predicting parameter of CA diagnosis (multiple logistic regression models P <0.00005 and P =0.0002, respectively) independent of the CA type. Conclusions— Our study demonstrated that in patients with thickened hearts, EF global longitudinal strain ratio has the best accuracy in detecting CA, even among the most “challenging” patient subgroups as those with mild hypertrophy and normal EF.

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Section: Deformation Indices and Diagnosis Of Ca: Why Efsr?supporting

confidence: 70%

“…6,7,22 These studies were mostly based either on sole CA populations or made comparisons between patients with possible or no cardiac infiltration. 5,19,23,24 The few studies that have used a "wider" hypertrophic spectrum 8,9,25,26 were restricted to a small number of echo parameters tested.…”

Section: Conventional Echo Parameters and Diagnosis Of Amyloidosismentioning

confidence: 99%

Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis

Pagourelias

Mirea

Duchenne

et al. 2017

Circ: Cardiovascular Imaging

228

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“…(20, 22–24) It is well recognized that GLS, a measure of longitudinal LV function, is more sensitive and accurate than LVEF in the assessment of myocardial contractility, particularly in cardiomyopathic conditions. (33, 34) LVEF is often normal despite the presence of myocardial dysfunction in the presence of the low end-diastolic volume and small cavity size seen in patients with amyloid cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…Recently myocardial strain by 2D speckle tracking echocardiography has emerged as a highly useful tool in the evaluation of patients with cardiac amyloidosis. (19–22) Global longitudinal strain (GLS) has shown to be a strong and independent predictor of outcome in patients with cardiac amyloidosis. (23–28) However whether GLS is a useful marker for prognostication of survival in patients undergoing HCT independent of troponin and BNP, remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Prognostic and Added Value of Two-Dimensional Global Longitudinal Strain for Prediction of Survival in Patients with Light Chain Amyloidosis Undergoing Autologous Hematopoietic Cell Transplantation

Pun

Landau

Riedel

et al. 2018

Journal of the American Society of Echocardiography

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Objectives To evaluate 1) the prognostic implication of baseline global longitudinal strain (GLS) and 2) the added value of GLS beyond the circulating cardiac biomarkers for risk stratification in patients with light chain (AL) amyloid undergoing autologous hematopoietic cell transplant (HCT). Background Autologous HCT is a first line therapy for prolonging survival in patients with AL amyloidosis. Cardiac involvement is the most important determinant of survival. However, patients with advanced cardiac involvement have often been excluded from HCT due to high risk of transplant related mortality and poor overall survival. Whether GLS can provide additional risk stratification and predict survival after HCT in this high risk population remains unclear. Methods 82 patients with newly diagnosed AL amyloidosis who underwent upfront HCT between January 2007 to April 2014 were included in the study. Clinical, echo and serum cardiac biomarker data were collected at baseline and 12 months following HCT. GLS measurements were performed using a vendor independent offline system. The median follow-up time for survivors was 58 months. Results 64% of the patients were in biomarker based Mayo stage II or III. GLS, BNP, troponin and mitral E/A ratio were identified as the strongest predictors of survival (p<0.0001). Other predictors included sex, creatinine, free light chain, wall thickness and EF. The Mayo stage was significantly associated with outcome with 5 year survival of 93%, 72% and 31% in stage I, II and III patients, respectively. A GLS of 17% was identified as the value which best discriminated survivors from non-survivors and the application of this cutoff value provided further mortality risk stratification within each Mayo stage. Conclusions GLS is a strong predictor of survival in patients with AL amyloidosis undergoing HCT, potentially providing incremental value over the serum cardiac biomarkers for risk stratification. GLS should be considered as a standard parameter along with the serum cardiac biomarkers when evaluating eligibility for HCT or other investigational therapies.

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“…8 However, the value of myocardial strain analysis by CMR in patients with cardiac amyloidosis remains to be elucidated and was the aim of this study.…”

Section: Cmr Protocolmentioning

confidence: 99%

Identification and Assessment of Cardiac Amyloidosis by Myocardial Strain Analysis of Cardiac Magnetic Resonance Imaging

Oda

Utsunomiya

Nakaura

et al. 2017

Circ J

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Background:We explored the usefulness of myocardial strain analysis on cardiac magnetic resonance imaging (CMR) scans for the identification of cardiac amyloidosis. Methods and Results:The 61 patients with systemic amyloidosis underwent 3.0-T CMR, including CMR tagging and late-gadolinium enhanced (LGE) imaging. The circumferential strain (CS) of LGE-positive and LGE-negative patients was measured on midventricular short-axis images and compared. Logistic regression modeling of CMR parameters was performed to detect patients with LGE-positive cardiac amyloidosis. Of the 61 patients with systemic amyloidosis 48 were LGE-positive and 13 were LGE-negative. The peak CS was significantly lower in the LGE-positive than in the LGE-negative patients (−9.5±2.3 vs. −13.3±1.4%, P<0.01). The variability in the peak CS time was significantly greater in the LGE-positive than in the LGE-negative patients (46.1±24.5 vs. 21.2±20.1 ms, P<0.01). The peak CS significantly correlated with clinical biomarkers. The sensitivity, specificity, and accuracy of the diagnostic model using CS parameters for the identification of LGE-positive amyloidosis were 93.8%, 76.9%, and 90.2%, respectively. Conclusions:Myocardial strain analysis by CMR helped detect LGE-positive amyloidosis without the need for contrast medium. The peak CS and variability in the peak CS time may correlate with the severity of cardiac amyloid deposition and may be more sensitive than LGE imaging for the detection of early cardiac disease in patients with amyloidosis.

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Causes and Consequences of Longitudinal LV Dysfunction Assessed by 2D Strain Echocardiography in Cardiac Amyloidosis

Abstract: Basal-to-apical LS abnormalities are similar across CA types and reflect the amyloid burden. Apical LS independently predicts MACE.

Cited by 160 publications

References 38 publications

Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis

Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis

Prognostic and Added Value of Two-Dimensional Global Longitudinal Strain for Prediction of Survival in Patients with Light Chain Amyloidosis Undergoing Autologous Hematopoietic Cell Transplantation

Identification and Assessment of Cardiac Amyloidosis by Myocardial Strain Analysis of Cardiac Magnetic Resonance Imaging

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