Left atrial function in cardiac amyloidosis

Abstract

Patients with atrial amyloidosis have an adverse left atrium remodeling associated with left atrium dysfunction. Left atrium assessment may provide useful information in the clinical and prognostic stratification of amyloidotic patients.

Reduced left atrial myocardial deformation irrespective of cavity size: a potential cause for atrial arrhythmia in hereditary transthyretin amyloidosis

“…This is an unexpected finding, since the LA, described as the "Cinderella of the left heart", is commonly enlarged in any form of LV disease [19,20]. This finding therefore suggests that LA myocardial infiltration with the amyloid limits LA distension, as has previously been found in cardiac examinations on patients with AL or ATTR amyloidosis [7,8,21]. This suggestion is also supported by the significantly reduced LA SR function during the atrial contraction phase, particularly in patients with increased LV wall thickness.…”

“…Thus, the relationship [4][5][6] between LA function and the frequently seen atrial arrhythmia in cardiac amyloidosis is not fully elucidated [6,7].…”

Left Atrial Morphology, Size and Function in Patients With Transthyretin Cardiac Amyloidosis and Primary Hypertrophic Cardiomyopathy – Comparative Strain Imaging Study –

“…In contrast, in patients with severe disarray of the wall structure these features might be lacking, matching the high levels of NT-proBNP previously demonstrated in CA patients. [6][7][8][9] This study also demonstrates that a preclinical LA dysfunction may occur in both groups irrespective of chamber dilatation, with poorer values in TTR-CA patients. It is not easy to give true mechanistic insights on this finding, but it could be present cut-off values for both LA reservoir phase and pump function as discriminators between less and more compromised patients, as well as whether such values are casesensitive or limited to hypertrophic cardiomyopathies.…”

“…30 Finally, large studies are needed in order to confirm the wall, indicating cMRI as the gold standard for detecting deposits by LGE technique. 6 On the other hand, interstitial fibrosis has been demonstrated to occur in a variable proportion of HCM patients, but with a different pathogenesis being…”

“…[1][2][3] Despite the absence of software tailored for the atria, recent studies suggest this technique is a powered detector of left atrial (LA) mechanics, and both speckle tracking and vectorvelocity (feature tracking) modalities have been used for that purpose. [4][5][6] CA represents a cause of LV wall thickening and dysfunction, gradually leading to heart failure as a consequence of amyloid deposits in intramural coronary arteries and endomyocardium. However, noninvasive diagnostic tools of cardiac involvement are challenging when the clinical diagnosis is deficient, and misdiagnoses can be potentially harmful in some patients, because of a failure to differentiate CA from Atrial Function in TTR-CA and HCM cMRI and 99 m Tc-DPD scintigraphy were performed only in some TTR-CA patients, especially when echocardiography was not conclusive.…”