Left atrial size—Another Differentiator for Cardiac Amyloidosis

Fitzgerald, B.; Scalia, G.; Cain, Peter; García, Mario J.; Thomas, James D.

doi:10.1016/j.hlc.2011.06.002

Cited by 24 publications

(18 citation statements)

References 7 publications

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“…However, the low-voltage ECGs of these patients would argue against a diagnosis of hypertensive heart disease. Additionally, patients with hypertension tend to have lower grades of diastolic dysfunction and smaller atria than cardiac amyloid patients [9]. Another infiltrative process should not have responded to the treatment of chemotherapy and BMT.…”

Section: Discussionmentioning

confidence: 99%

“…The echocardiogram and electrocardiograph (ECG) studies for these patients were assessed for the typical hallmarks of cardiac amyloidosis (thick, speckled walls, advanced diastolic dysfunction, dilated atria, and/or small pericardial effusions, and low voltages on ECG) [9], [10], [11], [12]. Global longitudinal strain and strain patterns were also recorded.…”

Section: Methodsmentioning

confidence: 99%

“…Diastolic function grade and left atrial area and volume were assessed and recorded. Diastolic function was assessed using mitral inflow, pulmonary vein Doppler, and Doppler Tissue Imaging, and then graded from normal function to grade 3 diastolic dysfunction (restrictive pattern) [9], [10], [11], [12]. Left atrial areas and volumes were measured at end-systole (the largest dimension or the end of the T wave) from the apical 4-chamber and apical 2-chamber views.…”

Section: Methodsmentioning

confidence: 99%

“…B.1) [9], [10], [11], [12]. These include thickened, speckled ventricular walls (left and right ventricle), small ventricular cavities, dilated atria, thickening of valve leaflet tissue, small pericardial effusions, and advanced diastolic dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…Global longitudinal strain as a more subtle measure of ventricular function may show early changes. Apical sparing strain patterns are thought to be pathognomonic in cardiac amyloidosis [9], [10], [11], [12], [13]. Cardiac magnetic resonance imaging (CMR) demonstrates diffuse circumferential subendocardial, mid-wall to transmural enhancement in a non-vascular distribution in the acute phases of the disease [14], [15], [16], [17].…”

Section: Introductionmentioning

confidence: 99%

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Regression of cardiac amyloidosis following stem cell transplantation: a comparison between echocardiography and cardiac magnetic resonance imaging in long-term survivors

Fitzgerald

Bashford

Newbigin

et al. 2017

IJC Heart & Vasculature

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BackgroundAL amyloidosis and multiple myeloma result in extracellular deposition of insoluble fibrillary protein in tissue and organs. Untreated median survival is very poor, and even worse with cardiac involvement. Chemotherapy and peripheral blood stem cell transplantation (PBSCT) have been shown to dramatically improve survival, with hematologic remission documented. Regression of cardiac changes has previously been shown, as assessed by echocardiography (TTE) and cardiac magnetic resonance imaging (CMR). This study is a comparison of TTE and CMR in long-term survivors of cardiac amyloidosis with regression.ResultsFour long-term survivors with cardiac amyloidosis and regression of cardiac features on TTE were identified. Mean age was 60 years and average survival was 139 months from the time of diagnosis of cardiac involvement. Statistically significant regression of the cardiac features of cardiac amyloidosis were demonstrated on TTE. In these survivors, post-PBSCT structural assessments were similar between TTE and CMR. Classical strain imaging features of cardiac amyloidosis were only present in 50%. All patients had diffuse, patchy gadolinium enhancement on CMR after PBSCT.ConclusionsTreatment of cardiac amyloidosis with chemotherapy and PBSCT may result in regression of abnormalities on TTE with marked improvement in survival. Post treatment, TTE and CMR structural assessments appear similar. Gadolinium imaging suggests that microscopic residual infiltration persists despite macroscopic regression. Significant cardiac improvements with prolonged survival are seen nonetheless. Multimodality imaging has a vital role in the management of cardiac amyloidosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Regression of cardiac amyloidosis following stem cell transplantation: a comparison between echocardiography and cardiac magnetic resonance imaging in long-term survivors

Fitzgerald

Bashford

Newbigin

et al. 2017

IJC Heart & Vasculature

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Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

et al. 2019

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AimsThe study aims to systematically assess the diagnostic performance of cardiac magnetic resonance (CMR) and nuclear scintigraphy (index tests) for the diagnosis and differentiation of subtypes of cardiac amyloidosis.Methods and resultsMEDLINE and Embase electronic databases were searched for studies evaluating the diagnostic performance of CMR or nuclear scintigraphy in detecting cardiac amyloidosis and subsequently in differentiating transthyretin amyloidosis (ATTR) from immunoglobulin light‐chain (AL) amyloidosis. In this meta‐analysis, histopathological examination of tissue from endomyocardial biopsy (EMB) or extra‐cardiac organs were reference standards. Pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated, and a random effects meta‐analysis was used to estimate diagnostic odds ratios. Methodological quality was assessed using a validated instrument. Of the 2947 studies identified, 27 met the criteria for inclusion. Sensitivity and specificity of CMR in diagnosing cardiac amyloidosis was 85.7% and 92.0% against EMB reference and 78.9% and 93.9% with any organ histology reference. Corresponding sensitivity and specificity of nuclear scintigraphy was 88.4% and 87.2% against EMB reference and 82.0% and 98.8% with histology from any organ. CMR was unable to reliably differentiate ATTR from AL amyloidosis (sensitivity 28.1–99.0% and specificity 11.0–60.0%). Sensitivity and specificity of nuclear scintigraphy in the differentiation of ATTR from AL amyloidosis ranged from 90.9% to 91.5% and from 88.6% to 97.1%. Pooled negative likelihood ratio and positive likelihood ratio for scintigraphy in this setting were 0.1 and 8, with EMB reference standard. Study quality assessed by QUADAS‐2 was generally poor with evidence of bias.ConclusionsCardiac magnetic resonance is a useful test for diagnosing cardiac amyloidosis but is not reliable in further classifying the disease. Nuclear scintigraphy offers strong diagnostic performance in both the detection of cardiac amyloidosis and differentiating ATTR from AL amyloidosis. Our findings support the use of both imaging modalities in a non‐invasive diagnostic algorithm that also tests for the presence of monoclonal protein.

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Echocardiographic assessment of cardiac amyloidosis

Agrawal

Nagueh

2021

Heart Fail Rev

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Left atrial size—Another Differentiator for Cardiac Amyloidosis

Cited by 24 publications

References 7 publications

Regression of cardiac amyloidosis following stem cell transplantation: a comparison between echocardiography and cardiac magnetic resonance imaging in long-term survivors

Regression of cardiac amyloidosis following stem cell transplantation: a comparison between echocardiography and cardiac magnetic resonance imaging in long-term survivors

Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

Echocardiographic assessment of cardiac amyloidosis

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