Longitudinal strain in the management of cardiac AL amyloidosis: do we need it?

Rapezzi, Claudio; Aimo, Alberto; Pavasini, Rita

doi:10.1093/eurheartj/ehab609

Cited by 12 publications

(6 citation statements)

References 12 publications

(19 reference statements)

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“…Advanced imaging modalities, in particular echocardiographic LA strain, seem to have additional value to standard echocardiography or LV strain analysis for the diagnosis of CA and ATTR‐CA. LA strain might refine the prediction of thromboembolic events (including in patients in sinus rhythm), and might also provide a surrogate biomarker of response to disease‐modifying therapies 56 . From a clinical perspective, two questions seem particularly compelling: (1) which patients with atrial amyloidosis and no history of AF require anticoagulation?, (2) is IAA a mechanism of atrial remodelling in patients with AF?…”

Section: Discussionmentioning

confidence: 99%

“…LA strain might refine the prediction of thromboembolic events (including in patients in sinus rhythm), and might also provide a surrogate biomarker of response to disease‐modifying therapies. 56 From a clinical perspective, two questions seem particularly compelling: (1) which patients with atrial amyloidosis and no history of AF require anticoagulation?, (2) is IAA a mechanism of atrial remodelling in patients with AF? A clinical trial is needed to answer the first question, with the randomization of patients with a dilated and dysfunctional LA to anticoagulation versus no anticoagulation, and the assessment of the safety and efficacy of this strategy.…”

Section: Discussionmentioning

confidence: 99%

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Atrial amyloidosis: mechanisms and clinical manifestations

Vergaro

Aimo

Rapezzi

et al. 2022

European J of Heart Fail

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Cardiac amyloidosis (CA) is now recognized as an important cause of heart failure. Increased wall thickness and diastolic dysfunction of the left ventricle are the most easily detectable manifestations of CA, but amyloid accumulates in all cardiac structures. Involvement of the left and right atria may be due to the haemodynamic effects of ventricular diastolic dysfunction, the effects of amyloid infiltration into the atrial wall, and the cardiotoxic damage of atrial cardiomyocytes by amyloid precursors. Atrial amyloidosis is an early manifestation of CA, and is associated with an increased risk of atrial fibrillation and thromboembolic events. Furthermore, atrial amyloidosis can be found even in the absence of systemic disease and ventricular involvement. This condition is named isolated atrial amyloidosis and is due to a local overproduction of atrial natriuretic peptide. In this review we summarize the evidence on the mechanisms and clinical relevance of atrial amyloidosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Atrial amyloidosis: mechanisms and clinical manifestations

Vergaro

Aimo

Rapezzi

et al. 2022

European J of Heart Fail

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“…Patient with GLS values indicating severe left ventricle impairment had worse prognosis independently of the Mayo staging system and LVEF 155 . Moreover, variations in GLS, during the progression of the disease, may reflect changes in cardiac function or potential response to therapy 156 …”

Section: Principal Clinical Applications Of Left Ventricular Strain A...mentioning

confidence: 99%

“…155 Moreover, variations in GLS, during the progression of the disease, may reflect changes in cardiac function or potential response to therapy. 156 GLS could possibly be a better predictor of survival compared to cardiac biomarkers and a potential tool to assess improvement and response to therapy. 157…”

Section: Amyloidosismentioning

confidence: 99%

Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice

Gherbesi,

Gianstefani,

Angeli

et al. 2024

Echocardiography

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Speckle tracking echocardiography (STE) is a reliable imaging technique of recognized clinical value in several settings. This method uses the motion of ultrasound backscatter speckles within echocardiographic images to derive myocardial velocities and deformation parameters, providing crucial insights on several cardiac pathological and physiological processes. Its feasibility, reproducibility, and accuracy have been widely demonstrated, being myocardial strain of the various chambers inserted in diagnostic algorithms and guidelines for various pathologies. The most important parameters are Global longitudinal strain (GLS), Left atrium (LA) reservoir strain, and Global Work Index (GWI): based on large studies the average of the lower limit of normality are −16%, 23%, and 1442 mmHg%, respectively. For GWI, it should be pointed out that myocardial work relies primarily on non‐invasive measurements of blood pressure and segmental strain, both of which exhibit high variability, and thus, this variability constitutes a significant limitation of this parameter. In this review, we describe the principal aspects of the theory behind the use of myocardial strain, from cardiac mechanics to image acquisition techniques, outlining its limitation, and its principal clinical applications: in particular, GLS have a role in determine subclinical myocardial dysfunction (in cardiomyopathies, cardiotoxicity, target organ damage in ambulatory patients with arterial hypertension) and LA strain in determine the risk of AF, specifically in ambulatory patients with arterial hypertension.

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“…14 GLS has proved to be superior to LVEF in diagnosis, risk stratification, and decision-making amongst patients with AL amyloidosis. 15 Cardiac magnetic resonance (CMR) utilizes its intrinsic property to differentiate normal myocardium from pathologic through T1 and T2 signals. This, when coupled with late gadolinium enhancement (LGE) and extracellular volume (ECV) measurement, vastly improves the diagnostic ability for CA.…”

Section: Diagnosismentioning

confidence: 99%

A review of recent advances in the diagnosis of cardiac amyloidosis, treatment of its cardiac complications, and disease-modifying therapies

Raval

Siddiq²,

Sharma³

et al. 2023

F1000Res

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Cardiac amyloidosis (CA), a significant condition resulting in infiltrative cardiomyopathy and heart failure with preserved ejection fraction (HFpEF), is caused by extracellular deposition of amyloid fibrils in the heart. Even though this has been known for an extended period, its prevalence in elderly patients with heart failure is increasingly being recognized. Recent advances in diagnosis with non-invasive methods like technetium pyrophosphate-labeled cardiac scintigraphy (i.e., Tc-PYP scan) and treatment options with tafamidis have played a pivotal role in awareness of the burden of this disease. Management of cardiac complications like heart failure, atrial arrhythmias, conduction block, ventricular arrhythmias, coronary artery disease, and aortic stenosis is now more critical than ever. We aim to review and outline the recent advances in diagnoses of CA. We also review management strategies for cardiac complications of CA with a brief summary of disease-modifying therapies.

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Longitudinal strain in the management of cardiac AL amyloidosis: do we need it?

Cited by 12 publications

References 12 publications

Atrial amyloidosis: mechanisms and clinical manifestations

Atrial amyloidosis: mechanisms and clinical manifestations

Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice

A review of recent advances in the diagnosis of cardiac amyloidosis, treatment of its cardiac complications, and disease-modifying therapies

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