Prognostic implication of relative regional strain ratio in cardiac amyloidosis

Abstract

High RRSR is adversely prognostic in patients with cardiac amyloid. This novel tool is both diagnostic and prognostic and may have implications in management and suitability for treatment.

Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis

“…While LVEF may be normal until the advanced stage of disease, reduction in peak systolic wall motion velocities, especially in the longitudinal axis, are present even in early disease 72 . In general, CA alters strain parameters to a much greater degree than other causes of LV hypertrophy and is characterized by a base-to-apex strain gradient (Figure 3, upper right panel) 70, 71, 73 . This is readily appreciated in parametric polar maps that show relative apical sparing of longitudinal strain, representing an important diagnostic clue differentiating CA from other cardiomyopathies 70 .…”

Simplified apical four‐chamber view evaluation of relative apical sparing of longitudinal strain in diagnosing AL amyloid cardiomyopathy

“…Recently, relative apical sparing (RAS) of longitudinal strain (LS) by speckle tracking was described as a specific echocardiographic sign of cardiac amyloidosis useful in the differential diagnosis of unclear LV hypertrophy . Furthermore, is has been also shown that RAS LS may serve as an independent prognostic factor in patients with amyloid heart disease . However, the evaluation of RAS LS using standard approach, which is based on the assessment of regional LS of all LV walls, may not be feasible in numerous patients due to suboptimal visualization of anterior as well as anteroseptal wall in apical two‐chamber and long‐axis view, respectively .…”

Transthyretin Cardiac Amyloidosis in Older Adults: Optimizing Cardiac Imaging to the Corresponding Diagnostic and Management Goal

“…early in the course of CA), or amyloid subtype [20, 28]. Apical sparing can be quantified as the relative regional strain ratio (RRSR), calculated as the average apical LS / (average basal + mid LS) [27, 29]. In a cohort of 55 patients with confirmed CA, a RRSR >1 was 93% sensitive and 82% specific for CA compared to HCM or AS [27].…”

“…Strain assessment of 172 patients with CA (56 ATTRwt, 36 ATTRm, 80 AL, mean age 66) demonstrated that impaired LV basal LS was independently associated with all-cause mortality [20]. Of 97 patients with CA (38 ATTR 59 AL, mean age 64) a higher RRSR (indicating more basal and mid ventricular strain impairment relative to the apex) predicted MACE [29]. …”