Prognostic significance of semiautomatic quantification of left ventricular long axis shortening in systemic light-chain amyloidosis

Riffel, Johannes; Mereles, Derliz; Emami, Mostafa; Korosoglou, Grigorios; Kristen, Arnt V.; Aurich, Matthias; Voss, Andreas; Schönland, Stefan; Hegenbart, Ute; Hardt, Stefan E.; Katus, Hugo A.; Buss, Sebastian J.

doi:10.3109/13506129.2014.992515

Cited by 15 publications

(15 citation statements)

References 41 publications

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“…As atrioventricular valve plane motion reflects the longitudinal shortening of the left ventricle, previous observations also support the significance of its impairment in AL. The relative longitudinal axes shortening (LAS) and global longitudinal strain (GLS) are both independent predictors of survival [ 6 , 8 ]. Other innovative risk predictors in amyloidosis have emerged in cardiac magnetic resonance imaging, including late gadolinium enhancement, T1 mapping, and extracellular volume (ECV) which allow for a non-invasive semi-quantitative assessment of amyloid infiltration [ 18 ] and correlate with all-cause mortality [ 13 , 19 – 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis

Ochs

Fritz

Arenja

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundTo compare the prognostic value of cardiac valve plane displacement (CVPD) on various locations in cardiac light chain (AL) amyloidosis.MethodsConsecutive patients with biopsy-proven cardiac involvement in AL amyloidosis who had undergone cardiovascular magnetic resonance (CMR) between 2005 and 2014 in our institution, were retrospectively identified and data analyzed. The primary combined endpoint was all-cause mortality or heart transplantation. Systolic CVPD were obtained from standard cine bSSFP in 2-, 3- and 4-chamber views at anterior aortic plane systolic excursion (AAPSE); anterior, anterolateral, inferolateral, inferior, inferoseptal mitral (MAPSE); and lateral tricuspid (TAPSE) annular segments.ResultsWe identified 68 patients (58 ± 10 years; 59% male). Median follow-up period was 1.2 years (IQR, 0.3-4.1). Significant differences in CVPD between patients who reached a primary endpoint (n = 44) and transplant-free survivors were found only for AAPSE (6.1 mm (IQR, 4.6-9.4) vs. 8.8 mm (IQR, 6.9-10.4); p = 0.02) and MAPSEanterolateral (7.3 mm (IQR, 5.4-11.7) vs. 10.5 mm (IQR, 8.1-13.4); p = 0.03). AAPSE (χ2 = 15.6; p = 0.0002) provided the best predictive value for transplant-free survival compared to all other valvular plane locations. A high-risk cutoff (AAPSE ≤ 7.6 mm) was calculated by ROC analysis to predict all-cause death or heart transplantation within 6 months from index examination (AUC = 0.80; CI: 0.68 to 0.89; p < 0.0001). AAPSE added incremental prognostic power to an imaging prediction model of late gadolinium enhancement and global longitudinal strain (GLS) (∆χ2 = 5.8, p = 0.02) as well as to a clinical model including Karnofsky index and NT-proBNP (∆χ2 = 6.2, p = 0.01).ConclusionIn patients with cardiac involvement in AL amyloidosis, systolic CVPD obtained from standard long axis cine views appear to indicate outcome better, when obtained in the anterior aortic plane (AAPSE) and provide incremental prognostic value to LGE and strain measurements.

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Section: Discussionmentioning

confidence: 99%

“…Longitudinal systolic deformation of the left ventricle (LV) is known to be strongly associated with survival in AL amyloidosis [ 6 – 8 ]. Atrioventricular plane displacement contributes approximately 60% to the LV stroke volume [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis

Ochs

Fritz

Arenja

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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“…33 The correlation of TMAD with echo-based values of global systolic function such as strain, the strain rate, and the ejection fraction (EF) was generally high, and the discriminatory ability of TMAD to identify patients with certain diseases such as amyloidosis and hypertrophic cardiomyopathy was also high. 36,37 An association of TMAD with hard clinical outcomes, for which none of these studies was powered, was ambiguous. 33,34,37,39 When the required times were measured, these were generally less than 15 seconds per echocardiographic view.…”

Section: Previous Studies Regarding Speckle-tracking-based Displacementmentioning

confidence: 99%

“…36,37 An association of TMAD with hard clinical outcomes, for which none of these studies was powered, was ambiguous. 33,34,37,39 When the required times were measured, these were generally less than 15 seconds per echocardiographic view. 33,38 Buss et al 33 also examined lower-quality images and found that in patients with reduced image quality (n = 67), TMAD acquisition could be performed more often than strain imaging (67 versus 43; P < .001).…”

Section: Previous Studies Regarding Speckle-tracking-based Displacementmentioning

confidence: 99%

“…With speckle-tracking echocardiography (STE), software-based technology has emerged that quantifies myocardial deformation on the basis of 2D image loops. 31 In particular, speckle-tracking-based measurements of longitudinal LV [32][33][34][35][36][37][38][39][40][41] or even right ventricular (RV) 34,35,42 annular motion seem promising. However, many speckle-tracking-based measures require clear visualization of the endocardial border, and image quality is a main factor limiting their utility, particularly in point-of-care settings.…”

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Rapid, Single‐View Speckle‐Tracking–Based Method for Examining Left Ventricular Systolic and Diastolic Function in Point of Care Ultrasound

Mauermann

Bouchez

Bové

et al. 2020

J of Ultrasound Medicine

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Objectives-A rapid, reliable quantitative assessment of left ventricular systolic and diastolic function is important for patient treatment in urgent and dynamic settings. Quantification of annular velocities based on a single 2-dimensional image loop, rather than on Doppler velocities, could be useful in point-of-care or focused cardiac ultrasound. We hypothesized that novel speckle-tracking-based mitral annular velocities would correlate with reference standard tissue Doppler imaging (TDI) velocities in a focused cardiac ultrasound-esque setting. Methods-Two echocardiographers each performed transthoracic echocardiographic measurements before and after induction of anesthesia in supine patients undergoing cardiac surgery. Speckle-tracking echocardiography (STE)-based systolic (S' STE) and diastolic (E' STE and A' STE) velocities were compared to TDI and global longitudinal strain/strain rate. We also compared mitral annular displacement by speckle tracking with M-mode imaging. Results-Twenty-five patients were included and examined in both preinduction and postinduction states. Speckle-tracking-based velocities correlated with TDI measurements in both states (S 0 , r = 0.73 and 0.76; E 0 , r = 0.87 and 0.65; and A 0 , r = 0.65 and 0.73), showing a mean bias of 25% to 30% of the reference standard measurement. The correlation of S' STE with strain and the strain rate (S-wave) and E' STE with the strain rate (E-wave) was good in awake, spontaneously breathing patients but was less strong in the ventilated state. Similarly, displacement by speckle tracking correlated with M-mode measurements in both states (r = 0.91 and 0.84). Measurements required medians of 31 and 34 seconds; reproducibility was acceptable for S' STE and E' STE. Conclusions-Speckle-tracking-based mitral annular velocities and displacement correlate well with conventional measures as well as with deformation imaging. They may be clinically useful in rapidly assessing both systolic and diastolic function from a single 2-dimensional image loop.

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Multicenter Study of Planar Technetium 99m Pyrophosphate Cardiac Imaging

et al. 2016

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In this multicenter study, Tc 99m PYP cardiac imaging conferred a high level of sensitivity and specificity for differentiation of patients with ATTR cardiac amyloidosis (irrespective of genotype) from patients with AL cardiac amyloidosis and patients with nonamyloid heart failure with preserved ejection fraction. An H/CL ratio of 1.6 or greater was associated with worse survival among patients with ATTR cardiac amyloidosis. Among patients for whom there is a high clinical suspicion of cardiac amyloidosis, Tc 99m PYP may be of diagnostic and prognostic importance.

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Prognostic significance of semiautomatic quantification of left ventricular long axis shortening in systemic light-chain amyloidosis

Abstract: LAS was an independent predictor of survival within the first year and offers incremental information in patients with AL amyloidosis evaluated prior to specific treatment.

Cited by 15 publications

References 41 publications

Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis

Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis

Rapid, Single‐View Speckle‐Tracking–Based Method for Examining Left Ventricular Systolic and Diastolic Function in Point of Care Ultrasound

Multicenter Study of Planar Technetium 99m Pyrophosphate Cardiac Imaging

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