Prognostic value of right ventricular global longitudinal strain in transthyretin amyloid cardiomyopathy

Usuku, Hiroki; Takashio, Seiji; Yamamoto, Eiichiro; Yamada, Toshihiro; Egashira, Koichi; Morioka, Mami; Nishi, Masato; Komorita, Takashi; Oike, Fumi; Tabata, Noriaki; Ishii, Masanobu; Yamanaga, Kenshi; Fujisue, Koichiro; Arima, Yuichiro; Araki, Satoshi; Oda, Shigeto; Misumi, Yohei; Kawano, Hiroaki; Matsushita, Kenichi; Ueda, Mitsuharu; Matsui, Hirotaka; Tsujita, Kenichi

doi:10.1016/j.jjcc.2022.02.010

Cited by 5 publications

(6 citation statements)

References 26 publications

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“…We previously reported the usefulness of LA and RV strain for prognostic factor in patients with ATTRwt-CM. 12,13 However, we had no data about the usefulness of RALS in these patients. Therefore, we have to evaluate the usefulness of RALS for prognostic factor in patients with ATTR-CM in the future.…”

Section: Discussionmentioning

confidence: 95%

“…9,10 Because cardiac amyloidosis is a diffuse disease that affects all four chambers, 11 we previously revealed the usefulness of left atrial longitudinal strain (LALS) and right ventricular (RV) GLS (RV-GLS) to predict cardiovascular events in wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM). 12,13 However, the usefulness of right atrial (RA) LS as a predictive factor in patients with AL cardiac amyloidosis has not been sufficiently clarified. Therefore, we investigated whether RALS estimated by twodimensional speckle-tracking echocardiography provides prognostic information in patients with AL cardiac amyloidosis.…”

Section: Introductionmentioning

confidence: 99%

“…Global reduction of left ventricular (LV) global longitudinal strain (GLS) (LV‐GLS) is a significant prognostic factor in cardiac amyloidosis 9,10 . Because cardiac amyloidosis is a diffuse disease that affects all four chambers, 11 we previously revealed the usefulness of left atrial longitudinal strain (LALS) and right ventricular (RV) GLS (RV‐GLS) to predict cardiovascular events in wild‐type transthyretin amyloid cardiomyopathy (ATTRwt‐CM) 12,13 . However, the usefulness of right atrial (RA) LS as a predictive factor in patients with AL cardiac amyloidosis has not been sufficiently clarified.…”

Section: Introductionmentioning

confidence: 99%

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A new staging system using right atrial strain in patients with immunoglobulin light‐chain cardiac amyloidosis

Usuku,

Yamamoto,

Sueta

et al. 2024

ESC Heart Failure

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AimsThere are minimal data on the prognostic impact of right atrial strain during the reservoir phase (RASr) in patients with immunoglobulin light‐chain (AL) cardiac amyloidosis.Methods and resultsAmong 78 patients who were diagnosed with AL cardiac amyloidosis at Kumamoto University Hospital from 2007 to 2022, 72 patients with sufficient two‐dimensional speckle tracking imaging data without chemotherapy before the diagnosis were retrospectively analysed. During a median follow‐up of 403 days, 31 deaths occurred. Age and the rate of male sex were not significantly different between the all‐cause death group and the survival group (age, 70.4 ± 8.8 years vs. 67.0 ± 10.0 years, P = 0.14, male sex, 65% vs. 66%, P = 0.91). The estimated glomerular filtration rate (eGFR) was significantly lower, and B‐type natriuretic peptide (BNP) and high sensitivity cardiac troponin T (hs‐cTnT) were significantly higher, in the all‐cause death group versus the survival group (eGFR, 48.2 ± 21.0 mL/min/1.73 m2 vs. 59.4 ± 24.4 mL/min/1.73 m2, P < 0.05, BNP, 725 [360–1312] pg/mL vs. 123 [81–310] pg/mL, P < 0.01, hs‐cTnT, 0.12 [0.07–0.18] ng/mL vs. 0.05 [0.03–0.08] ng/mL, P < 0.01). Left ventricular (LV) global longitudinal strain (GLS) (LV‐GLS), left atrial strain during the reservoir phase (LASr), right ventricular GLS (RV‐GLS), and RASr were significantly lower in the all‐cause death group versus the survival group (LV‐GLS, 8.5 ± 4.3% vs. 11.8 ± 3.8%, P < 0.01, LASr, 8.8 ± 7.1% vs. 14.3 ± 8.1%, P < 0.01, RV‐GLS, 11.6 ± 5.1% vs. 16.4 ± 3.9%, P < 0.01, RASr, 10.2 ± 7.3% vs. 20.7 ± 9.5%, P < 0.01). RASr was significantly associated with all‐cause death after adjusting for RV‐GLS, LV‐GLS and LASr (hazard ratio [HR]: 0.91, 95% confidence interval [95% CI]: 0.83–0.99, P < 0.05). RASr and log‐transformed BNP were significantly associated with all‐cause death after adjusting for log‐transformed troponin T and eGFR (RASr, HR: 0.93, 95% CI: 0.87–1.00, P < 0.05; log‐transformed BNP, HR: 2.10, 95% CI: 1.17–3.79, P < 0.05). The optimal cut‐off values were RASr: 16.4% (sensitivity: 66%, specificity: 84%, area under curve [AUC]: 0.81) and BNP: 311.2 pg/mL (sensitivity: 83%, specificity: 78%, AUC: 0.82) to predict all‐cause mortality using ROC analysis. Kaplan–Meier analysis revealed that patients with low RASr (<16.4%) or high BNP (>311.2 pg/mL) had a significantly high probability of all‐cause death (both, P < 0.01). We devised a new staging score by adding 1 point if RASr decreased or BNP levels increased more than each cut‐off value. The HR for all‐cause death using score 0 as a reference was 5.95 (95% CI: 1.19–29.79; P < 0.05) for score 1 and 23.29 (95% CI: 5.37–100.98; P < 0.01) for score 2.ConclusionsThe new staging system using RASr and BNP predicted prognosis in patients with AL cardiac amyloidosis.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A new staging system using right atrial strain in patients with immunoglobulin light‐chain cardiac amyloidosis

Usuku,

Yamamoto,

Sueta

et al. 2024

ESC Heart Failure

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“…There are only a few publications referring to the utility of RVLS for the diagnosis or prognosis of light-chain amyloidosis 38,39 or ATTR-CM. 40 However, since the early years of echocardiography, amyloid infiltrations in the RV wall have been detected. 41 In this sense, it is a relatively new finding, but it is not surprising that our cohort demonstrated RVLS as a discriminator of 99m Tc-PYP scintigraphypositive cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…There are only a few publications referring to the utility of RVLS for the diagnosis or prognosis of light‐chain amyloidosis 38,39 or ATTR‐CM 40 . However, since the early years of echocardiography, amyloid infiltrations in the RV wall have been detected 41 .…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic score for the screening of cardiac amyloidosis with positive 99m technetium pyrophosphate scintigraphy result

et al. 2023

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Introduction Speckle‐tracking‐derived strains in cardiac chambers may provide better solutions for transthyretin amyloid cardiomyopathy (ATTR‐CM) screening. This study aimed to evaluate the efficacy of biventricular strain measurements using speckle tracking for screening 99mTc‐pyrophosphate (99mTc‐PYP) scintigraphy‐positive cardiomyopathy, which is nearly equivalent to ATTR‐CM. Methods We performed a retrospective analysis of transthoracic echocardiographic studies using vendor‐independent speckle tracking analysis in older patients (≥65 years) who underwent 99mTc‐PYP scintigraphy to evaluate the etiology of suspected ATTR‐CM in our institute between January 2019 and December 2022. Results The entire cohort (n = 89) was divided into two subgroups positive 99mTc‐PYP scan results (n = 34) and negative 99mTc‐PYP scan results (n = 55). In the multivariate analysis, posterior wall thickness (p = .003, odds ratio [OR]:1.48, 95% confidence interval [CI]:1.14 –1.92), left ventricular longitudinal strain apical/basal ratio (LVLSapi/bas) (p = .015, OR: 2.78, 95% CI: 1.23–6.32, and right ventricular longitudinal strain (RVLS) (p = .003, OR: 1.15, 95% CI: 1.05 –1.26) were selected to be the most representative echocardiographic findings in 99mTc‐PYP positive cardiomyopathy. The receiver operating characteristic analysis indicated that posterior wall thickness (p < .0001, area under the curve [AUC]: .821, cut‐off value: 14.0 mm), LVLSapi/bas (p < .001, AUC: .802, cut‐off value: 2,16), and RVLS (p < .001, AUC: .791, cut‐off value: ‐18.7%) could significantly detect 99mTc‐PYP positive results with an excellent credibility. Echocardiographic score points calculated using the summary of these three parameters in each patient revealed that a 2‐point score had a fair sensitivity (85%) and an excellent specificity (93%), while a 1‐point score had an excellent sensitivity (91%) and a modest specificity (53%). Conclusion Our proposed echocardiographic screening tool for 99mTc‐PYP scintigraphy‐positive cardiomyopathy may help clinicians manage patients with suspected ATTR‐CM.

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Prognostic value of right ventricular global longitudinal strain in patients with immunoglobulin light-chain cardiac amyloidosis

Usuku

Yamamoto

Sueta

et al. 2023

European Heart Journal Open

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Background Left ventricular (LV) global longitudinal strain (GLS) (LV-GLS) is a strong and independent predictor of outcomes in patients with immunoglobulin light-chain (AL) cardiac amyloidosis. This study was performed to investigate whether right ventricular (RV) GLS (RV-GLS) provides prognostic information in patients with AL amyloidosis. Methods and Results Among 74 patients who were diagnosed with AL cardiac amyloidosis at Kumamoto University Hospital from December 2005 to December 2022, 65 patients who had enough information for two-dimensional speckle tracking imaging and did not receive chemotherapy before the diagnosis of cardiac amyloidosis were retrospectively analyzed. During a median follow-up of 359 days, 29 deaths occurred. In two-dimensional echocardiographic findings, LV-GLS, left atrium reservoir strain (LASr) and RV-GLS were significantly lower in the all-cause death group than in the survival group (LV-GLS; 8.9 ± 4.2 vs. 11.7 ± 3.9, p < 0.01, LASr; 9.06 ± 7.28 vs. 14.09 ± 8.32, p < 0.05, RV-GLS; 12.0 ± 5.1 vs. 16.8 ± 4.0, p < 0.01). Multivariable Cox proportional hazard analysis showed RV-GLS was significantly and independently associated with all-cause death in patients with AL cardiac amyloidosis (hazard ratio 0.85; 95% confidence interval, 0.77–0.94; p < 0.01). Receiver operating characteristic analysis showed that the area under the curve of RV-GLS for all-cause death was 0.774 and that the best cutoff value of RV-GLS was 14.5% (sensitivity, 75%; specificity, 72%). In the Kaplan–Meier analysis, patients with AL cardiac amyloidosis who had low RV-GLS (<14.5%) had a significantly higher probability of all-cause death (p < 0.01). Conclusion RV-GLS has prognostic value in patients with AL cardiac amyloidosis and provides greater prognostic power than LV-GLS and LASr.

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Prognostic value of right ventricular global longitudinal strain in transthyretin amyloid cardiomyopathy

Cited by 5 publications

References 26 publications

A new staging system using right atrial strain in patients with immunoglobulin light‐chain cardiac amyloidosis

A new staging system using right atrial strain in patients with immunoglobulin light‐chain cardiac amyloidosis

Echocardiographic score for the screening of cardiac amyloidosis with positive 99m technetium pyrophosphate scintigraphy result

Prognostic value of right ventricular global longitudinal strain in patients with immunoglobulin light-chain cardiac amyloidosis

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