Right ventricular function in AL amyloidosis: characteristics and prognostic implication

Cappelli, Francesco; Porciani, Maria Cristina; Bergesio, Franco; Perlini, Stefano; Attanà, Paola; Pignone, Alberto Moggi; Salinaro, Francesco; Musca, Francesco; Padeletti, Luigi; Perfetto, Federico

doi:10.1093/ejechocard/jer289

Cited by 106 publications

(77 citation statements)

References 27 publications

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“…Tissue Doppler and speckle tracking strain parameters have been shown to be superior to conventional echo parameters in identifying ARVC [31]. In several conditions such as heart failure [32], pulmonary hypertension, acute myocardial infarction [4], and amyloidosis [33], peak global longitudinal RV strain has prognostic value. In a recent prospective study of 575 patients, RV strain was prognostic in pulmonary arterial hypertension and correlated well with several clinical measures such as WHO functional class, right-sided heart failure, 6-min walk test, and NT-proBNP.…”

Section: Strainmentioning

confidence: 99%

Echocardiographic Evaluation of the Right Ventricle: a 2014 Perspective

Portnoy

Rudski

2015

Curr Cardiol Rep

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The ability to properly evaluate the right ventricular size and function can have important consequences for clinical management and prognosis. Echocardiography is and will remain the leading method of right ventricle (RV) assessment due to its ease of use and wealth of diagnostic information provided. Understanding the various strengths and limitations of the diverse echocardiographic methods of RV assessment can allow a systematic approach to resolve situations where one's quantitative parameters are not necessarily concordant. Quantification of RV volume can be done by two-dimensional (2D) and three-dimensional (3D) echocardiography. Measurements of RV systolic function include fractional area change (FAC), right-sided index of myocardial performance (RIMP), RV ejection fraction (RVEF), tricuspid annular plane excursion by M-Mode (TAPSE), tricuspid annular systolic longitudinal velocity by tissue Doppler (S'), and regional strain and strain rate. RVEF can also be assessed volumetrically by 3D echocardiography. This article will review the current methods used in contemporary echocardiography laboratories, with an emphasis on a guideline-based approach as well as emerging techniques.

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Section: Strainmentioning

confidence: 99%

Echocardiographic Evaluation of the Right Ventricle: a 2014 Perspective

Portnoy

Rudski

2015

Curr Cardiol Rep

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“…Fourth, the timing of the echocardiographic examinations may have influenced the detection of PE. Finally, we could not demonstrate LV and RV strains using speckle tracking echocardiography, which were recently shown to have prognostic potential in patients with AL amyloidosis (3,4,(8)(9)(10)(11). However, since special dedicated software is required for determination of LV and RV strains, risk stratification for AL amyloidosis using LV and/or RV strains is currently difficult in many institutes.…”

Section: Study Limitationsmentioning

confidence: 82%

“…Age, advanced stage heart failure, LV systolic and diastolic dysfunctions, renal dysfunction, elevated levels of serum cardiac troponin, BNP and free light chain levels, cardiac involvement, and number of involved organs have been demonstrated as significant predictors of mortality in Western patients with AL amyloidosis (3)(4)(5)(6)(7)(8)(9)(10)(11). Of these predictors, renal dysfunction, cardiac involvement, elevated serum free light chain levels and the number of involved organs were indicated to be predictors of mortality in Asian patients (12-15); however, the significance of the other predictors remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Left and right ventricular (RV) functions assessed by conventional and advanced echocardiography [e.g., tissue Doppler echocardiography (TDE) and speckle tracking echocardiography] and cardiac biomarkers, such as cardiac troponin and brain natriuretic peptide (BNP), have been shown to be strong predictors of mortality in patients with AL amyloidosis (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). However, the majority of previous studies have been conducted in Western countries (3)(4)(5)(6)(7)(8)(9)(10)(11), and the predictors of mortality in Asian patients with AL amyloidosis have not yet been characterized (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Pericardial Effusion and Multiple Organ Involvement Are Independent Predictors of Mortality in Patients with Systemic Light Chain Amyloidosis

et al. 2015

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Objective Left ventricular (LV) functions assessed by echocardiography and cardiac biomarkers are strong predictors of mortality in patients with systemic light chain (AL) amyloidosis. However, most previous studies have been conducted in Western countries, and the predictors of mortality in Asian patients with AL amyloidosis have not been characterized. To address this issue, we aimed to determine the predictors of mortality in Asian patients with biopsy-confirmed AL amyloidosis. Methods We retrospectively enrolled 31 patients (59±11 years, 55% men) in whom AL amyloidosis was confirmed by biopsies from cardiac or non-cardiac tissues. Of these patients, 15 (48%) met the international echocardiographic criteria for cardiac amyloidosis (mean LV wall thickness >12 mm without other causes of LV hypertrophy). Results During a mean follow-up period of 21±20 months, 15 patients died. Non-survivors had a higher number of involved organs, lower e', and higher rates of E/e' >15, pericardial effusion (PE), low voltage on an electrocardiogram and a New York Heart Association (NYHA) functional class !III, compared with survivors. In multivariate analysis, a NYHA functional class !III (p=0.024) and cardiac involvement (p=0.032) were independent predictors of PE in patients with AL amyloidosis. Multivariate Cox proportional hazard analysis indicated that PE (hazard ratio: 21.9, p=0.025) and the number of involved organs (hazard ratio: 2.8, p=0.015), but not LV diastolic parameters of tissue Doppler echocardiography, independently predict mortality in patients with AL amyloidosis. Conclusion PE and multiple organ involvement, compared with e' and E/e', are stronger predictors of mortality in patients with AL amyloidosis. The advanced disease stage of AL amyloidosis might underlie the strong association between PE and a poor outcome.

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“…Also, compared to conventional mitral inflow spectral Doppler velocities (E wave and A wave), left 4 and right 5 ventricular tissue Doppler imaging (early diastolic parameters of e’ and a’) (Figure 2), tricuspid annular plane excursion 6 (TAPSE) (Figure 3), and strain imaging of the right 5, 6 and left ventricles (longitudinal 2D-strain) (Figure 4) are more insightful and sensitive for the early identification of cardiac amyloidosis. A specific pattern of longitudinal strain characterized by worse longitudinal strain in the mid and basal ventricle with relative sparing of the apex 4 may help distinguish left ventricular infiltration due to amyloid from true ventricular hypertrophy of hypertensive heart disease or hypertrophic cardiomyopathy.…”

Section: Diagnosis Of Cardiac Amyloidosismentioning

confidence: 99%