The prognostic value of right ventricular deformation derived from cardiac magnetic resonance tissue tracking for all-cause mortality in light-chain amyloidosis patients

Abstract

Background: Early detection of right ventricular (RV) dysfunction is vital for determining the prognosis of light-chain amyloidosis (AL) patients. While few studies focused on RV deformation due to the limitation of research methods. The aim of this study was to determine the prognostic significance of RV myocardial strain in AL patients assessed by cardiac magnetic resonance (CMR) tissue tracking. Methods: Sixty-four AL patients (28 females and 36 males, mean age 58±12.8 years old; range 25-81 years old) were enrolled from 1 October 2014 through 31 March 2017 and compared with 20 age-and sex-matched controls. Fifty-one AL patients met the criteria for cardiac amyloidosis (CA). Deformation parameters of both RV and left ventricle (LV) were measured by the CMR tissue tracking technique including myocardial global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS). The follow-up time was 20 months or until the occurrence of death. Results: Thirty-two (50%) had preserved RV ejection fraction (RVEF ≥45%). AL patients had significantly lower RV-GRPS (20.3±2.12 vs. 31.31±7.61), GCPS (−2.12±0.88 vs. −13.71±2.53), and GLPS (−5.33±0.64 vs. −14.239±2.99) than controls even RVEF remain preserved (all P<0.001). Compared with controls and patients without CA, RV-GRPS (12.26±1.26 vs. 29.72±3.54, P<0.001) and RV-GLPS (−3.78±2.25 vs. −5.66±2.08, P<0.05) were significantly lower in patients with CA. Cox multivariate analyses demonstrated that RV-GRPS [hazard ratio (HR) =0.93, 95% CI: 0.88-0.98, P=0.007] and Mayo stage were (HR =3.11, 95% CI: 1.30-7.41, P=0.01) predictors of mortality in AL patients.Conclusions: CMR tissue tracking is a feasible and highly reproducible technique for the analysis of RV deformation and could aid in the early diagnosis of RV involvement in AL patients. RV-GRPS of RV strain and Mayo stage provides prognostic information about mortality in AL patients.

The Prognostic Importance of Right Ventricular Longitudinal Strain in Patients with Cardiomyopathies, Connective Tissue Diseases, Coronary Artery Disease, and Congenital Heart Diseases

“…Similar results of the significant predictive value of RV free wall LS were found in patients with connective tissue diseases and patients with coronary artery disease [7,8]. Even though echocardiography remains the main imaging tool for RVLS assessment, cardiac magnetic resonance (CMR) became an important additional source of RVLG information in patients with different indications, primarily various CMPs [9][10][11]. These findings support the routine evaluation of RVLS in the majority of CV patients.…”

“…Multivariate analysis revealed only RVLS and RV LGE as independent predictors of overall mortality during follow-up [50]. A similar study reported not only that RV multidirectional strain (longitudinal, circumferential, and radial) could be used for discrimination between AL patients with and without cardiac involvement, but also between patients with normal and reduced RVEF and those with and without RV LGE [10]. RV LGE, RVLS, and radial strain were predictors of mortality in univariate analysis, but after adjustment for all RV and LV parameters, as well as for the stage of disease, only RV radial strain was an independent predictor of mortality [10].…”

“…A similar study reported not only that RV multidirectional strain (longitudinal, circumferential, and radial) could be used for discrimination between AL patients with and without cardiac involvement, but also between patients with normal and reduced RVEF and those with and without RV LGE [10]. RV LGE, RVLS, and radial strain were predictors of mortality in univariate analysis, but after adjustment for all RV and LV parameters, as well as for the stage of disease, only RV radial strain was an independent predictor of mortality [10]. Wan et al followed 129 AL patients for 38 months and revealed that almost all parameters of CMR-derived RV systolic function (RVEF, TAPSE, FAC, RV global LS, RV free-wall LS) were independent predictors of all-cause mortality in AL patients [51].…”

Characterization and clinical significance of biventricular mechanics in patients with systemic lupus erythematosus by 3T cardiovascular magnetic resonance tissue tracking

“…The CMR tissue tracking technology that tracks features of the images and recognizes them in the contiguous image of the cine sequence can be used to quantitatively evaluate the displacement, motion function, and deformation of the myocardium in global or regional mode, particularly for the left ventricle (LV) and right ventricle (RV) (9,10). Of note, CMR deformation analysis has been shown to detect early abnormalities of the LV or RV contractile dysfunction beyond conventional global functional assessment with ejection fraction (EF) and provide prognostic information in some cardiovascular diseases (10)(11)(12)(13).…”

Light-Chain Cardiac Amyloidosis: A Case Report and Review of the Literature

“…Matched AL patients had worse LV diastolic function than Fabry cardiomyopathy, signi cant left ventricular systolic dysfunction was rare at early stages (17). MR imaging also plays an important role in the comprehensive evaluation of LV brosis (18-23).Moreover, cardiac MR tissue tracking is a feasible and valuable technique for the analysis of right ventricular deformation and could aid in the early diagnosis of right ventricle involvement in AL patients (24). T1 mapping may have the potential to detect a characteristic amyloid deposition with a decreasing gradient from base to apex (25).…”