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Hereditary amyloidosis represents 10% of all amyloid deposit diseases. Cardiac involvement clinically presents as heart failure. As advanced imaging methods have become available, subclinical detection of cardiac involvement has become a must in those patients since it changes the prognosis of the disease. The objective of the present paper was to determine if echocardiographic parameters of auricular and ventricular mechanics better predict cardiac involvement compared to the classic echocardiographic parameters suggestive of amyloid deposit in the heart. This was a prospective, observational and descriptive study of a cohort of 30 patients with diagnosis of hereditary TTR+ amyloidosis without known cardiac involvement. We performed 2 and 3D echocardiography with left auricular and ventricular mechanics by strain method. Each patient was evaluated at the beginning of the study and at a 1-year follow-up visit. The grade of diastolic disfunction increased from a normal diastole in 67% of patients to only 53% at 1-year follow-up. The antero-posterior diameter of the left atrium increased (p = 0.04), the E/e’ Index also increased (p = 0.01), both suggestive of increased left ventricular filling pressures. The LVEF, as a classic parameter of left ventricular function remained normal in 97% of patients during follow-up. No differences were found in terms of systolic ventricular mechanics; however, diastolic mechanics were altered. Untwist was increased (p = 0.02) and the reservoir auricular function was decreased from 34 to 30% (p = 0.03). Table. Echocardiographic strain and 3D echocardiography can show changes early in patients with cardiac involvement in patients with hereditary TTR+ amyloidosis. Statistically significant results Variable Basal 1 year follow-up P Left atrial anteroposterior diameter (mm) 32.8 ± 5 35.1 ± 5.6 0.004 Ventricular mass (gr/m2SC) 70.7 (61-90.8) 82.6 (69.2-113.7) <0.0001 Left ventricular telediastolic volume (ml) 37.2 ± 11 41.6 ± 11.6 0.03 Mitral A velocity (ms) 113.7 ± 28.6 130.5 ± 19.5 0.03 Lateral e mitral velocity (cm/s) 13.8 ± 5.5 12.4 ± 4.8 0.04 Mitral E/e’ index 7.9 ± 5.2 9.5 ± 5.5 0.01 Untwist 110.8 ± 49.9 127.5 ± 62.6 0.02 Reservoir auricular strain (%) 34.8 ± 8.6 30.8 ± 9.4 0.03 Telesystolic left atrial volume (ml) 25.9 ± 8.8 27.4 ± 11 0.01 Telediastolic left atrial volume (ml) 42.5 ± 12.9 40.7 ± 13.7 0.03 Left atrial ejection fraccion (%) 0.42 ± 0.20 0.34 ± 0.18 0.03 Table 1. Statistically significant results.

A cohort of patients with breast cancer HER2 positive are exposed to chemotherapy with cardiotoxic drugs like anthracyclines (A) and trastuzumab (T). The decrease in longitudinal strain is a helpful tool to predict clinical cardiotoxicity. The purpose of this paper is to determine if echocardiographic parameters like longitudinal strain with speckle tracking predict subclinical cardiotoxicity compared to conventional echocardiographic parameters. This was a retrospective, observational cohort study that involved 20 patients with breast cancer HER2+ who were treated with a chemotherapy reverse sequence (TH-A). We made a basal echocardiogram, 3, 6, 9 and 12 months after chemotherapy with a cumulative dose of 240mg/m2 of doxorrubicin. Cardiotoxicity was defined as a decrease in left ventricular ejection fraction of 10% below 53%, and subclinical cardiotoxicity as a decline of >15% of longitudinal strain. 5 patients (25%) developed decline in longitudinal strain (subclinical cardiotoxicity) 3 months after initiation of chemotherapy, despite 2 of them had normal LVEF (p = 0.01), with the use of heart failure medication they showed partial reversibility. Lineal regression analysis showed that patients with GLS >-19% at baseline did not present cardiotoxicity during the follow up (p = 0.03). Changes in GLS were independent of left ventricular mass, E/A and peak s’ wave velocity (p = 0.01). The diagnosis of subclinical cardiotoxicity by the decrease of GLS is a useful tool with possible therapeutic implications and possible reversibility of cardiotoxicity in patients with reverse chemotherapy sequence. Significant results Binary analysis of echocardiographic variables Value LVEF p GLS p Basal 62.4 ± 6.7 -19.8 ± 1.8 3 months 59.4 ± 11.1 0.615 -18.1 ± 3.9 0.01 6 months 60.2 ± 8.7 0.354 -18.9 ± 3.3 0.185 9 months 61.6 ± 6.0 0.862 -19.65± 1.9 0.408 12 months 61.1 ± 5.7 0.379 -19.8 ± 1.9 0.859 Binary analysis of echocardiographic variables Abstract P1773 Figure. Sequence of chemotherapy