Left atrial function in patients with light chain amyloidosis: A transthoracic 3D speckle tracking imaging study

Mohty, Dania; Petitalot, Vincent; Magné, Julien; Fadel, Bahaa M.; Boulogne, Cyrille; Rouabhia, Dounia; Elhamel, Chahrazed; Lavergne, David; Damy, Thibaud; Aboyans, Victor; Jaccard, Arnaud

doi:10.1016/j.jjcc.2017.10.007

Cited by 38 publications

(29 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[3][4][5][6] By using 3D virtual atrial models, volumetric and functional variables can be assessed simultaneously. 7,8 However, limited information is available regarding the 3DSTE-derived volumetric variables in the literature, including their normal values. The present study aimed to determine normal reference values of 3DSTE-derived RA volumetric data and volumebased functional properties in healthy adult subjects.…”

Section: Introductionmentioning

confidence: 99%

Normal reference values of three‐dimensional speckle‐tracking echocardiography‐derived right atrial volumes and volume‐based functional properties in healthy adults (Insights from the MAGYAR‐Healthy Study)

Nemes

Kormányos

Domsik

et al. 2019

J of Clinical Ultrasound

View full text Add to dashboard Cite

Introduction: The right atrium (RA) roles include being a systolic reservoir, an early diastolic conduit, and a late-diastolic booster pump. The present study aimed to assess normal reference values of three-dimensional speckle-tracking echocardiography (3DSTE)-derived RA volumetric data and volume-based functional properties in healthy adult subjects. Methods: We included 260 healthy adult subjects in sinus rhythm with complete clinical and demographic dataset, but excluded 110 of them because of inferior image quality. The remaining population sample comprised 150 subjects (31.0 ± 11.6 years, 79 males). Complete two-dimensional Doppler echocardiography and 3DSTE have been performed in all subjects.Results: Systolic RA volumetric variables did not show changes over time, but after 50 years, a significant reduction could be demonstrated in RA stroke volume and emptying fraction. While early diastolic RA volume increased over time, RA stroke volume and emptying fraction decreased. While late-diastolic RA volume increased over age decades, similar increase could be detected in RA stroke volume but a reduction occurred in older ages. Late-diastolic RA emptying fraction showed an increasing (after the 40s)-decreasing (after the 50s) pattern. Conclusions:Our study provides normal reference values of 3DSTE-derived RA volumes and volume-based functional properties and their age-and gender dependency in healthy adult subjects. K E Y W O R D S echocardiography, healthy subjects, right atrium, speckle-tracking, three-dimensional

show abstract

Section: Introductionmentioning

confidence: 99%

Normal reference values of three‐dimensional speckle‐tracking echocardiography‐derived right atrial volumes and volume‐based functional properties in healthy adults (Insights from the MAGYAR‐Healthy Study)

Nemes

Kormányos

Domsik

et al. 2019

J of Clinical Ultrasound

View full text Add to dashboard Cite

show abstract

“…Abnormalities in several echocardiographic imaging parameters (e.g., LV longitudinal strain, early mitral inflow [E-wave], deceleration time, myocardial performance index, pericardial effusion) are associated with worse outcomes and should alert the clinician to the potential of advanced disease (9,51,60,66,71,(149)(150)(151)(152)(153)(154)(155)(156)(157)(158)(159)(160)(161)(162)(163)(164)(165)(166)(167). At the present time, however, there is no formal staging system for ATTRv, ATTRwt, or AL cardiac amyloidosis that uses echocardiographic parameters.…”

mentioning

confidence: 99%

ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2—Evidence Base and Standardized Methods of Imaging

Dorbala

Ando

Bokhari

et al. 2019

Journal of Cardiac Failure

128

108

View full text Add to dashboard Cite

accurate recognition at earlier stages. Imaging provides non-invasive tools for follow-up of disease remission/progression complementing clinical evaluation. Additional areas not defined include appropriate clinical indications for imaging, optimal imaging utilization by clinical presentation, accepted imaging methods, accurate image interpretation, and comprehensive and clear reporting. Prospective randomized clinical trial data for the diagnosis of amyloidosis and for imaging-based strategies for treatment are not available. A consensus of expert opinion is greatly needed to guide the appropriate clinical utilization of imaging in cardiac amyloidosis.

show abstract

“…

We read with great interest the letter written by Antonio Recupero et al and we are thankful for their comments regarding our manuscript. The main findings of our study [1] indicate that left atrial (LA) function parameters are significantly altered among patients with systemic light chain amyloidosis (AL) compared to a group of control patients, especially in those with moderate or severe cardiac involvement. Additionally, LA functional parameters are associated with worse diastolic dysfunction and overall mortality irrespective of the New York Heart Association functional class, Mayo Clinic staging, and LA volumes.

…”

mentioning

confidence: 79%

Author's reply

Mohty

Petitalot

Magné

et al. 2018

Journal of Cardiology

Self Cite

View full text Add to dashboard Cite

We read with great interest the letter written by Antonio Recupero et al. and we are thankful for their comments regarding our manuscript. The main findings of our study [1] indicate that left atrial (LA) function parameters are significantly altered among patients with systemic light chain amyloidosis (AL) compared to a group of control patients, especially in those with moderate or severe cardiac involvement. Additionally, LA functional parameters are associated with worse diastolic dysfunction and overall mortality irrespective of the New York Heart Association functional class, Mayo Clinic staging, and LA volumes. In our study, LA dysfunction appears to have an incremental prognostic value over the classic prognostic parameters. Its prognostic value was not related only to Mayo Clinic staging as stated in the letter by Recuperon et al. but was also associated with outcome by multivariate analysis independently of the Mayo clinic staging and LA volumes as shown in Table 4 of our paper. Still we acknowledged in the limitations and conclusion in our manuscript that larger studies from other centers are required in order to confirm our findings and to investigate whether LA dysfunction may turn out to be an earlier diagnostic marker of cardiac involvement in AL patients. Moreover, we did not demonstrate only "a continuum in LA dysfunction" from early to mild to moderate then severe Mayo Clinic staging, but it also suggested an early impairment in function when control subjects were compared to stage I AL patients with minimal cardiac involvement (Table 2). This phenomenon was evident even before any significant changes in LA volumes. Our findings suggest that LA dysfunction occurs before the LA begins to dilate in AL patients. The authors of the letter also stated that "the LA chamber might be the primary target" of amyloid deposits in patients with transthyretin amyloidosis because late gadolinium enhancement (LGE) was seen early within the LA wall and before left ventricular (LV) involvement. However, this statement is an assumption since there was no correlation done between LGE and fibril location on myocardial biopsy. Therefore, one cannot state that the LA is infiltrated by amyloid fibrils before the LV unless this statement is supported by histological data in a longitudinal chronological manner. Our current understanding of the disease process in AL amyloidosis is that the amyloid deposits are likely to be first detected at the basal segments of the LV walls (as demonstrated using strain, magnetic resonance imaging and histological correlation by Ternacle et al. in 2016 [2]) and gradually progress toward the LV apex showing a basal-to-apical gradient of amyloid fibrils deposition. Additional histological studies are still required to better understand the course and the natural history of AL amyloidosis.Finally, the association between LA function and outcome that was suggested by our study is beginning to emerge as a concept in other disease states [3]. The recent interest in studying LA functional param...

show abstract

Left atrial function in patients with light chain amyloidosis: A transthoracic 3D speckle tracking imaging study

Abstract: Functional LA parameters are progressively altered in AL patients according to the MC stage. A decrease in 3D-PALS is associated with worse outcome, independently of LA volume.

Cited by 38 publications

References 26 publications

Normal reference values of three‐dimensional speckle‐tracking echocardiography‐derived right atrial volumes and volume‐based functional properties in healthy adults (Insights from the MAGYAR‐Healthy Study)

Normal reference values of three‐dimensional speckle‐tracking echocardiography‐derived right atrial volumes and volume‐based functional properties in healthy adults (Insights from the MAGYAR‐Healthy Study)

ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2—Evidence Base and Standardized Methods of Imaging

Author's reply

Contact Info

Product

Resources

About