Longitudinal Myocardial Function Assessed by Tissue Velocity, Strain, and Strain Rate Tissue Doppler Echocardiography in Patients With AL (Primary) Cardiac Amyloidosis

Abstract

Background— AL amyloidosis with heart failure is associated with decreased longitudinal myocardial contraction measured by pulsed tissue Doppler imaging. We sought to clarify whether new modalities of myocardial strain Doppler (change in length per unit length) or strain rate (the temporal derivative of strain) were more sensitive than tissue Doppler and could detect early regional myocardial dysfunction before the onset of congestive heart failure (CHF) in patients with AL (primary) amyloidosis. Methods and Results— Ninety-seven biopsy-proven patients with AL amyloidosis were divided into 3 groups. Group 1 patients had no cardiac involvement (n=36), group 2 had heart involvement but no CHF (n=32), and group 3 had heart involvement and CHF (n=29). All patients underwent tissue velocity (TV) imaging, strain, and strain rate imaging (SR) at the basal, mid, and apical ventricle in 2 apical views. With the use of TV, differences in systolic function were only apparent between group 3 (basal mean value, 3.0±1.1 cm/s) and groups 1 and 2 (5.0±1.3 and 4.6±1.2 cm/s, respectively). In contrast, basal peak systolic SR (l/s) showed significant differences among all 3 groups (−2.0±0.4, −1.55±0.6, and −0.76±0.3 for groups 1 to 3, respectively. P <0.01). Basal strain also demonstrated statistically significant differences among the groups (−19±4%, −15±4.5%, and −8.0±5%; P <0.01). Conclusions— Cardiac amyloidosis is characterized by an early impairment in systolic function at a time when fractional shortening remains normal. This abnormality precedes the onset of CHF and can be detected by strain and SR but is not apparent by TV imaging.

Myocardial Strain Imaging is a Superior Method for Evaluating Papillry Muscle Contractility in Patients With Myocardial Infarction

“…Therefore, the assessment of PM contractility is considered to be problematic through the use of tissue velocity imaging only. It has also been reported that LV contraction abnormalities identified by myocardial strain imaging precede the onset of congestive heart failure, but it is not apparent by tissue velocity imaging in patients with cardiac amyloidosis [15]. The present study indicates that peak systolic strain in the posteromedial PM correlated positively and negatively with peak systolic strain in the LV I/P wall and LVEF, respectively, but did not correlate with the severity of MR.…”

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

“…In the nondialysis population, GLS is proved as a more reliable and sensitive parameter for representing LV systolic function in patients with cardiomyopathies, advanced-stage CKD, or HF with preserved LVEF (11,12,(27)(28)(29)(30). Less negative GLS is also proved as a powerful predictor of all-cause mortality in the general population (9), and is reported to be useful in the preclinical diagnosis of a number of other cardiomyopathies, including diabetes, hypertrophic cardiomyopathy, and amyloidosis (28)(29)(30). In these cardiomyopathies, only GLS precedes any clinical evidence of overt systolic dysfunction, suggesting that abnormal GLS may represent an early stage of abnormal LV geometry and function.…”

Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): A consensus opinion from the 10th International Symposium on Amyloid and Amyloidosis

“…Abnormalities in strain echocardiography [59], elevation of the N terminal Pro brain natriuretic peptide (NT-Pro BNP) [60], and elevation of cardiac troponins [61] are seen in a wide variety of cardiac disorders, and the sensitivity and specificity of these tests compared with echocardiography have not been evaluated sufficiently for these variables to be incorporated as criteria of cardiac involvement. Myocardial amyloid is excluded by normal values of NT-Pro BNP [62].…”