Myocardial Contraction Fraction by M-Mode Echocardiography Is Superior to Ejection Fraction in Predicting Mortality in Transthyretin Amyloidosis

Rubin, Jonah; Steidley, D. Eric; Carlsson, Martin; Ong, Moh-Lim; Maurer, Mathew S.

doi:10.1016/j.cardfail.2018.07.001

Cited by 52 publications

(50 citation statements)

References 56 publications

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“…Myocardial contraction fraction (MCF), which indexed the SV to the myocardial volume, was calculated as previously described. 24 Disproportionate hypertrophy was defined as an IVSd greater than 1.9 cm in males or 1.6 cm in females. ‘Classical’ low-flow, low-gradient was defined as an aortic valve area ≤1.0 cm 2 , with an LVEF <50%, an indexed SV <35 mL/m 2 , a peak aortic valve velocity <4 m/s, and a mean gradient <40 mmHg, conversely ‘paradoxical’ low-flow, low-gradient was defined as an LVEF ≥50%, but an indexed SV <35 mL/m 2 , peak velocity <4 m/s, and mean gradient <40 mmHg.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation

Scully

Patel

Treibel

et al. 2020

European Heart Journal

153

158

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Aims Cardiac amyloidosis is common in elderly patients with aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI). We hypothesized that patients with dual aortic stenosis and cardiac amyloid pathology (AS-amyloid) would have different baseline characteristics, periprocedural and mortality outcomes. Methods and results Patients aged ≥75 with severe AS referred for TAVI at two sites underwent blinded bone scintigraphy prior to intervention (Perugini Grade 0 negative, 1–3 increasingly positive). Baseline assessment included echocardiography, electrocardiogram (ECG), blood tests, 6-min walk test, and health questionnaire, with periprocedural complications and mortality follow-up. Two hundred patients were recruited (aged 85 ± 5 years, 50% male). AS-amyloid was found in 26 (13%): 8 Grade 1, 18 Grade 2. AS-amyloid patients were older (88 ± 5 vs. 85 ± 5 years, P = 0.001), with reduced quality of life (EQ-5D-5L 50 vs. 65, P = 0.04). Left ventricular wall thickness was higher (14 mm vs. 13 mm, P = 0.02), ECG voltages lower (Sokolow–Lyon 1.9 ± 0.7 vs. 2.5 ± 0.9 mV, P = 0.03) with lower voltage/mass ratio (0.017 vs. 0.025 mV/g/m2, P = 0.03). High-sensitivity troponin T and N-terminal pro-brain natriuretic peptide were higher (41 vs. 21 ng/L, P < 0.001; 3702 vs. 1254 ng/L, P = 0.001). Gender, comorbidities, 6-min walk distance, AS severity, prevalence of disproportionate hypertrophy, and post-TAVI complication rates (38% vs. 35%, P = 0.82) were the same. At a median follow-up of 19 (10–27) months, there was no mortality difference (P = 0.71). Transcatheter aortic valve implantation significantly improved outcome in the overall population (P < 0.001) and in those with AS-amyloid (P = 0.03). Conclusions AS-amyloid is common and differs from lone AS. Transcatheter aortic valve implantation significantly improved outcome in AS-amyloid, while periprocedural complications and mortality were similar to lone AS, suggesting that TAVI should not be denied to patients with AS-amyloid.

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Section: Methodsmentioning

confidence: 99%

Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation

Scully

Patel

Treibel

et al. 2020

European Heart Journal

153

158

View full text Add to dashboard Cite

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“…The deposit of those proteins disrupts the structure and function of the heart with a thickening of the ventricular wall, an increase of the myocardial mass and a reduction in end-diastolic volume leading to a diastolic dysfunction, an impaired myocardial contraction, and a progressive heart failure and death. [1][2][3] Untreated, CA is life threatening from few months for AL to few years for ATTR. [4][5][6] Consequently, identifying patients with a poor prognosis is fundamental to ensure adequate treatment and a timely referral to specialised centres.…”

Section: Introductionmentioning

confidence: 99%

Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis?

et al. 2020

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BackgroundCardiac amyloidosis (CA) is a life-threatening restrictive cardiomyopathy. Identifying patients with a poor prognosis is essential to ensure appropriate care. The aim of this study was to compare myocardial work (MW) indices with standard echocardiographic parameters in predicting mortality among patients with CA.MethodsClinical, biological and transthoracic echocardiographic parameters were retrospectively compared among 118 patients with CA. Global work index (GWI) was calculated as the area of left ventricular pressure–strain loop. Global work efficiency (GWE) was defined as percentage ratio of constructive work to sum of constructive and wasted works. Sixty-one (52%) patients performed a cardiopulmonary exercise.ResultsGWI, GWE, global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and myocardial contraction fraction (MCF) were correlated with N-terminal prohormone brain natriuretic peptide (R=−0.518, R=−0.383, R=−0.553, R=−0.382 and R=−0.336, respectively; p<0.001). GWI and GLS were correlated with peak oxygen consumption (R=0.359 and R=0.313, respectively; p<0.05). Twenty-eight (24%) patients died during a median follow-up of 11 (4–19) months. The best cut-off values to predict all-cause mortality for GWI, GWE, GLS, LVEF and MCF were 937 mm Hg/%, 89%, 10%, 52% and 15%, respectively. The area under the receiver operator characteristic curve of GWE, GLS, GWI, LVEF and MCF were 0.689, 0.631, 0.626, 0.511 and 0.504, respectively.ConclusionIn CA population, MW indices are well correlated with known prognosis markers and are better than LVEF and MCF in predicting mortality. However, MW does not perform better than GLS.

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“…In another major study cohort, the Multi-Ethnic Study of Atherosclerosis, Abdalla et al also reported that the lowest MCF quartiles was associated with an increased risk for incident CVD (myocardial infarction, resuscitated cardiac arrest, stroke, coronary heart disease and stroke death) (HR: 2.42, 95%CI: 1.58-3.72) 18 . In patients with cardiomyopathy, including cardiac amyloidosis and non-ischemic cardiomyopathy, historical studies consistently confirmed the prognostic capacity for adverse outcomes [9][10][11] . Few data have evaluated the role of MCF played in patients with HCM.…”

Section: Discussionmentioning

confidence: 84%

Myocardial contraction fraction predicts mortality for patients with hypertrophic cardiomyopathy

Liao

Wang

Zhao³

et al. 2020

Sci Rep

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The myocardial contraction fraction (MCF: stroke volume to myocardial volume) is a novel volumetric measure of left ventricular myocardial shortening. The purpose of the present study was to assess whether MCF could predict adverse outcomes for HCM patients. A retrospective cohort study of 438 HCM patients was conducted. The primary and secondary endpoints were all-cause mortality and HCM-related mortality. The association between MCF and endpoints was analysed. During a follow-up period of 1738.2 person-year, 76 patients (17.2%) reached primary endpoint and 50 patients (65.8%) reached secondary endpoint. Both all-cause mortality rate and HCM-related mortality rate decreased across MCF tertiles (24.7% vs. 17.9% vs. 9.5%, P trend = 0.003 for all-cause mortality; 16.4% vs. 9.7% vs. 6.1%, P trend = 0.021 for HCM-related mortality). Patients in the third tertile had a significantly lower risk of developing adverse outcomes than patients in the first tertile: all-cause mortality (adjusted HR: 0.26, 95% CI: 0.12–0.56, P = 0.001), HCM-related mortality (adjusted HR: 0.17, 95% CI: 0.07–0.42, P < 0.001). At 1-, 3-, and 5-year of follow-up, areas under curve were 0.699, 0.643, 0.618 for all-cause mortality and 0.749, 0.661, 0.613 for HCM-related mortality (all P value < 0.001), respectively. In HCM patients, MCF could independently predict all-cause mortality and HCM-related mortality, which should be considered for overall risk assessment in clinical practice.

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Myocardial Contraction Fraction by M-Mode Echocardiography Is Superior to Ejection Fraction in Predicting Mortality in Transthyretin Amyloidosis

Abstract: NCT00628745.

Cited by 52 publications

References 56 publications

Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation

Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation

Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis?

Myocardial contraction fraction predicts mortality for patients with hypertrophic cardiomyopathy

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