Prognostic assessment of relative apical sparing pattern of longitudinal strain for severe aortic valve stenosis

Saito, Makoto; Imai, Misaki; Wake, Daisuke; Higaki, R; Nakao, Yosuke; Morioka, Hiroshi; Sumimoto, Takumi; Inoue, Kentaro

doi:10.1016/j.ijcha.2020.100551

Cited by 8 publications

(16 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some concerns remain regarding the following: 1) dependency on the midventricular strain value, 2) offset of variation of the strain value based on the use of average values, 3) false positive results due to increased strain value of the entire left ventricle, and 4) no established threshold for assessment. Owing to the potential limitation of qRASP assessment, we recently introduced semi-quantitative method of RASP (sRASP) [ 8 , 9 ]. Currently, GE and Philipps have adopted a color range divided into eight equal parts from − 20% (red) to 20% (blue) when the strain value is represented on a bull’s eye plot.…”

Section: Methodsmentioning

confidence: 99%

Cardiac amyloidosis screening using a relative apical sparing pattern in patients with left ventricular hypertrophy

Nakao

Saito²,

Inoue

et al. 2021

Cardiovasc Ultrasound

Self Cite

View full text Add to dashboard Cite

Background Cardiac amyloidosis (CA) mimics left ventricular hypertrophy (LVH). It is treatable, but its prognosis is poor. A simple screening tool for CA would be valuable. CA is more precisely diagnosed with echocardiographic deformation parameters (e.g., relative apical sparing pattern [RASP]) than with conventional parameters. We aimed to 1) investigate incremental benefits of echocardiographic deformation parameters over established parameters for CA screening; 2) determine the resultant risk score for CA screening; and 3) externally validate the score in LVH patients. Methods We retrospectively studied 295 consecutive non-ischemic LVH patients who underwent detailed diagnostic tests. CA was diagnosed with biopsy or 99mTc-PYP scintigraphy. The base model comprised age (≥65 years [men], ≥70 years [women]), low voltage on the electrocardiogram, and posterior wall thickness ≥ 14 mm in reference to the literature. The incremental benefit of each binarized echocardiographic parameter over the base model was assessed using receiver operating characteristic curve analysis and comparisons of the area under the curve (AUC). Results Fifty-four (18%) patients had CA. RASP showed the most incremental benefit for CA screening over the base model. After conducting multiple logistic regression analysis for CA screening using four variables (RASP and base model components), a score was determined (range, 0–4 points). The score demonstrated adequate discrimination ability for CA (AUC = 0.86). This result was confirmed in another validation cohort (178 patients, AUC = 0.88). Conclusions We developed a score incorporating RASP for CA screening. This score is potentially useful in the risk stratification and management of LVH patients.

show abstract

Section: Methodsmentioning

confidence: 99%

Cardiac amyloidosis screening using a relative apical sparing pattern in patients with left ventricular hypertrophy

Nakao

Saito²,

Inoue

et al. 2021

Cardiovasc Ultrasound

Self Cite

View full text Add to dashboard Cite

show abstract

“…The revision of full-length articles allowed the exclusion of fourteen studies due to wrong study design or irrelevant information in their content. Thus, seventeen studies ( 6 , 7 , 13 – 17 , 19 , 20 , 24 – 31 ), enrolling 1,988 subjects (1,658 AS alone and 330 AS with CA), were included in the qualitative and quantitative analyses of main patients with AS characteristics with and without CA (14 studies), difference in mortality (9 studies), and treatment strategy (10 studies).…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence of CA was accessed in 14 studies ( 6 , 7 , 13 – 17 , 19 , 20 , 25 , 28 – 31 ), including 1,934 subjects (276 with concomitant CA and AS), resulting in a mean of 15.4%. Our results suggest that the prevalence of CA is lower in patients with AS under 80 years old compared with patients over 80 years old (7.1 vs. 18.2%, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…We included in the analysis only studies on patients with AS with suspected or confirmed CA at echocardiography, cardiac magnetic resonance (CMR), and bone scintigraphy. In particular, we included two echocardiographic studies that identified patients with concomitant CA and severe AS with apical sparing pattern at LV strain analysis ( 19 , 20 ). In each study, data regarding major clinical, demographic, echocardiographic, electrocardiographic variables, and prevalence of cardiovascular risk factors in patients with AS with and without CA were extracted.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Red Flags, Prognostic Impact, and Management of Patients With Cardiac Amyloidosis and Aortic Valve Stenosis: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

BackgroundCardiac amyloidosis (CA) has been recently recognized as a condition frequently associated with aortic stenosis (AS). The aim of this study was to evaluate: the main characteristics of patients with AS with and without CA, the impact of CA on patients with AS mortality, and the effect of different treatment strategies on outcomes of patients with AS with concomitant CA.Materials and MethodsA detailed search related to CA in patients with AS and outcomes was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies enrolling 1,988 subjects (1,658 AS alone and 330 AS with CA) were included in the qualitative and quantitative analysis of main patients with AS characteristics with and without CA, difference in mortality, and treatment strategy.ResultsThe prevalence of CA resulted in a mean of 15.4% and it was even higher in patients with AS over 80 years old (18.2%). Patients with the dual diagnosis were more often males, had lower body mass index (BMI), were more prone to have low flow, low gradient with reduced left ventricular ejection fraction AS phenotype, had higher E/A and E/e', and greater interventricular septum hypertrophy. Lower Sokolow–Lyon index, higher QRS duration, higher prevalence of right bundle branch block, higher levels of N-terminal pro-brain natriuretic peptide, and high-sensitivity troponin T were significantly associated with CA in patients with AS. Higher overall mortality in the 178 patients with AS + CA in comparison to 1,220 patients with AS alone was observed [odds ratio (OR) 2.25, p = 0.004]. Meta-regression analysis showed that younger age and diabetes were associated with overall mortality in patients with CS with CA (Z-value −3.0, p = 0.003 and Z-value 2.5, p = 0.013, respectively). Finally, patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) had a similar overall mortality risk, but lower than medication-treated only patients.ConclusionResults from our meta-analysis suggest that several specific clinical, electrocardiographic, and echocardiographic features can be considered “red flags” of CA in patients with AS. CA negatively affects the outcome of patients with AS. Patients with concomitant CA and AS benefit from SAVR or TAVI.

show abstract

“…This study focused on LA behaviour in patients with CA and HCM. It is of course important to diagnose the two phenotypes by evaluating electrocardiographic voltage criteria and LV apical sparing pattern 17,21,22 . The echocardiographic and CMR assessments of LA structure and function could improve a diagnostic accuracy in these patients.…”

Section: Discussionmentioning

confidence: 99%

Restricted left atrial dilatation can visually differentiate cardiac amyloidosis from hypertrophic cardiomyopathy

et al. 2021

Self Cite

View full text Add to dashboard Cite

Aims Cardiac amyloidosis (CA) is an infiltrative myocardial disease that occasionally mimics hypertrophic cardiomyopathy (HCM). The aim of this study is to investigate the discriminatory ability of visual assessment of left atrial (LA) function between CA and HCM on echocardiography. Methods and results In total, 93 patients with cardiac magnetic resonance imaging (CMR)-confirmed HCM and 34 with cardiac biopsy-confirmed CA were retrospectively assessed. LA dilatation was assessed via echocardiography in an apical four-chamber view. Visual assessment was performed to identify LA dilatation grade (preserved = 1, abnormal = 2, and restricted = 3) based on the extent of outward expansion in the LA reservoir phase. Regarding the reproducibility of visually assessing LA dilatation grade, the kappa values between intra-and inter-observer measurements were 0.82 and 0.70, respectively. Of 127 participants, 57 (45%), 42 (33%), and 28 (22%) presented with LA dilatation Grades 1, 2, and 3, respectively. All 57 patients with preserved LA dilatation (Grade 1) had HCM, and 20 of 28 patients (71%) with restricted LA dilatation (Grade 3) presented with CA. Patients with CA had a higher LA dilatation grade than those with HCM (P < 0.01). LA emptying fraction and reservoir strain were also quantitatively evaluated. The area under the curves of LA dilatation grade (0.88) and LA emptying fraction (0.88) for differentiation of these two diseases were higher than that of LA reservoir strain (0.73) (P < 0.01, respectively). During follow-up, nine patients with HCM and 16 with CA experienced cardiac event (cardiac death or hospitalization due to heart failure). In Kaplan-Meier analysis including both groups of HCM and CA, the incidence of cardiac events was higher in patients with restricted LA dilatation than in those with preserved or abnormal LA dilatation (log-rank test, P < 0.01). Conclusions Restricted LA dilatation is an indicator for the diagnosis of CA. Further, visual assessment of abnormal LA motion may facilitate diagnosis in patients with CA and high-risk patients with HCM.

show abstract

Prognostic assessment of relative apical sparing pattern of longitudinal strain for severe aortic valve stenosis

Cited by 8 publications

References 39 publications

Cardiac amyloidosis screening using a relative apical sparing pattern in patients with left ventricular hypertrophy

Cardiac amyloidosis screening using a relative apical sparing pattern in patients with left ventricular hypertrophy

Red Flags, Prognostic Impact, and Management of Patients With Cardiac Amyloidosis and Aortic Valve Stenosis: A Systematic Review and Meta-Analysis

Restricted left atrial dilatation can visually differentiate cardiac amyloidosis from hypertrophic cardiomyopathy

Contact Info

Product

Resources

About