Prognostic Utility of Echocardiographic Atrial and Ventricular Strain Imaging in Patients With Cardiac Amyloidosis

Huntjens, Peter; Zhang, Kathleen W.; Soyama, Yuko; Karmpalioti, Maria; Lenihan, Daniel J.; Gorcsan, John

doi:10.1016/j.jcmg.2021.01.016

Cited by 67 publications

(43 citation statements)

References 33 publications

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“…Recently, myocardial deformation of both LA and LV have been shown to be linked to prognosis in CA. In particular, a reservoir function <13.2% demonstrated a 7.5-fold increased risk of all-cause mortality over a median follow-up of 5 years (95% CI 3.8–14.7, p < 0.001) in a cohort of 136 patients ( 48 ). Remarkably, in a large population of >900 subjects with ATTR, the LA stiffness, estimated as the ratio between E/e' and reservoir function, has been shown to be an independent marker of prognosis, after adjustment for the main echocardiographic and clinical parameters.…”

Section: La Mechanics In Hf Stagesmentioning

confidence: 99%

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

Bandera

Mollo

Frigelli

et al. 2022

Front. Cardiovasc. Med.

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The left atrium (LA) is emerging as a key element in the pathophysiology of several cardiac diseases due to having an active role in contrasting heart failure (HF) progression. Its morphological and functional remodeling occurs progressively according to pressure or volume overload generated by the underlying disease, and its ability of adaptation contributes to avoid pulmonary circulation congestion and to postpone HF symptoms. Moreover, early signs of LA dysfunction can anticipate and predict the clinical course of HF diseases before the symptom onset which, particularly, also applies to patients with increased risk of HF with still normal cardiac structure (stage A HF). The study of LA mechanics (chamber morphology and function) is moving from a research interest to a clinical application thanks to a great clinical, prognostic, and pathophysiological significance. This process is promoted by the technological progress of cardiac imaging which increases the availability of easy-to-use tools for clinicians and HF specialists. Two-dimensional (2D) speckle tracking echocardiography and feature tracking cardiac magnetic resonance are becoming essential for daily practice. In this context, a deep understanding of LA mechanics, its prognostic significance, and the available approaches are essential to improve clinical practice. The present review will focus on LA mechanics, discussing atrial physiology and pathophysiology of main cardiac diseases across the HF stages with specific attention to the prognostic significance. Imaging techniques for LA mechanics assessment will be discussed with an overlook on the dynamic (under stress) evaluation of the chamber.

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Section: La Mechanics In Hf Stagesmentioning

confidence: 99%

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

Bandera

Mollo

Frigelli

et al. 2022

Front. Cardiovasc. Med.

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“…Huntjens et al also revealed prognostic utility of both atrial and ventricular strain imaging in patients with cardiac amyloidosis. 20 However, these reports enrolled patients with various types of amyloid cardiomyopathy. Because the prognosis depends on the type of amyloid cardiomyopathy, 21 specific evaluations should be performed according to each type of amyloid cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of left atrial strain in patients with wild‐type transthyretin amyloid cardiomyopathy

et al. 2021

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Aims This study was performed to investigate whether left atrial (LA) strain by echocardiography provides prognostic information in patients with wild‐type transthyretin amyloid cardiomyopathy (ATTRwt‐CM). Methods and results Among 129 patients who were diagnosed with ATTRwt‐CM at Kumamoto University Hospital from December 2002 to December 2019, 113 patients who had enough information for two‐dimensional speckle tracking echocardiography were enrolled in this study. During a median follow‐up of 668 days, 28 cardiovascular deaths occurred. Compared with patients in the non‐event group, those in the cardiovascular death group were significantly older (81.5 ± 7.4 vs. 78.1 ± 6.1 years, P < 0.01), had a lower incidence of carpal tunnel syndrome (21% vs. 47%, P < 0.05), and had a higher high‐sensitivity cardiac troponin T [0.085 (0.063–0.105) vs. 0.049 (0.036–0.079) ng/mL, P < 0.01] and B‐type natriuretic peptide concentrations [419 (239–541) vs. 271 (155–462) pg/mL, P < 0.01] and lower estimated glomerular filtration rate (41.8 ± 15.4 vs. 53.4 ± 14.6 mL/min/1.73 m2, P < 0.01). Electrocardiography showed higher rate of a V1–V3 QS pattern (52% vs. 24%, P < 0.01) and complete left bundle branch block (27% vs. 6%, P < 0.01), and echocardiography showed a significantly lower peak LA strain rate during the contraction phase (0.16 ± 0.13 vs. 0.28 ± 0.27 S−1, P < 0.05), LA strain during the reservoir phase (LASr) (5.84 ± 2.41 vs. 8.22 ± 4.05%, P < 0.01), and peak LA strain rate during the reservoir phase (0.26 ± 0.09 vs. 0.33 ± 0.15 S−1, P < 0.05) in the cardiovascular death group than in non‐event group. By contrast, conventional echocardiographic findings were not significantly different between these two groups. After adjusting for conventional predictive factors of ATTRwt‐CM (age, high‐sensitivity cardiac troponin T and B‐type natriuretic peptide concentrations, and estimated glomerular filtration rate), multivariable Cox proportional hazard analyses showed that LASr was significantly and independently associated with cardiovascular death in patients with ATTRwt‐CM (odds ratio, 0.84; 95% confidence interval, 0.72–0.98; P < 0.05). After adjusting for age and echocardiographic findings associated with cardiovascular death (LA volume index and peak LA strain rate during the contraction phase), LASr was significantly and independently associated with cardiovascular death in patients with ATTRwt‐CM (odds ratio, 0.83; 95% confidence interval, 0.70–0.98; P < 0.05). Receiver operating characteristic curve analysis showed that the area under the curve of LASr for cardiovascular death was 0.686 and that the best cut‐off value of LASr was 6.69% (sensitivity, 62.4%; specificity, 64.3%). In the Kaplan–Meier analysis, patients with low LASr (<6.69%) had a significantly higher probability of total cardiovascular death (P < 0.05) and heart failure‐related hospitalization (P < 0.05). Conclusions Left atrial strain during the reservoir phase provides significant prognostic value in patients with ATTRwt‐CM even after adjusting for ...

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“…It also could have been of interest to analyse left atrial strain since recent literature showed its good prognostic value and diagnostic accuracy in CA. This echographical parameter might be useful in CA and will be the subject of further analyses [ 36 , 37 , 38 ]. Moreover, our cohort includes various phenotypical presentations, some with few cardiac symptoms or non-typical echocardiographic findings, which could be attributed to the recent availability of multimodality assessment.…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic Patterns of Left Ventricular Diastolic Function in Cardiac Amyloidosis: An Updated Evaluation

Oghina

Bougouin

Kharoubi

et al. 2021

JCM

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Aims: Multimodal imaging has allowed cardiac amyloidosis (CA) to be increasingly recognised as a treatable cause of heart failure with preserved ejection fraction, but its prognosis remains poor due to late diagnosis. To assess the left ventricular diastolic function (LVDF) patterns in a large contemporary CA cohort according to the current recommendations and to identify their determinants. Methods and Results: We conducted a monocentric, observational study on a cohort of CA patients from a tertiary CA referral centre. Diastolic function was analysed using standard echocardiography and clinical, laboratory and survival parameters were collected. Four hundred and sixty-four patients with one of the three main type of CA were included: 41% had grade III diastolic dysfunction (restrictive mitral pattern), 25% had grade II diastolic dysfunction, and 25% had grade I diastolic dysfunction; 9% were unclassified. No difference was found between the main CA types. After multivariate analyses, grades II and III were independently associated with dyspnoea, elevated NT-proBNP, cardiac infiltration and systolic dysfunction (global longitudinal strain). Grade I patients had a better prognosis. Conclusion: All LVDF patterns can be observed in CA. One quarter of CA patients have grade I LVDF, reflecting the emergence of earlier stage-related phenotypes with a better prognosis.

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Prognostic Utility of Echocardiographic Atrial and Ventricular Strain Imaging in Patients With Cardiac Amyloidosis

Cited by 67 publications

References 33 publications

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

Prognostic value of left atrial strain in patients with wild‐type transthyretin amyloid cardiomyopathy

Echocardiographic Patterns of Left Ventricular Diastolic Function in Cardiac Amyloidosis: An Updated Evaluation

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