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Echocardiographic markers of cardiac amyloidosis in patients with heart failure and left ventricular hypertrophy
, 2, 1, 3, 4, 4, 2, 5, 4
Affiliations- Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Nuclear Medicine Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Biochemistry and Molecular Biology, IIS-Aragón, Zaragoza, Spain
- Internal Medicine Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Abstract
Background: Cardiac amyloidosis (CA), following a non-invasive diagnosis, constitutes an increasingly
prevalent heart failure (HF) etiology. This study aims to determine which echocardiography
findings help to diagnose CA in patients with left ventricular hypertrophy (LVH) admitted for decompensated
HF.
Methods: The present study is a retrospective observational study on a cohort of 85 LVH patients admitted
for HF decompensation, in which 99mTc-DPD scanning was performed to rule out transthyretin
CA. The echocardiographic findings obtained were compared between CA and non-CA groups.
Results: From a total number of 85 patients, 49 (57.6%) met the CA criteria and 36 (42.3%) were
ruled out for the disease. Interventricular septum thickness (16 ± 3 mm vs. 14 ± 3 mm), left ventricular
posterior wall thickness (14 ± 3 mm vs. 11 ± 2 mm), left ventricular mass (259 ± 76 g vs. 224 ± 53 g),
left ventricular end-diastolic diameter (48 ± 7 mm vs. 53 ± 6 mm), left ventricular end-diastolic indexed
volume (51 ± 18 cm3/m2 vs. 59 ± 16 cm3/m2), tricuspid annular plane systolic excursion (16 ±
5 mm vs. 20 ± 4 mm), right atrial area (27.4 ± 8.4 cm2 vs. 22.2 ± 5.7 cm2) and strain relative apical
sparing (2.2 ± 0.9 vs. 1.03 ± 0.4; p = 0.04) were significantly associated with the diagnosis of CA.
Conclusions: In patients with LVH admitted for HF decompensation, there are several echocardiographic
features (LVH, reduced left ventricular cavity size, strain relative apical sparing, right atrial
dilation, and altered right ventricular function) that are associated with the diagnosis of cardiac amyloidosis.
Abstract
Background: Cardiac amyloidosis (CA), following a non-invasive diagnosis, constitutes an increasingly
prevalent heart failure (HF) etiology. This study aims to determine which echocardiography
findings help to diagnose CA in patients with left ventricular hypertrophy (LVH) admitted for decompensated
HF.
Methods: The present study is a retrospective observational study on a cohort of 85 LVH patients admitted
for HF decompensation, in which 99mTc-DPD scanning was performed to rule out transthyretin
CA. The echocardiographic findings obtained were compared between CA and non-CA groups.
Results: From a total number of 85 patients, 49 (57.6%) met the CA criteria and 36 (42.3%) were
ruled out for the disease. Interventricular septum thickness (16 ± 3 mm vs. 14 ± 3 mm), left ventricular
posterior wall thickness (14 ± 3 mm vs. 11 ± 2 mm), left ventricular mass (259 ± 76 g vs. 224 ± 53 g),
left ventricular end-diastolic diameter (48 ± 7 mm vs. 53 ± 6 mm), left ventricular end-diastolic indexed
volume (51 ± 18 cm3/m2 vs. 59 ± 16 cm3/m2), tricuspid annular plane systolic excursion (16 ±
5 mm vs. 20 ± 4 mm), right atrial area (27.4 ± 8.4 cm2 vs. 22.2 ± 5.7 cm2) and strain relative apical
sparing (2.2 ± 0.9 vs. 1.03 ± 0.4; p = 0.04) were significantly associated with the diagnosis of CA.
Conclusions: In patients with LVH admitted for HF decompensation, there are several echocardiographic
features (LVH, reduced left ventricular cavity size, strain relative apical sparing, right atrial
dilation, and altered right ventricular function) that are associated with the diagnosis of cardiac amyloidosis.
Keywords
cardiac amyloidosis, echocardiography, heart failure, left ventricular hypertrophy
About this articleTitle
Echocardiographic markers of cardiac amyloidosis in patients with heart failure and left ventricular hypertrophy
Journal
Issue
Article type
Original Article
Pages
266-275
Published online
2021-08-02
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3487
Article views/downloads
1031
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(2):266-275.
Keywords
cardiac amyloidosis
echocardiography
heart failure
left ventricular hypertrophy
Authors
Jorge Melero Polo
Ana Roteta Unceta-Barrenechea
Pablo Revilla Martí
Raquel Pérez-Palacios
Anyuli Gracia Gutiérrez
Esperanza Bueno Juana
Alejandro Andrés Gracia
Saida Atienza Ayala
Miguel Ángel Aibar Arregui
References (29)- Gillmore JD, Maurer MS, Falk RH, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation. 2016; 133(24): 2404–2412.
- Garcia-Pavia P, Domínguez F, Gonzalez-Lopez E. Amiloidosis cardíaca por transtiretina. Medicina Clínica. 2021; 156(3): 126–134.
- Kittleson MM, Maurer MS, Ambardekar AV, et al. Cardiac amyloidosis: evolving diagnosis and management: a scientific statement from the American Heart Association. Circulation. 2020; 142(1): e7–ee22.
- González-López E, Gallego-Delgado M, Guzzo-Merello G, et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J. 2015; 36(38): 2585–2594.
- Ruberg FL. Cardiac amyloidosis: a zebra hiding in plain sight? Circ Cardiovasc Imaging. 2017; 10(3): e006186.
- Uzan C, Lairez O, Raud-Raynier P, et al. Right ventricular longitudinal strain: a tool for diagnosis and prognosis in light-chain amyloidosis. Amyloid. 2018; 25(1): 18–25.
- Liu D, Hu K, Niemann M, et al. Effect of combined systolic and diastolic functional parameter assessment for differentiation of cardiac amyloidosis from other causes of concentric left ventricular hypertrophy. Circ Cardiovasc Imaging. 2013; 6(6): 1066–1072.
- Pagourelias ED, Mirea O, Duchenne J, et al. Echo parameters for differential diagnosis in cardiac amyloidosis: a head-to-head comparison of deformation and nondeformation parameters. Circ Cardiovasc Imaging. 2017; 10(3): e005588.
- Sun JP, Stewart WJ, Yang XS, et al. Differentiation of hypertrophic cardiomyopathy and cardiac amyloidosis from other causes of ventricular wall thickening by two-dimensional strain imaging echocardiography. Am J Cardiol. 2009; 103(3): 411–415.
- Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure. 2016; 18(8): 891–975.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28(1): 1–39.e14.
- Perugini E, Guidalotti PL, Salvi F, et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol. 2005; 46(6): 1076–1084.
- Ruberg F, Grogan M, Hanna M, et al. Transthyretin amyloid cardiomyopathy. J Am Coll Cardiol. 2019; 73(22): 2872–2891.
- Maurer MS, Schwartz JH, Gundapaneni B, et al. Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med. 2018; 379(11): 1007–1016.
- Adams D, Suhr OB, Dyck PJ, et al. Trial design and rationale for APOLLO, a Phase 3, placebo-controlled study of patisiran in patients with hereditary ATTR amyloidosis with polyneuropathy. BMC Neurol. 2017; 17(1): 181.
- Manolis A, Manolis A, Manolis T, et al. Cardiac amyloidosis: An underdiagnosed/underappreciated disease. Eur J Intern Med. 2019; 67: 1–13.
- Maurer MS, Bokhari S, Damy T, et al. Expert consensus recommendations for the suspicion and diagnosis of transthyretin cardiac amyloidosis. Circ Heart Fail. 2019; 12(9): e006075.
- Damy T, Maurer M, Rapezzi C, et al. Clinical, ECG and echocardiographic clues to the diagnosis of TTR-related cardiomyopathy. Open Heart. 2016; 3(1): e000289.
- Chacko L, Martone R, Bandera F, et al. Echocardiographic phenotype and prognosis in transthy-retin cardiac amyloidosis. Eur Heart J. 2020; 41(14): 1439–1447.
- Di Nunzio D, Recupero A, de Gregorio C, et al. Echocardiographic findings in cardiac amyloidosis: inside two-dimensional, Doppler, and strain imaging. Curr Cardiol Rep. 2019; 21(2): 7.
- Boldrini M, Cappelli F, Chacko L, et al. Multiparametric echocardiography scores for the diagnosis of cardiac amyloidosis. JACC Cardiovasc Imaging. 2020; 13(4): 909–920.
- Bellavia D, Pellikka PA, Dispenzieri A, et al. Comparison of right ventricular longitudinal strain imaging, tricuspid annular plane systolic excursion, and cardiac biomarkers for early diagnosis of cardiac involvement and risk stratification in primary systematic (AL) amyloidosis: a 5-year cohort study. Eur Heart J Cardiovasc Imaging. 2012; 13(8): 680–689.
- Bodez D, Ternacle J, Guellich A, et al. Prognostic value of right ventricular systolic function in cardiac amyloidosis. Amyloid. 2016; 23(3): 158–167.
- Cappelli F, Porciani MC, Bergesio F, et al. Right ventricular function in AL amyloidosis: characteristics and prognostic implication. Eur Heart J Cardiovasc Imaging. 2012; 13(5): 416–422.
- Fitzgerald BT, Scalia GM, Cain PA, et al. Left atrial size--another differentiator for cardiac amyloidosis. Heart Lung Circ. 2011; 20(9): 574–578.
- Quarta CC, Solomon SD, Uraizee I, et al. Left ventricular structure and function in transthyretin-related versus light-chain cardiac amyloidosis. Circulation. 2014; 129(18): 1840–1849.
- Phelan D, Collier P, Thavendiranathan P, et al. Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis. Heart. 2012; 98(19): 1442–1448.
- Takashio S, Yamamuro M, Izumiya Y, et al. Diagnostic utility of cardiac troponin T level in patients with cardiac amyloidosis. ESC Heart Fail. 2018; 5(1): 27–35.
- Gillmore JD, Damy T, Fontana M, et al. A new staging system for cardiac transthyretin amyloidosis. Eur Heart J. 2018; 39(30): 2799–2806.
