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Right Ventricular Strain Improves the Echocardiographic Diagnosis and Risk Stratification of Transthyretin Cardiac Amyloidosis Among Other Phenotypes of Left Ventricular Hypertrophy.
- Source :
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Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography [J Am Soc Echocardiogr] 2024 Oct; Vol. 37 (10), pp. 947-959. Date of Electronic Publication: 2024 Jun 26. - Publication Year :
- 2024
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Abstract
- Aims: Cardiac amyloidosis is a diffuse disease affecting all cardiac chambers. The value of right ventricular free-wall strain is uncertain as an echocardiographic red flag. We hypothesized that right ventricular free-wall strain is of added value for diagnostic and prognostic purposes in patients with transthyretin cardiac amyloidosis (ATTR-CA).<br />Method: A diagnosis of ATTR-CA required positive Tc-99m pyrophosphate scintigraphy and negative serum clonal dyscrasia. Patients with left ventricular (LV) hypertrophy (LVH; interventricular septal thickness ≥1.2 cm) by echocardiography and negative pyrophosphate scintigraphy served as controls after exclusion of amyloid light-chain cardiac amyloidosis. Longitudinal strain was computed with speckle-tracking echocardiography.<br />Results: We studied 108 subjects with ATTR-CA and 106 controls with LVH, retrospectively. Right ventricular free-wall strain was independently associated with the diagnosis of ATTR-CA after adjusting for classical echocardiographic parameters, namely, relative apical sparing (RAS), e', and E/e'. Right ventricular free-wall strain ≥ -16% was incremental to LV RAS in the overall group and in the subgroup without extreme wall thickness (≤1.4 cm; Harrell's C, net reclassification improvement = 0.213, P < .001; and net reclassification improvement = 0.463, P = .015, respectively). Major adverse cardiovascular and cerebrovascular events (heart failure hospitalization, stroke, death) occurred in 47 ATTR-CA patients, during follow-up (median, 38; range, 6-60 months). Right ventricular free-wall strain ≥-16% was associated with 3-fold increased risk of MACCE in ATTR-CA patients independently of age, comorbidities, B-type natriuretic peptide, and tafamidis treatment. Right ventricular free-wall strain was additive to LV ejection fraction for risk stratification (chi square = 10.2; P = .017).<br />Conclusions: Right ventricular free-wall strain >-16% has incremental value to LV RAS for the differential diagnosis of ATTR-CA among LVH phenotypes and is associated with poor prognosis.<br />Competing Interests: Conflicts of Interest None.<br /> (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Aged
Retrospective Studies
Risk Assessment methods
Phenotype
Middle Aged
Prognosis
Hypertrophy, Left Ventricular physiopathology
Hypertrophy, Left Ventricular diagnosis
Echocardiography methods
Amyloid Neuropathies, Familial complications
Amyloid Neuropathies, Familial diagnostic imaging
Amyloid Neuropathies, Familial physiopathology
Amyloid Neuropathies, Familial diagnosis
Heart Ventricles diagnostic imaging
Heart Ventricles physiopathology
Cardiomyopathies physiopathology
Cardiomyopathies diagnosis
Cardiomyopathies complications
Cardiomyopathies diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6795
- Volume :
- 37
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
- Publication Type :
- Academic Journal
- Accession number :
- 38942217
- Full Text :
- https://doi.org/10.1016/j.echo.2024.06.006