Right Ventricular Strain Improves the Echocardiographic Diagnosis and Risk Stratification of Transthyretin Cardiac Amyloidosis Among Other Phenotypes of Left Ventricular Hypertrophy.
J Am Soc Echocardiogr
; 37(10): 947-959, 2024 Oct.
Article
em En
| MEDLINE
| ID: mdl-38942217
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).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.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).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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ecocardiografia
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Hipertrofia Ventricular Esquerda
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Neuropatias Amiloides Familiares
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Ventrículos do Coração
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Cardiomiopatias
Limite:
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Am Soc Echocardiogr
/
J. Am. Soc. Echocardiogr
/
Journal of the American Society of Echocardiography
Assunto da revista:
DIAGNOSTICO POR IMAGEM
Ano de publicação:
2024
Tipo de documento:
Article