Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Am Soc Echocardiogr. 2010 Jun;23(6):643-52. doi: 10.1016/j.echo.2010.03.027.
The prognostic value of Doppler myocardial imaging, including myocardial velocity imaging, strain, and strain rate imaging, in patients with primary (AL) amyloidosis is uncertain. The aim of this longitudinal study was to identify independent predictors of survival, comparing clinical data, hematologic and cardiac biomarkers, and standard echocardiographic and Doppler myocardial imaging measures in a cohort of patients with AL amyloidosis.
A total of 249 consecutive patients with AL amyloidosis were prospectively enrolled. The primary end point was all-cause mortality, and during a median follow-up period of 18 months, 75 patients (30%) died. Clinical and electrocardiographic data, biomarkers (brain natriuretic peptide and cardiac troponin T) and standard echocardiographic and longitudinal systolic and diastolic Doppler myocardial imaging measurements for 16 left ventricular segments were tested as potential independent predictors of survival.
Age (hazard ratio [HR], 1.03; P = .03), New York Heart Association class III or IV (HR, 2.47; P = .01), the presence of pleural effusion (HR, 1.79; P = .08), brain natriuretic peptide level (HR, 1.29; P = .01), ejection time (HR, 0.99; P = .13), and peak longitudinal systolic strain of the basal anteroseptal segment (HR, 1.05; P = .02) were independent predictors in the final model.
Multivariate survival analysis identified independent predictors of clinical outcome in patients with AL amyloidosis: New York Heart Association class III or IV, presence of pleural effusion, brain natriuretic peptide level > 493 pg/mL, ejection time < 273 ms, and peak longitudinal systolic basal anteroseptal strain less negative than or equal to -7.5% defined a high-risk group of patients.
多普勒心肌成像（包括心肌速度成像、应变和应变率成像）在原发性（AL）淀粉样变性患者中的预后价值尚不确定。本纵向研究的目的是确定 AL 淀粉样变性患者的生存的独立预测因子，比较临床数据、血液学和心脏生物标志物以及标准超声心动图和多普勒心肌成像测量。
共前瞻性纳入 249 例连续 AL 淀粉样变性患者。主要终点为全因死亡率，在中位数为 18 个月的随访期间，75 例患者（30%）死亡。测试了临床和心电图数据、生物标志物（脑钠肽和心脏肌钙蛋白 T）以及 16 个左心室节段的标准超声心动图和纵向收缩和舒张多普勒心肌成像测量，以作为生存的潜在独立预测因子。
年龄（危险比 [HR]，1.03；P =.03）、纽约心脏协会（NYHA）分级 III 或 IV 级（HR，2.47；P =.01）、胸腔积液（HR，1.79；P =.08）、脑钠肽水平（HR，1.29；P =.01）、射血时间（HR，0.99；P =.13）和基底前间隔节段的峰值纵向收缩应变（HR，1.05；P =.02）是最终模型中的独立预测因子。
多变量生存分析确定了 AL 淀粉样变性患者临床结局的独立预测因子：NYHA 分级 III 或 IV 级、胸腔积液、脑钠肽水平 > 493pg/mL、射血时间 < 273ms、以及峰值纵向收缩基底前间隔应变小于或等于 -7.5%，定义了高危患者群体。
