Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
Heart. 2012 Oct;98(19):1442-8. doi: 10.1136/heartjnl-2012-302353. Epub 2012 Aug 3.
The diagnosis of cardiac amyloidosis (CA) is challenging owing to vague symptomatology and non-specific echocardiographic findings.
To describe regional patterns in longitudinal strain (LS) using two-dimensional speckle-tracking echocardiography in CA and to test the hypothesis that regional differences would help differentiate CA from other causes of increased left ventricular (LV) wall thickness.
55 consecutive patients with CA were compared with 30 control patients with LV hypertrophy (n=15 with hypertrophic cardiomyopathy, n=15 with aortic stenosis). A relative apical LS of 1.0, defined using the equation (average apical LS/(average basal LS + mid-LS)), was sensitive (93%) and specific (82%) in differentiating CA from controls (area under the curve 0.94). In a logistic regression multivariate analysis, relative apical LS was the only parameter predictive of CA (p=0.004).
CA is characterised by regional variations in LS from base to apex. A relative 'apical sparing' pattern of LS is an easily recognisable, accurate and reproducible method of differentiating CA from other causes of LV hypertrophy.
由于心脏淀粉样变性（CA）的症状模糊和超声心动图表现非特异性，其诊断具有挑战性。
使用二维斑点追踪超声心动图描述 CA 中的纵向应变（LS）的区域性模式，并验证以下假设，即区域性差异有助于区分 CA 与其他导致左心室（LV）壁增厚的原因。
将 55 例连续的 CA 患者与 30 例 LV 肥厚的对照患者（LVH）进行比较（肥厚型心肌病 15 例，主动脉瓣狭窄 15 例）。使用方程（平均心尖 LS/（平均基底 LS+中段 LS））定义的相对心尖 LS 为 1.0，在区分 CA 与对照组方面具有较高的敏感性（93%）和特异性（82%）（曲线下面积 0.94）。在多变量逻辑回归分析中，相对心尖 LS 是唯一预测 CA 的参数（p=0.004）。
CA 的 LS 从基底到心尖呈现出区域性变化。LS 的相对“心尖保留”模式是一种易于识别、准确且可重复的方法，可用于区分 CA 与其他导致 LVH 的原因。
