Ochs Marco M, Riffel Johannes, Kristen Arnt V, Hegenbart Ute, Schönland Stefan, Hardt Stefan E, Katus Hugo A, Mereles Derliz, Buss Sebastian J
Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
J Am Soc Echocardiogr. 2016 Dec;29(12):1188-1196. doi: 10.1016/j.echo.2016.09.003. Epub 2016 Oct 27.
Anterior aortic plane systolic excursion (AAPSE) was evaluated in the present pilot study as a novel echocardiographic indicator of transplant-free survival in patients with systemic light-chain amyloidosis.
Eighty-nine patients with light-chain amyloidosis were included in the post-hoc analysis. A subgroup of 54 patients with biopsy-proven cardiac amyloid infiltration were compared with 41 healthy individuals to evaluate the discriminative ability of echocardiographic findings. AAPSE is defined as the systolic excursion of the anterior aortic margin. To quantify AAPSE, the M-mode cursor was placed on the aortic valve plane in parasternal long-axis view at end-diastole. Index echocardiography had been performed before chemotherapy. Median follow-up duration was 2.4 years. The primary combined end point was heart transplantation or overall death.
Mean AAPSE was 14 ± 2 mm in healthy individuals (mean age=57 ± 10 years; 56% men; BMI=25 ± 4 kg/m). AAPSE < 11 mm separated patients from age-, gender-, and BMI-matched control subjects with 93% sensitivity and 97% specificity. Median transplant-free survival of patients with AAPSE < 5 mm was 0.7 versus 4.8 years (P = .0001). AAPSE was an independent indicator of transplant-free survival in multivariate Cox regression (echocardiographic model: hazard ratio=0.72 [P = .03]; biomarker model: hazard ratio=0.62 [P = .0001]). Sequential regression analysis suggested incremental power of AAPSE as a marker of transplant-free survival. An ejection fraction-based model with an overall χ value of 22.8 was improved by the addition of log NT-proBNP (χ = 32.6, P < .005), troponin-T (χ = 39.6, P < .01), and AAPSE (χ = 54.0, P < .0001).
AAPSE is suggested as an indicator of transplant-free survival in patients with systemic light-chain amyloidosis. AAPSE provided significant incremental value to established staging models.
在本初步研究中，评估了主动脉前平面收缩期偏移（AAPSE）作为系统性轻链淀粉样变患者无移植生存的一种新型超声心动图指标。
89例轻链淀粉样变患者纳入事后分析。将54例经活检证实有心脏淀粉样变浸润的患者亚组与41名健康个体进行比较，以评估超声心动图检查结果的鉴别能力。AAPSE定义为主动脉前缘的收缩期偏移。为量化AAPSE，在舒张末期将M型光标置于胸骨旁长轴视图的主动脉瓣平面上。化疗前已进行超声心动图检查。中位随访时间为2.4年。主要联合终点是心脏移植或全因死亡。
健康个体的平均AAPSE为14±2mm（平均年龄=57±10岁；56%为男性；BMI=25±4kg/m²）。AAPSE<11mm可将患者与年龄、性别和BMI匹配的对照受试者区分开来，敏感性为93%，特异性为97%。AAPSE<5mm的患者无移植生存的中位时间为0.7年，而对照组为4.8年（P=0.0001）。在多变量Cox回归中，AAPSE是无移植生存的独立指标（超声心动图模型：风险比=0.72[P=0.03]；生物标志物模型：风险比=0.62[P=0.0001]）。序贯回归分析表明AAPSE作为无移植生存标志物的预测能力增强。基于射血分数的模型总体χ²值为22.8，加入log NT-proBNP（χ²=32.6，P<0.005）、肌钙蛋白-T（χ²=39.6，P<0.01）和AAPSE（χ²=54.0，P<0.0001）后有所改善。
建议将AAPSE作为系统性轻链淀粉样变患者无移植生存的指标。AAPSE为已建立的分期模型提供了显著的增量价值。
