相位分析左心房应变以鉴别不明原因心肌肥厚患者的心脏淀粉样变性。

Phasic left atrial strain analysis to discriminate cardiac amyloidosis in patients with unclear thick heart pathology.

机构信息

Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany.

DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.

出版信息

Eur Heart J Cardiovasc Imaging. 2021 May 10;22(6):680-687. doi: 10.1093/ehjci/jeaa043.

DOI:10.1093/ehjci/jeaa043

PMID:32243500

Abstract

AIMS

Traditional echocardiographic parameters for the assessment of suspected cardiac amyloidosis (CA) are of limited diagnostic accuracy. We sought to explore differences and the discriminative value of phasic left atrial strain (LAS) reductions and of regional longitudinal left ventricular (LV) strain alterations (relative apical sparing; RELAPS) in CA and other causes of LV wall thickening (LVH).

METHODS AND RESULTS

We included 54 patients with unclear LVH (mean septal diastolic wall thickness 17.8 ± 3.5 mm); CA was bioptically confirmed in 35 patients (8 mATTR, 6 wtATTR, 20 AL, and 1 AA amyloidosis) and LVH in 19 subjects. We analysed RELAPS as well as LA reservoir (LASr), conduit (LAScd), and contraction strain (LASct) using 2D speckle tracking echocardiography (EchoPAC software, GE). RELAPS was higher (1.37 ± 0.94 vs. 0.86 ± 0.29, P < 0.007), whereas atrial mechanics were significantly reduced in CA (LASr, LAScd, and LASct: 9.7 ± 5.2%, -6.5 ± 3.5%, and -5.0 ± 4.1% in CA; and 22.7 ± 7.8%, -13.9 ± 5.2%, and -13.0 ± 5.5% in LVH, respectively; P < 0.001 each). With an area under the curve (AUC) of 0.91 [95% confidence interval (CI) 0.82-0.99], LASr showed a higher diagnostic accuracy in discriminating CA than RELAPS (AUC 0.74, 95% CI 0.59-0.88). LASr and LAScd remained significantly associated with CA in a multivariate regression model.

CONCLUSION

Phasic LAS was significantly reduced in patients with CA and showed a higher diagnostic accuracy in discriminating CA than RELAPS. The additional assessment of phasic LAS may be useful to rule in the possible diagnosis of CA in patients with unclear LVH.

摘要

目的

评估疑似心脏淀粉样变性（CA）的传统超声心动图参数的诊断准确性有限。我们试图探讨节段性左心房应变（LAS）减少和区域性纵向左心室（LV）应变改变（相对心尖保留；RELAPS）在 CA 和其他导致 LV 壁增厚（LVH）的病因中的差异和鉴别价值。

方法和结果

我们纳入了 54 名 LVH 不明确的患者（平均室间隔舒张壁厚度 17.8 ± 3.5 mm）；35 名患者经活检证实为 CA（8 名 mATTR、6 名 wtATTR、20 名 AL 和 1 名 AA 淀粉样变性），19 名患者为 LVH。我们使用二维斑点追踪超声心动图（EchoPAC 软件，GE）分析了 RELAPS 以及左心房储备（LASr）、传导（LAScd）和收缩应变（LASct）。CA 患者的 RELAPS 较高（1.37 ± 0.94 比 0.86 ± 0.29，P < 0.007），而心房力学在 CA 中明显降低（LASr、LAScd 和 LASct：CA 中分别为 9.7 ± 5.2%、-6.5 ± 3.5%和-5.0 ± 4.1%；LVH 中分别为 22.7 ± 7.8%、-13.9 ± 5.2%和-13.0 ± 5.5%；P < 0.001 每个）。曲线下面积（AUC）为 0.91 [95%置信区间（CI）0.82-0.99]，LASr 区分 CA 的诊断准确性高于 RELAPS（AUC 0.74，95%CI 0.59-0.88）。在多变量回归模型中，LASr 和 LAScd 与 CA 仍有显著相关性。