Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.
School of Medicine, Griffith University, Gold Coast, Rode Road, Chermside, QLD, 4032, Australia.
Int J Cardiovasc Imaging. 2021 Jan;37(1):81-90. doi: 10.1007/s10554-020-01948-9. Epub 2020 Jul 29.
Echocardiographic diagnosis of cardiac amyloidosis (CA) can be difficult to differentiate from increased left ventricular (LV) wall thickness from hypertensive heart disease. The aim of this study was to evaluate left atrial (LA) function and deformation using strain and strain rate (SR) imaging in cardiac amyloidosis. We reviewed 44 cases of CA confirmed by tissue biopsy or a combination of clinical and cardiac imaging data. Cases were classified according two subgroups: amyloid light chain (AL) or amyloid transthyretin (ATTR). These subjects underwent 2D-Speckle tracking echocardiographic derived (STE) LA strain analysis. These were compared to 25 hypertensive (HT) patients with increased LV wall thickness. The three phases of LA function were evaluated using strain and strain rate parameters. Despite a similar increase in LV wall thickness, all LA strain parameters were significantly reduced in the AL cohort compared to the HT cohort (reservoir strain/LAs: 11.0 vs. 24.8%, p < 0.05). The ATTR cohort had significantly thicker LV walls and higher atrial fibrillation burden compared to AL and HT patients but similar reduction in LA strain values compared to AL group. A reservoir strain (S-LAs) cut off value of 20% was 86.4% sensitive and 88.6% specific for detecting CA compared to HT heart disease in this cohort. LA strain parameters were able to identify LA dysfunction in all types of CA. LA function in CA is significantly worse compared with hypertensive patients despite similar increase in LV wall thickness. In combination with other clinical and imaging features, LA strain may provide incremental value in differentiating cardiac amyloidosis from increased wall thickness secondary to hypertension.
超声心动图诊断心脏淀粉样变（CA）时，可能难以将其与高血压性心脏病引起的左心室（LV）壁增厚区分开来。本研究旨在评估心肌淀粉样变患者左心房（LA）功能和变形的应变和应变率（SR）成像。我们回顾了 44 例经组织活检或临床和心脏影像学综合数据证实的 CA 病例。根据淀粉样轻链（AL）或转甲状腺素蛋白（ATTR）将这些病例分为两个亚组。这些患者接受了二维斑点追踪超声心动图衍生（STE）LA 应变分析。并将其与 25 例 LV 壁增厚的高血压（HT）患者进行比较。使用应变和应变率参数评估 LA 功能的三个阶段。尽管 LV 壁厚度相似增加，但与 HT 组相比，AL 组的所有 LA 应变参数均显著降低（储备应变/LAs：11.0%比 24.8%，p<0.05）。与 AL 和 HT 患者相比，ATTR 组的 LV 壁明显更厚，心房颤动负担更高，但与 AL 组相比，LA 应变值的降低更为显著。在该队列中，LA 应变（S-LAs）截断值为 20%时，对 CA 的敏感性为 86.4%，特异性为 88.6%，与 HT 心脏病相比。LA 应变参数能够识别所有类型 CA 中的 LA 功能障碍。尽管 LV 壁厚度相似增加，但 CA 患者的 LA 功能明显差于高血压患者。与其他临床和影像学特征相结合，LA 应变可能在区分高血压引起的壁增厚继发的心脏淀粉样变方面提供额外的价值。
