Henein Michael Y, Lindqvist Per
Heart Centre, Department of Cardiology, Umeå University, 90585 Umeå, Sweden.
Institute of Public Health and Clinical Medicine, Umeå University, 90585 Umeå, Sweden.
J Clin Med. 2021 Sep 30;10(19):4555. doi: 10.3390/jcm10194555.
Reduced LV longitudinal strain (GLS) and increased relative apical sparing (RELAPS) and increased wall thickness have been proposed as features for transthyretin cardiac amyloidosis (ATTR-CA). Myocardial work (MW) has recently been shown as useful afterload independent disease marker, hence we aimed to investigate its use in differentiating ATTR-CA from heart failure with increased septal thickness but no cardiac amyloidosis (CA) (HFnCA).
This study included patients with HF and increased septal thickness ≥ 14 mm. We included 59 patients with hereditary (ATTRv) and 27 wild type transthyretin amyloidosis (ATTRwt) described as ATTR-CA based on DPD scintigraphy. We also enrolled 30 non-amyloidosis heart failure patients with negative DPD scintigraphy, as a control group. Myocardial work (MW) was used to assess the index (GWI), constructive (GCW) and wasted (GWW) work. Relative wall thickness (RWT) and relative apical sparing (RELAPS) were tested as conventional measures.
The RWT and RELAPS were higher in ATTR-CA ( < 0.001) and predicted ATTR-CA (RWT; AUC = 0.84, < 0.001) and RELAPS (AUC = 0.81, < 0.001). MW; GWI ( = 0.04), GCW ( = 0.03), GWW ( = 0.001) were all lower in ATTR-CA compared with HFnCA but only GWW predicted ATTR-CA, (AUC = 0.75, < 0.001). Binary logistic univariate regression analysis showed RWT ( = 0.003, = 16.2) and RELAPS ( = 0.003, = 2.3) to be associated with ATTR-CA but not MW. GWI and GCW correlated with NT-proBNP ( < 0.05) and Troponin ( < 0.01), but not RWT or RELAPS.
Myocardial work had lower accuracy, compared to RWT or RELAPS, in identifying ATTR-CA but was better related to biomarkers. Thus, MW assessment is unlikely to have additional value in improving the diagnosis of heart failure due to ATTR-CA.
左心室纵向应变（GLS）降低、相对心尖保留增加（RELAPS）以及室壁厚度增加已被提出作为转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）的特征。心肌做功（MW）最近被证明是一种有用的与后负荷无关的疾病标志物，因此我们旨在研究其在鉴别ATTR-CA与室间隔增厚但无心脏淀粉样变性（CA）的心力衰竭（HFnCA）中的应用。
本研究纳入了室间隔增厚≥14mm的心力衰竭患者。我们纳入了59例遗传性（ATTRv）和27例野生型转甲状腺素蛋白淀粉样变性（ATTRwt）患者，根据双膦酸盐闪烁扫描将其描述为ATTR-CA。我们还纳入了30例双膦酸盐闪烁扫描阴性的非淀粉样变性心力衰竭患者作为对照组。使用心肌做功（MW）来评估指数做功（GWI）、建设性做功（GCW）和浪费做功（GWW）。测试相对室壁厚度（RWT）和相对心尖保留（RELAPS）作为传统指标。
RWT和RELAPS在ATTR-CA中更高（<0.001），并可预测ATTR-CA（RWT；AUC = 0.84；<0.001）和RELAPS（AUC = 0.81；<0.001）。与HFnCA相比，ATTR-CA中的MW；GWI（=0.04）、GCW（=0.03）、GWW（=0.001）均较低，但只有GWW可预测ATTR-CA（AUC = 0.75；<0.001）。二元逻辑单变量回归分析显示RWT（=0.003；=16.2）和RELAPS（=0.003；=2.3）与ATTR-CA相关，但与MW无关。GWI和GCW与NT-proBNP（<0.05）和肌钙蛋白（<0.01）相关，但与RWT或RELAPS无关。
与RWT或RELAPS相比，心肌做功在识别ATTR-CA方面准确性较低，但与生物标志物的相关性更好。因此，MW评估在改善ATTR-CA所致心力衰竭的诊断方面不太可能具有额外价值。
