Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
Center of Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
ESC Heart Fail. 2022 Jun;9(3):1976-1986. doi: 10.1002/ehf2.13909. Epub 2022 Mar 25.
To clarify the usefulness of left atrial (LA) function and left ventricular (LV) function obtained by two-dimensional (2D) speckle tracking echocardiography to diagnose concomitant transthyretin amyloid cardiomyopathy (ATTR-CM) in patients with aortic stenosis (AS).
We analysed 72 consecutive patients with moderate to severe AS who underwent Tc-pyrophosphate (PYP) scintigraphy at Kumamoto University Hospital from January 2012 to September 2020. We divided these 72 patients into 2 groups based on their Tc-PYP scintigraphy positivity or negativity. Among 72 patients, 16 patients (22%) were positive, and 56 patients (78%) were negative for Tc-PYP scintigraphy. In clinical baseline characteristics, natural logarithm troponin T was significantly higher in the Tc-PYP scintigraphy-positive than scintigraphy-negative group (-2.9 ± 0.5 vs. -3.5 ± 0.8 ng/mL, P < 0.05). In conventional echocardiography, the severity of AS was not significantly different between these two groups. In 2D speckle tracking echocardiography, the relative apical longitudinal strain (LS) index (RapLSI) [apical LS/ (basal LS + mid LS)] was significantly higher (1.09 ± 0.49 vs. 0.78 ± 0.23, P < 0.05) and the peak longitudinal strain rate (LSR) in LA was significantly lower in the Tc-PYP scintigraphy-positive than scintigraphy-negative group (0.36 ± 0.14 vs. 0.55 ± 0.20 s , P < 0.05). Multivariable logistic analysis revealed the peak LSR in LA and RapLSI were significantly associated with Tc-PYP scintigraphy positivity. Receiver operating characteristic analysis showed that the area under the curve (AUC) of the peak LSR in LA for Tc-PYP scintigraphy positivity was 0.79 and that the best cut-off value of the peak LSR in LA was 0.47 s (sensitivity: 78.6% and specificity: 72.3%). The AUC of RapLSI for Tc-PYP scintigraphy positivity was 0.69, and the cut-off value of RapLSI was decided as 1.00 (sensitivity: 43.8% and specificity: 87.5%) according to the previous report. The Tc-PYP scintigraphy positivity in patients with RapLSI ≥ 1.0 and the peak LSR in LA ≤ 0.47 s was 83.3% (5/6), and the Tc-PYP scintigraphy negativity in patients with RapLSI < 1.0 and the peak LSR in LA > 0.47 s was 96.6% (28/29).
Left atrial and LV strain analysis were significantly associated with Tc-PYP scintigraphy positivity in ATTR-CM patients with moderate to severe AS. The combination of the peak LSR in LA and RapLSI might be a useful predictor of the presence of ATTR-CM in patients with moderate to severe AS.
明确二维斑点追踪超声心动图测量的左心房（LA）和左心室（LV）功能在诊断合并转甲状腺素蛋白淀粉样心肌病（ATTR-CM）的中重度主动脉瓣狭窄（AS）患者中的作用。
我们分析了 2012 年 1 月至 2020 年 9 月在熊本大学医院接受铊-焦磷酸盐（PYP）闪烁显像的 72 例连续中重度 AS 患者。我们根据 Tc-PYP 闪烁显像的阳性或阴性将这 72 例患者分为两组。72 例患者中，16 例（22%）为阳性，56 例（78%）为阴性。在临床基线特征方面， Tc-PYP 闪烁显像阳性组的自然对数肌钙蛋白 T 明显高于阴性组（-2.9±0.5 vs. -3.5±0.8ng/ml，P<0.05）。在常规超声心动图中，两组间 AS 严重程度无显著差异。在二维斑点追踪超声心动图中，相对心尖长轴应变（LS）指数（RapLSI）[心尖 LS/（基底 LS+中间 LS）]明显较高（1.09±0.49 vs. 0.78±0.23，P<0.05），LA 峰值纵向应变率（LSR）明显较低（0.36±0.14 vs. 0.55±0.20s，P<0.05）。多变量逻辑回归分析显示，LA 峰值 LSR 和 RapLSI 与 Tc-PYP 闪烁显像阳性显著相关。受试者工作特征分析显示，LA 峰值 LSR 对 Tc-PYP 闪烁显像阳性的曲线下面积（AUC）为 0.79，LA 峰值 LSR 的最佳截断值为 0.47s（敏感性：78.6%，特异性：72.3%）。RapLSI 对 Tc-PYP 闪烁显像阳性的 AUC 为 0.69，根据既往报道，RapLSI 的截断值定为 1.00（敏感性：43.8%，特异性：87.5%）。RapLSI≥1.0 和 LA 峰值 LSR≤0.47s 的 Tc-PYP 闪烁显像阳性患者为 83.3%（5/6），RapLSI<1.0 和 LA 峰值 LSR>0.47s 的 Tc-PYP 闪烁显像阴性患者为 96.6%（28/29）。
在中重度 AS 合并 ATTR-CM 患者中，LA 和 LV 应变分析与 Tc-PYP 闪烁显像阳性显著相关。LA 峰值 LSR 和 RapLSI 的联合可能是中重度 AS 患者存在 ATTR-CM 的有用预测指标。
