Eckstein Jan, Körperich Hermann, Weise Valdés Elena, Sciacca Vanessa, Paluszkiewicz Lech, Burchert Wolfgang, Farr Martin, Sommer Philipp, Sohns Christian, Piran Misagh
Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, University of Bochum, Germany.
Clinic for Electrophysiology, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, University of Bochum, Germany.
Int J Cardiol Heart Vasc. 2022 Dec 28;44:101167. doi: 10.1016/j.ijcha.2022.101167. eCollection 2023 Feb.
Right ventricular (RV) strain has provided valuable prognostic information for patients with cardiac amyloidosis (CA). However, the extent to which RV strain and strain rate can differentiate CA is not yet clinically established. CA underdiagnosis delays treatment strategies and exacerbates patient prognosis.
Evaluation of cardiac magnetic resonance (CMR) quantified RV global and regional strain of CA and HCM patients along with CA subtypes.
CMR feature tracking attained longitudinal, radial and circumferential global and regional strain in 47 control subjects (CTRL), 43 CA-, 20 hypertrophic cardiomyopathy- (HCM) patients. CA patients were subdivided in 21 transthyretin-related amyloidosis (ATTR) and 20 acquired immunoglobulin light chain (AL) patients. Strain data and baseline clinical parameters were statistically analysed with respect to diagnostic performance and discriminatory power between the different clinical entities.
Effective differentiation of CA from HCM patients was achieved utilizing global longitudinal (GLS: 16.5 ± 3.9% vs. -21.3 ± 6.7%, p = 0.032), radial (GRS: 11.7 ± 5.3% vs. 16.5 ± 7.1%, p < 0.001) and circumferential (GCS: -7.6 ± 4.0% vs. -9.4 ± 4.4%, p = 0.015) right ventricular strain. Highest strain-based hypertrophic phenotype differentiation was attained using GRS (AUC = 0.86). Binomial regression found right ventricular ejection fraction (RV-EF) (p = 0.017) to be a significant predictor of CA-HCM differentiation. CA subtypes had comparable cardiac strains.
CMR-derived RV global strains and various regional longitudinal strains provide discriminative radiological features for CA-HCM differentiation. However, in terms of feasibility, cine-derived RV-EF quantification may suffice for efficient differential diagnostic support.
右心室（RV）应变已为心脏淀粉样变性（CA）患者提供了有价值的预后信息。然而，RV应变和应变率在区分CA方面的程度尚未在临床上确定。CA的漏诊会延迟治疗策略并加重患者预后。
评估心脏磁共振（CMR）量化CA和肥厚型心肌病（HCM）患者以及CA亚型的右心室整体和局部应变。
CMR特征追踪在47名对照受试者（CTRL）、43名CA患者、20名肥厚型心肌病（HCM）患者中获得纵向、径向和周向的整体和局部应变。CA患者被分为21名转甲状腺素蛋白相关淀粉样变性（ATTR）患者和20名获得性免疫球蛋白轻链（AL）患者。就不同临床实体之间的诊断性能和鉴别能力而言，对应变数据和基线临床参数进行了统计分析。
利用整体纵向（GLS：16.5±3.9%对-21.3±6.7%，p = 0.032）、径向（GRS：11.7±5.3%对16.5±7.1%，p < 0.001）和周向（GCS：-7.6±4.0%对-9.4±4.4%，p = 0.015）右心室应变实现了CA与HCM患者的有效区分。使用GRS实现了基于应变的最高肥厚表型区分（AUC = 0.86）。二项式回归发现右心室射血分数（RV-EF）（p = 0.017）是CA-HCM区分的重要预测指标。CA亚型具有相当的心脏应变。
CMR衍生的RV整体应变和各种局部纵向应变为CA-HCM区分提供了有鉴别力的放射学特征。然而，就可行性而言，电影衍生的RV-EF量化可能足以提供有效的鉴别诊断支持。
