Usuku Hiroki, Yamamoto Eiichiro, Sueta Daisuke, Noguchi Momoko, Fujisaki Tomohiro, Egashira Koichi, Oike Fumi, Fujisue Koichiro, Hanatani Shinsuke, Arima Yuichiro, Takashio Seiji, Kawano Yawara, Oda Seitaro, Kawano Hiroaki, Matsushita Kenichi, Ueda Mitsuharu, Matsui Hirotaka, Matsuoka Masao, Tsujita Kenichi
Department of Laboratory Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
Eur Heart J Open. 2023 May 9;3(3):oead048. doi: 10.1093/ehjopen/oead048. eCollection 2023 May.
Left ventricular (LV) global longitudinal strain (GLS) (LV-GLS) is a strong and independent predictor of outcomes in patients with immunoglobulin light-chain (AL) cardiac amyloidosis. This study was performed to investigate whether right ventricular (RV) GLS (RV-GLS) provides prognostic information in patients with AL amyloidosis.
Among 74 patients who were diagnosed with AL cardiac amyloidosis at Kumamoto University Hospital from December 2005 to December 2022, 65 patients who had enough information for two-dimensional speckle tracking imaging and did not receive chemotherapy before the diagnosis of cardiac amyloidosis were retrospectively analysed. During a median follow-up of 359 days, 29 deaths occurred. In two-dimensional echocardiographic findings, LV-GLS, left atrium reservoir strain (LASr), and RV-GLS were significantly lower in the all-cause death group than in the survival group (LV-GLS: 8.9 ± 4.2 vs. 11.7 ± 3.9, < 0.01; LASr: 9.06 ± 7.28 vs. 14.09 ± 8.32, < 0.05; RV-GLS: 12.0 ± 5.1 vs. 16.8 ± 4.0, < 0.01). Multivariable Cox proportional hazard analysis showed RV-GLS was significantly and independently associated with all-cause death in patients with AL cardiac amyloidosis (hazard ratio 0.85; 95% confidence interval, 0.77-0.94; < 0.01). Receiver operating characteristic analysis showed that the area under the curve of RV-GLS for all-cause death was 0.774 and that the best cut-off value of RV-GLS was 14.5% (sensitivity, 75%; specificity, 72%). In the Kaplan-Meier analysis, patients with AL cardiac amyloidosis who had low RV-GLS (<14.5%) had a significantly higher probability of all-cause death ( < 0.01).
RV-GLS has prognostic value in patients with AL cardiac amyloidosis and provides greater prognostic power than LV-GLS and LASr.
左心室（LV）整体纵向应变（GLS）（LV-GLS）是免疫球蛋白轻链（AL）型心脏淀粉样变性患者预后的一个强有力的独立预测指标。本研究旨在调查右心室（RV）GLS（RV-GLS）是否能为AL淀粉样变性患者提供预后信息。
在2005年12月至2022年12月期间于熊本大学医院被诊断为AL型心脏淀粉样变性的74例患者中，对65例有足够信息进行二维斑点追踪成像且在心脏淀粉样变性诊断前未接受化疗的患者进行回顾性分析。在中位随访359天期间，发生了29例死亡。在二维超声心动图检查结果中，全因死亡组的LV-GLS、左心房储备应变（LASr）和RV-GLS显著低于存活组（LV-GLS：8.9±4.2对11.7±3.9，<0.01；LASr：9.06±7.28对14.09±8.32，<0.05；RV-GLS：12.0±5.1对16.8±4.0，<0.01）。多变量Cox比例风险分析显示，RV-GLS与AL型心脏淀粉样变性患者的全因死亡显著且独立相关（风险比0.85；95%置信区间，0.77-0.94；<0.01）。受试者工作特征分析显示，RV-GLS预测全因死亡的曲线下面积为0.774，RV-GLS的最佳截断值为14.5%（敏感性，75%；特异性，72%）。在Kaplan-Meier分析中，RV-GLS低（<14.5%）的AL型心脏淀粉样变性患者全因死亡概率显著更高（<0.01）。
RV-GLS对AL型心脏淀粉样变性患者具有预后价值，且比LV-GLS和LASr具有更强的预后预测能力。
