Usuku Hiroki, Yamamoto Eiichiro, Sueta Daisuke, Imamura Kanako, Oike Fumi, Marume Kyohei, Ishii Masanobu, Hanatani Shinsuke, Arima Yuichiro, Takashio Seiji, Oda Seitaro, Kawano Hiroaki, Ueda Mitsuharu, Matsui Hirotaka, Tsujita Kenichi
Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Int J Cardiol Heart Vasc. 2023 Jun 22;47:101227. doi: 10.1016/j.ijcha.2023.101227. eCollection 2023 Aug.
Left ventricular (LV) apical sparing by transthoracic echocardiography (TTE) has not been widely accepted to diagnose transthyretin amyloid cardiomyopathy (ATTR-CM), because it is time consuming and requires a level of expertise. We hypothesized that automatic assessment may be the solution for these problems.
METHODS-AND-RESULTS: We enrolled 63 patients aged ≥70 years who underwent Tc-labeled pyrophosphate (Tc-PYP) scintigraphy on suspicion of ATTR-CM and performed TTE by EPIQ7G, and had enough information for two-dimensional speckle tracking echocardiography at Kumamoto University Hospital from January 2016 to December 2019. LV apical sparing was described as a high relative apical longitudinal strain (LS) index (RapLSI). Measurement of LS was repeated using the same apical images with three different measurement packages as follows: (1) full-automatic assessment, (2) semi-automatic assessment, and (3) manual assessment. The calculation time for full-automatic assessment (14.7 ± 1.4 sec/patient) and semi-automatic assessment (66.7 ± 14.4 sec/patient) were significantly shorter than that for manual assessment (171.2 ± 59.7 sec/patient) (p < 0.01 for both). Receiver operating characteristic curve analysis showed that the area under curve of the RapLSI evaluated by full-automatic assessment for predicting ATTR-CM was 0.70 (best cut-off point; 1.14 [sensitivity 63%, specificity 81%]), by semi-automatic assessment was 0.85 (best cut-off point; 1.00 [sensitivity, 66%; specificity, 100%]) and by manual assessment was 0.83 (best cut-off point; 0.97 [sensitivity, 72%; specificity, 97%]).
There was no significant difference between the diagnostic accuracy of RapLSI estimated by semi-automatic assessment and that estimated by manual assessment. Semi-automatically assessed RapLSI is useful to diagnose ATTR-CM in terms of rapidity and diagnostic accuracy.
经胸超声心动图（TTE）检测左心室（LV）心尖保留情况尚未被广泛用于诊断转甲状腺素蛋白淀粉样心肌病（ATTR-CM），因为该方法耗时且需要一定专业水平。我们推测自动评估可能是解决这些问题的方法。
我们纳入了63例年龄≥70岁、因疑似ATTR-CM接受锝标记焦磷酸盐（Tc-PYP）闪烁扫描且在熊本大学医院于2016年1月至2019年12月期间接受EPIQ7G型超声心动图检查且有足够二维斑点追踪超声心动图信息的患者。左心室心尖保留被描述为高相对心尖纵向应变（LS）指数（RapLSI）。使用相同的心尖图像，采用以下三种不同测量程序重复测量LS：（1）全自动评估，（2）半自动评估，（3）手动评估。全自动评估（14.7±1.4秒/患者）和半自动评估（66.7±14.4秒/患者）的计算时间显著短于手动评估（171.2±59.7秒/患者）（两者p均<0.01）。受试者工作特征曲线分析显示，全自动评估的RapLSI用于预测ATTR-CM时曲线下面积为0.70（最佳截断点；1.14[灵敏度63%，特异性81%]），半自动评估为0.85（最佳截断点；1.00[灵敏度66%；特异性100%]），手动评估为0.83（最佳截断点；0.97[灵敏度72%；特异性97%]）。
半自动评估估计的RapLSI诊断准确性与手动评估估计的结果无显著差异。半自动评估的RapLSI在快速性和诊断准确性方面对诊断ATTR-CM有用。
