Cotella Juan, Randazzo Michael, Maurer Mathew S, Helmke Stephen, Scherrer-Crosbie Marielle, Soltani Marwa, Goyal Akash, Zareba Karolina, Cheng Richard, Kirkpatrick James N, Yogeswaran Vidhushei, Kitano Tetsuji, Takeuchi Masaaki, Fernandes Fábio, Hotta Viviane Tiemi, Campos Vieira Marcelo Luiz, Elissamburu Pablo, Ronderos Ricardo, Prado Aldo, Koutroumpakis Efstratios, Deswal Anita, Pursnani Amit, Sarswat Nitasha, Addetia Karima, Mor-Avi Victor, Asch Federico M, Slivnick Jeremy A, Lang Roberto M
University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA.
Columbia University, New York, NY, USA.
Eur Heart J Cardiovasc Imaging. 2024 May 31;25(6):754-761. doi: 10.1093/ehjci/jeae021.
Although impaired left ventricular (LV) global longitudinal strain (GLS) with apical sparing is a feature of cardiac amyloidosis (CA), its diagnostic accuracy has varied across studies. We aimed to determine the ability of apical sparing ratio (ASR) and most common echocardiographic parameters to differentiate patients with confirmed CA from those with clinical and/or echocardiographic suspicion of CA but with this diagnosis ruled out.
We identified 544 patients with confirmed CA and 200 controls (CTRLs) as defined above (CTRL patients). Measurements from transthoracic echocardiograms were performed using artificial intelligence software (Us2.AI, Singapore) and audited by an experienced echocardiographer. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance and optimal cut-offs for the differentiation of CA patients from CTRL patients. Additionally, a group of 174 healthy subjects (healthy CTRL) was included to provide insight on how patients and healthy CTRLs differed echocardiographically. LV GLS was more impaired (-13.9 ± 4.6% vs. -15.9 ± 2.7%, P < 0.0005), and ASR was higher (2.4 ± 1.2 vs. 1.7 ± 0.9, P < 0.0005) in the CA group vs. CTRL patients. Relative wall thickness and ASR were the most accurate parameters for differentiating CA from CTRL patients [area under the curve (AUC): 0.77 and 0.74, respectively]. However, even with the optimal cut-off of 1.67, ASR was only 72% sensitive and 66% specific for CA, indicating the presence of apical sparing in 32% of CTRL patients and even in 6% healthy subjects.
Apical sparing did not prove to be a CA-specific biomarker for accurate identification of CA, when compared with clinically similar CTRLs with no CA.
尽管左心室（LV）整体纵向应变（GLS）受损且心尖部保留是心脏淀粉样变性（CA）的一个特征，但其诊断准确性在不同研究中有所差异。我们旨在确定心尖部保留率（ASR）和最常见的超声心动图参数区分确诊CA患者与临床和/或超声心动图怀疑CA但诊断被排除的患者的能力。
我们确定了544例确诊CA患者和200例对照（CTRLs）（定义如上，即对照患者）。经胸超声心动图测量使用人工智能软件（新加坡Us2.AI）进行，并由经验丰富的超声心动图医生审核。采用受试者工作特征曲线分析来评估区分CA患者与对照患者的诊断性能和最佳截断值。此外，纳入了一组174名健康受试者（健康对照），以了解患者和健康对照在超声心动图方面的差异。与对照患者相比，CA组的LV GLS受损更严重（-13.9±4.6%对-15.9±2.7%，P<0.0005），ASR更高（2.4±1.2对1.7±0.9，P<0.0005）。相对室壁厚度和ASR是区分CA与对照患者最准确的参数[曲线下面积（AUC）：分别为0.77和0.74]。然而，即使ASR的最佳截断值为1.67，其对CA的敏感性仅为72%，特异性为66%，这表明32%的对照患者甚至6%的健康受试者存在心尖部保留。
与无CA的临床相似对照相比，心尖部保留并未被证明是准确识别CA的CA特异性生物标志物。
