Edbom Fredrik, Lindqvist Per, Wiklund Urban, Pilebro Björn, Anan Intissar, Flachskampf Frank A, Arvidsson Sandra
Department of Diagnostics and Intervention, Clinical Physiology, Umeå University, Universitetstorget 4, 90187 Umeå, Sweden.
Department of Diagnostics and Intervention, Biomedical Engineering and Radiation Physics, Umeå University, Umeå, Sweden.
Eur Heart J Imaging Methods Pract. 2024 Sep 26;2(3):qyae100. doi: 10.1093/ehjimp/qyae100. eCollection 2024 Jul.
Transthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative disease of the myocardium in which extracellular deposits of amyloid cause progressive cardiac impairment. We aimed to evaluate left atrial (LA) deformation and its association with left ventricular (LV) deformation using LA-LV strain loops in patients with ATTR-CM and patients with LV hypertrophy (LVH). We hypothesized that LA strain in ATTR-CM patients is abnormal and more independent of LV strain, compared to LVH patients.
Retrospective study based on echocardiographic data including 30 patients diagnosed with ATTR-CM based on an end-diastolic interventricular septal (IVSd) thickness of ≥14 mm, and 29 patients with LVH (IVSd ≥ 14 mm and no ATTR-CM diagnosis) together with 30 controls. LV global longitudinal strain (LV-GLS) and LA strain, assessed as peak atrial longitudinal strain (PALS), were acquired and plotted to construct LA-LV strain loops and used regression line to determine a LA-LV strain slope. Significantly lower PALS and LA-LV strain slope values were detected in ATTR-CM patients compared to LVH patients ( = 0.004 and = 0.014, respectively). A receiver operating characteristic (ROC) curve demonstrated similar area under the curve (AUC) using PALS (AUC 0.72) and LA-LV slope (AUC 0.71), with both resulting in higher values than recorded for LV-GLS (AUC 0.62).
LA deformation demonstrates an independent ability to differentiate ATTR-CM from LVH. Combining LV strain and LA deformation analysis displays the mechanical LA-LV dissociation in ATTR cardiac amyloidosis and potentially unmasks LA amyloid infiltration; this could potentially enable quicker diagnosis and initiation of treatment for ATTR-CM.
转甲状腺素蛋白淀粉样变心肌病（ATTR-CM）是一种心肌浸润性疾病，其中淀粉样蛋白的细胞外沉积导致进行性心脏损害。我们旨在使用LA-LV应变环评估ATTR-CM患者和左心室肥厚（LVH）患者的左心房（LA）变形及其与左心室（LV）变形的关系。我们假设，与LVH患者相比，ATTR-CM患者的LA应变异常且更独立于LV应变。
基于超声心动图数据的回顾性研究，包括30例根据舒张末期室间隔（IVSd）厚度≥14 mm诊断为ATTR-CM的患者、29例LVH患者（IVSd≥14 mm且未诊断为ATTR-CM）以及30例对照。获取左心室整体纵向应变（LV-GLS）和LA应变，并将其评估为心房纵向峰值应变（PALS），绘制LA-LV应变环，并使用回归线确定LA-LV应变斜率。与LVH患者相比，ATTR-CM患者的PALS和LA-LV应变斜率值显著降低（分别为 = 0.004和 = 0.014）。受试者工作特征（ROC）曲线显示，使用PALS（曲线下面积[AUC]为0.72）和LA-LV斜率（AUC为0.71）时曲线下面积相似，两者均高于LV-GLS记录的值（AUC为0.62）。
LA变形显示出区分ATTR-CM和LVH的独立能力。结合LV应变和LA变形分析可显示ATTR心脏淀粉样变中LA-LV的机械分离，并可能揭示LA淀粉样蛋白浸润；这可能有助于更快地诊断和启动ATTR-CM的治疗。
