Inoue Katsuji, Nakao Yasuhisa, Saito Makoto, Kinoshita Masaki, Higashi Haruhiko, Yamaguchi Osamu
Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Ohhira 1-638, Yawatahama, Ehime, 796-8502, Japan.
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine, Toon, Japan.
Cardiovasc Ultrasound. 2025 Mar 17;23(1):4. doi: 10.1186/s12947-025-00339-1.
Left ventricular (LV) long-axis shortening at the cardiac base is a determinant of left atrial (LA) reservoir function. Cardiac amyloidosis (CA) is characteristic of amyloid deposition predominantly in the LV basal wall. We investigated the relationship between LV basal strain and LA reservoir strain among patients with pathological LV hypertrophy and subsequently evaluated the diagnostic ability of LA reservoir strain to identify CA etiology and its predictive value for heart failure hospitalization.
We retrospectively analyzed 341 patients with LV hypertrophy. Cardiac etiologies were diagnosed by tissue biopsy, cardiac magnetic resonance imaging or Tc-PYP scintigraphy. LV basal strain and LA reservoir strain were analyzed.
Patients were diagnosed with CA (n = 75) and other etiologies (n = 266). LV basal strain was correlated with LA reservoir strain in the CA group (r = 0.58, p < 0.01) and the non-CA group (r = 0.44, p < 0.01). A binary logistic regression analysis showed that relative apical sparing of longitudinal strain, septal E/e' and LA reservoir strain had the ability to discriminate between the CA and non-CA groups (p < 0.01 for all). The area under the curve for relative apical sparing of longitudinal strain had a stronger ability than LA reservoir strain to discriminate CA from non-CA etiologies (0.90 versus 0.81, respectively; p < 0.01). During the follow-up period (median 2.7 years), the incidence of heart failure hospitalization was higher in the CA group than the non-CA group (35% versus 14%, respectively; p < 0.01). According to univariate Cox regression analysis, three LA factors (LA reservoir strain, E/e' and LA volume index) were associated with heart failure hospitalization in the non-CA group (p < 0.05 for all).
LA reservoir strain was associated with LV basal strain among patients with pathological LV hypertrophy. Echocardiographic assessment of LA reservoir strain might add diagnostic value to identify CA etiology in these patients.
心脏基底部左心室（LV）长轴缩短是左心房（LA）储器功能的一个决定因素。心脏淀粉样变性（CA）的特征是淀粉样蛋白主要沉积在左心室基底部壁。我们研究了病理性左心室肥厚患者左心室基底部应变与左心房储器应变之间的关系，随后评估了左心房储器应变对识别CA病因的诊断能力及其对心力衰竭住院的预测价值。
我们回顾性分析了341例左心室肥厚患者。通过组织活检、心脏磁共振成像或锝-焦磷酸盐闪烁扫描术诊断心脏病因。分析左心室基底部应变和左心房储器应变。
患者被诊断为CA（n = 75）和其他病因（n = 266）。在CA组（r = 0.58，p < 0.01）和非CA组（r = 0.44，p < 0.01）中，左心室基底部应变与左心房储器应变相关。二元逻辑回归分析显示，纵向应变的相对心尖保留、室间隔E/e'和左心房储器应变能够区分CA组和非CA组（所有p < 0.01）。纵向应变相对心尖保留的曲线下面积比左心房储器应变具有更强的区分CA与非CA病因的能力（分别为0.90对0.81；p < 0.01）。在随访期间（中位时间2.7年），CA组心力衰竭住院发生率高于非CA组（分别为35%对14%；p < 0.01）。根据单变量Cox回归分析，三个左心房因素（左心房储器应变、E/e'和左心房容积指数）与非CA组心力衰竭住院相关（所有p < 0.05）。
在病理性左心室肥厚患者中，左心房储器应变与左心室基底部应变相关。超声心动图评估左心房储器应变可能为识别这些患者的CA病因增加诊断价值。
