Matsumoto Yuna, Ichikawa Naoko, Matsuzawa Yuina, Saito Sachika, Niinuma Hiroyuki, Aoki Jiro, Komiyama Nobuyuki
Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan.
Clinical Laboratory, St. Luke's International Hospital, 9-1 Akashi Chuo-ku, Tokyo, Tokyo, 104-8560, Japan.
Int J Cardiovasc Imaging. 2025 Sep 15. doi: 10.1007/s10554-025-03517-4.
Early detection and treatment of cardiac amyloidosis (CA) are essential to improve prognosis, following recent therapeutic advances. Therefore, echocardiographic evaluation is crucial, and an increased wall thickness (IWT) score was proposed in 2020. 35% of patients with CA were previously diagnosed with other cardiomyopathies, such as Hypertensive Heart Disease (HHD). However, using the IWT score for all patients with left ventricular wall thickening remains controversial. In this study, we investigated characteristic IWT score patterns in patients with HHD.
We assessed patients with HHD who underwent echocardiography between August and November 2024. IWT scores were calculated using transthoracic echocardiography. Two groups were compared: mild and moderate-to-severe left ventricular hypertrophy (LVH). Logistic regression analysis was conducted for mild LVH cases with IWT scores between 2 and 7 points (suspected CA, gray zone) to analyze parameters that influenced this classification.
Among 121 patients (mean age: 60.3 ± 11.5 years), 84 (69%), 23 (19%), and 14 (12%) had mild, moderate and severe LVH, respectively. Sixty-two (51%) patients fell into the gray zone. Significant factors affecting IWT score included the systolic apex-to-base ratio (SAB) (Odds ratio [OR] = 42.4, p < 0.001), relative wall thickness (RWT) (OR = 5.0, p = 0.022), and tricuspid annular plane systolic excursion (TAPSE) (OR = 22.5, p < 0.001). Modifying the SAB formula and establishing a TAPSE cutoff value of 17 mm decreased the number of gray zone cases to 35 (29%).
Half of the patients with HHD demonstrated IWT scores consistent with suspected CA.
随着近期治疗进展，心脏淀粉样变性（CA）的早期检测和治疗对于改善预后至关重要。因此，超声心动图评估至关重要，2020年提出了增加壁厚度（IWT）评分。35%的CA患者此前被诊断为其他心肌病，如高血压性心脏病（HHD）。然而，将IWT评分用于所有左心室壁增厚患者仍存在争议。在本研究中，我们调查了HHD患者的特征性IWT评分模式。
我们评估了2024年8月至11月期间接受超声心动图检查的HHD患者。使用经胸超声心动图计算IWT评分。比较了两组：轻度和中度至重度左心室肥厚（LVH）。对IWT评分为2至7分（疑似CA，灰色区域）的轻度LVH病例进行逻辑回归分析，以分析影响该分类的参数。
在121例患者（平均年龄：60.3±11.5岁）中，分别有84例（69%）、23例（19%）和14例（12%）患有轻度、中度和重度LVH。62例（51%）患者属于灰色区域。影响IWT评分的显著因素包括收缩期心尖至心底比值（SAB）（比值比[OR]=42.4，p<0.001）、相对壁厚度（RWT）（OR=5.0，p=0.022）和三尖瓣环平面收缩期位移（TAPSE）（OR=22.5，p<0.001）。修改SAB公式并将TAPSE临界值设定为17 mm可将灰色区域病例数减少至35例（29%）。
一半的HHD患者表现出与疑似CA一致的IWT评分。
