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Myocardial Contraction Fraction by M-Mode Echocardiography Is Superior to Ejection Fraction in Predicting Mortality in Transthyretin Amyloidosis. J Card Fail 2018; 24:504-511. [PMID: 30010028 DOI: 10.1016/j.cardfail.2018.07.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Transthyretin amyloidosis (ATTR) is often associated with cardiac involvement manifesting as conduction disease as well as restrictive cardiomyopathy causing heart failure and death. Myocardial contraction fraction (MCF), the ratio of left ventricular stroke volume (SV) to myocardial volume (MV), is a volumetric measure of myocardial shortening that is superior to ejection fraction (EF) in predicting mortality in patients with primary amyloid light chain cardiac amyloidosis. We hypothesized that MCF would be an independent predictor of survival in TTR-CA. METHODS AND RESULTS MCF was derived from 2-dimensional echocardiography-guided M-mode data for 530 subjects in the Transthyretin Amyloidosis Outcomes Survey (THAOS) database: age 61 ± 16years, 74% male, 158 wild-type (ATTRwt) and 372 mutant (ATTRm), follow-up 1.5 ± 1.7years. Using multivariate Cox proportional hazard regression models, MCF <25% was highly associated with survival (hazard ratio [HR] 8.5, 95% confidence interval [CI] 4.8-14.9,-P < .0001), which was stronger than the association of EF dichotomized at 50% (HR 2.8, 95% CI 1.8-4.4; P < .0001). MCF <25% remained significantly predictive of survival in a multivariate model that included systolic blood pressure, estimated glomerular filtration rate <65 mL·min-1·m-2, New York Heart Association (NYHA) functional class, and health status based on the EuroQol-5D-3L questionnaire (area under the receiver operating characteristic curve [AUC] = 0.83, 95% CI 0.78-0.89). CONCLUSIONS MCF was superior to EF in predicting mortality in patients with ATTR. A predictive model combining MCF with systolic blood pressure, renal function, NYHA functional class, and health status was strongly associated with survival in patients with ATTR. CLINICALTRIALS. GOV IDENTIFIER NCT00628745.
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Knight DS, Zumbo G, Barcella W, Steeden JA, Muthurangu V, Martinez-Naharro A, Treibel TA, Abdel-Gadir A, Bulluck H, Kotecha T, Francis R, Rezk T, Quarta CC, Whelan CJ, Lachmann HJ, Wechalekar AD, Gillmore JD, Moon JC, Hawkins PN, Fontana M. Cardiac Structural and Functional Consequences of Amyloid Deposition by Cardiac Magnetic Resonance and Echocardiography and Their Prognostic Roles. JACC Cardiovasc Imaging 2018; 12:823-833. [PMID: 29680336 DOI: 10.1016/j.jcmg.2018.02.016] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This cross-sectional study aimed to describe the functional and structural cardiac abnormalities that occur across a spectrum of cardiac amyloidosis burden and to identify the strongest cardiac functional and structural prognostic predictors in amyloidosis using cardiac magnetic resonance (CMR) and echocardiography. BACKGROUND Cardiac involvement in light chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Numerous measures of cardiac structure and function are assessed by multiple imaging modalities in amyloidosis. METHODS A total f 322 subjects (311 systemic amyloidosis and 11 transthyretin gene mutation carriers) underwent comprehensive CMR and transthoracic echocardiography. The probabilities of 11 commonly measured structural and functional cardiac parameters being abnormal with increasing cardiac amyloidosis burden were evaluated. Cardiac amyloidosis burden was quantified using CMR-derived extracellular volume. The prognostic capacities of these parameters to predict death in amyloidosis were assessed using Cox proportional hazards models. RESULTS Left ventricular mass and mitral annular plane systolic excursion by CMR along with strain and E/e' by echocardiography have high probabilities of being abnormal at low cardiac amyloid burden. Reductions in biventricular ejection fractions and elevations in biatrial areas occur at high burdens of infiltration. The probabilities of indexed stroke volume, myocardial contraction fraction, and tricuspid annular plane systolic excursion (TAPSE) being abnormal occur more gradually with increasing extracellular volume. Ninety patients (28%) died during a median follow-up of 22 months (interquartile range: 10 to 38 months). Univariable analysis showed that all imaging markers studied significantly predicted outcome. Multivariable analysis showed that TAPSE (hazard ratio: 1.46; 95% confidence interval: 1.16 to 1.85; p < 0.01) and indexed stroke volume (hazard ratio: 1.24; 95% confidence interval: 1.04 to 1.48; p < 0.05) by CMR were the only independent predictors of mortality. CONCLUSIONS Specific functional and structural abnormalities characterize different burdens of cardiac amyloid deposition. In a multimodality imaging assessment of a large cohort of amyloidosis patients, CMR-derived TAPSE and indexed stroke volume are the strongest prognostic cardiac functional markers.
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Affiliation(s)
- Daniel S Knight
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Giulia Zumbo
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - William Barcella
- Department of Statistical Science, University College London, United Kingdom
| | - Jennifer A Steeden
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Institute of Cardiovascular Science, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Thomas A Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Amna Abdel-Gadir
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom
| | - Tushar Kotecha
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Rohin Francis
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Tamer Rezk
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Candida C Quarta
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Carol J Whelan
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Helen J Lachmann
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, United Kingdom.
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Uzan C, Lairez O, Raud-Raynier P, Garcia R, Degand B, Christiaens LP, Rehman MB. Right ventricular longitudinal strain: a tool for diagnosis and prognosis in light-chain amyloidosis. Amyloid 2018; 25:18-25. [PMID: 29260587 DOI: 10.1080/13506129.2017.1417121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Light-chain (AL) amyloidosis can lead to an infiltrative cardiomyopathy with increased wall thickness (IWT) of very poor prognosis. Our primary aim was to analyse the right ventricle (RV) in patients with IWT to discriminate AL amyloidosis from IWT due to hypertrophic cardiomyopathy (HCM) or to arterial hypertension (HTN). Our secondary aim was to assess if RV dysfunction predicts overall mortality in cardiac AL amyloidosis. METHODS We retrospectively and consecutively compared clinical, biological and echocardiographic data of 315 patients with IWT: 105 biopsy-proven AL amyloidosis patients, 105 patients with HCM and 105 patients with HTN. The prognostic value of these parameters was analysed in the AL amyloidosis group. RESULTS Free-wall right ventricular longitudinal strain (FWRVLS) worse than -21.2% discriminates AL amyloidosis [area under the curve (AUC) = 0.744)] from patients with IWT due to other aetiologies. In AL amyloidosis, FWRVLS is the strongest echocardiographic prognostic marker with AUC =0.722 and -16.5% as the optimal cut-off value, beyond which overall mortality increases significantly. It is also the only independent echocardiographic predictor of overall mortality (HR =1.113; 95%CI 1.029-1.204; p = .007), even when adjusted to the Mayo stage and global left ventricular longitudinal strain. CONCLUSIONS FWRVLS should be considered in the diagnostic and prognostic workup in light-chain amyloidosis.
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Affiliation(s)
- Charles Uzan
- a Cardiology Department , CHU de Poitiers , Poitiers , France
| | - Olivier Lairez
- b Imaging Center, University Hospital of Rangueil , Toulouse , France
| | | | - Rodrigue Garcia
- a Cardiology Department , CHU de Poitiers , Poitiers , France
| | - Bruno Degand
- a Cardiology Department , CHU de Poitiers , Poitiers , France
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Wan K, Sun J, Han Y, Luo Y, Liu H, Yang D, Cheng W, Zhang Q, Zeng Z, Chen Y. Right ventricular involvement evaluated by cardiac magnetic resonance imaging predicts mortality in patients with light chain amyloidosis. Heart Vessels 2018; 33:170-179. [PMID: 28840397 DOI: 10.1007/s00380-017-1043-y3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/18/2017] [Indexed: 05/25/2023]
Abstract
Few studies have focused on right ventricular (RV) involvement in cardiac amyloidosis (CA). We investigated the prognostic value of RV assessment by cardiovascular magnetic resonance (CMR) in CA. In 2011-2014, consecutive patients with suspected CA referred for CMR were retrospectively evaluated. Demographic and baseline clinical characteristics were collected. Healthy volunteers were matched for sex and age and served as controls. All subjects underwent a contrast-enhanced CMR examination. RV size, function, and late gadolinium enhancement (LGE) were analyzed. All deaths during follow-up were recorded. Sixty-one patients [37 males (60.7%), age 60 ± 11 years] were included; CA was diagnosed in 47 (77.0%) patients. CA patients displayed decreased biventricular ejection fraction, elevated left ventricular mass index, and increased biventricular end-systolic volume index (ESVi) compared with controls. A total of 27 deaths (57.4%) occurred in the CA group at 21-month median follow-up. Multivariable analysis demonstrated that RVESVi (HR 1.033, 95% CI 1.004-1.063, P = 0.026) and RV-LGE (HR 2.814, 95% CI 1.063-7.450, P = 0.037) were independent predictors of mortality in CA. For all amyloid patients, log NT-proBNP (HR 3.412; 95% CI 1.484-7.845; P = 0.004) and RV-LGE (HR 4.149; 95% CI 1.623-10.607; P = 0.003) were identified as independent predictors. RVESVi and RV-LGE are independent predictors of survival and evaluation of RV by CMR enables risk stratification in patients with CA.
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Affiliation(s)
- Ke Wan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiayu Sun
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yong Luo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dan Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wei Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhi Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Clemmensen TS, Eiskjær H, Mølgaard H, Larsen AH, Soerensen J, Andersen NF, Tolbod LP, Harms HJ, Poulsen SH. Abnormal Coronary Flow Velocity Reserve and Decreased Myocardial Contractile Reserve Are Main Factors in Relation to Physical Exercise Capacity in Cardiac Amyloidosis. J Am Soc Echocardiogr 2017; 31:71-78. [PMID: 29111120 DOI: 10.1016/j.echo.2017.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the clinical importance of echocardiographic coronary flow velocity reserve (CFVR), resting and exercise left ventricular global longitudinal strain (LVGLS), and myocardial work efficiency (MWE) in patients with cardiac amyloidosis (CA). METHODS The study population comprised 69 subjects: group A, 27 patients with CA confirmed by endomyocardial biopsy (CA positive); group B, 42 healthy control subjects. The amyloid phenotype in group A was as follows: patients with wild-type transthyretin-related amyloidosis (n = 10), carriers of the Danish familial transthyretin amyloidosis mutation with cardiac involvement (n = 5), and patients with amyloid light chain amyloidosis with cardiac involvement (n = 12). All subjects underwent comprehensive echocardiographic evaluation during rest and during symptom-limited, semisupine exercise testing. Furthermore, CFVR was assessed using Doppler echocardiography. RESULTS Patients with CA had significantly lower CFVR (1.7 ± 0.6 vs 3.9 ± 0.8, P < .0001), MWE (1.9 ± 1.0 vs 3.0 ± 0.7, P < .0001), and LVGLS magnitude (11% [10%-14%] vs 20% [18%-21%], P < .0001) than control subjects. Patients with CA showed severely reduced deformation and efficiency reserve compared with control subjects (ΔLVGLS 0.9 ± 2.8% vs 5.6 ± 2.3%, P < .0001; ΔMWE 2.5 ± 2.8 vs 8.8 ± 2.6, P < .0001). In patients with CA, a strong relation was seen between physical capacity by the metabolic equivalent of tasks test and CFVR (r = 0.55, P < .01), peak exercise LVGLS (r = 0.64, P < .0001), and peak exercise MWE (r = 0.60, P < .01). CONCLUSIONS Patients with CA had a profound lack of CFVR and longitudinal myocardial deformation reserve compared with healthy control subjects. Both parameters were significantly associated with exercise capacity and may prove useful for evaluating cardiac performance in patients with CA.
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Affiliation(s)
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Henning Mølgaard
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Jens Soerensen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Skejby, Denmark
| | | | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Skejby, Denmark
| | - Hendrik J Harms
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Skejby, Denmark
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White JA, Fine NM. Recent Advances in Cardiovascular Imaging Relevant to the Management of Patients with Suspected Cardiac Amyloidosis. Curr Cardiol Rep 2017; 18:77. [PMID: 27319007 DOI: 10.1007/s11886-016-0752-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiac amyloidosis is a form of infiltrative cardiomyopathy typically presenting with progressive heart failure. The clinical presentation and morphological findings often overlap with other cardiovascular diseases, and frequently results in misdiagnosis and consequent under-reporting. Cardiovascular imaging is playing an increasingly important diagnostic and prognostic role in this referral population, and is reducing the reliance on endomyocardial biopsy as a confirmatory testing. Advancements across multiple cardiac imaging modalities, including echocardiography, magnetic resonance imaging, nuclear imaging, and computed tomography, are improving diagnostic accuracy and offering novel approaches to sub-type differentiation and prognostication. This review explores recent advancements in cardiac imaging for the diagnosis, typing, and staging of cardiac amyloidosis, with a focus on new and evolving techniques. Emphasis is also placed on the promise of non-invasive cardiac imaging to provide value across the spectrum of this clinical disease, from early disease identification (prior to the development of increased wall thickness) through to markers of advanced disease associated with early mortality.
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Affiliation(s)
- James A White
- Stephenson Cardiovascular Imaging Center, University of Calgary, Calgary, Alberta, Canada. .,Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Stephenson Cardiovascular Imaging Center, Foothills Medical Centre Suite #0700, SSB, 1403-29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada.,South Health Campus, 4448 Front Street SE, Calgary, Alberta, T3M 1M4, Canada
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Right ventricular involvement evaluated by cardiac magnetic resonance imaging predicts mortality in patients with light chain amyloidosis. Heart Vessels 2017; 33:170-179. [PMID: 28840397 PMCID: PMC5766713 DOI: 10.1007/s00380-017-1043-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/18/2017] [Indexed: 02/05/2023]
Abstract
Few studies have focused on right ventricular (RV) involvement in cardiac amyloidosis (CA). We investigated the prognostic value of RV assessment by cardiovascular magnetic resonance (CMR) in CA. In 2011–2014, consecutive patients with suspected CA referred for CMR were retrospectively evaluated. Demographic and baseline clinical characteristics were collected. Healthy volunteers were matched for sex and age and served as controls. All subjects underwent a contrast-enhanced CMR examination. RV size, function, and late gadolinium enhancement (LGE) were analyzed. All deaths during follow-up were recorded. Sixty-one patients [37 males (60.7%), age 60 ± 11 years] were included; CA was diagnosed in 47 (77.0%) patients. CA patients displayed decreased biventricular ejection fraction, elevated left ventricular mass index, and increased biventricular end-systolic volume index (ESVi) compared with controls. A total of 27 deaths (57.4%) occurred in the CA group at 21-month median follow-up. Multivariable analysis demonstrated that RVESVi (HR 1.033, 95% CI 1.004–1.063, P = 0.026) and RV-LGE (HR 2.814, 95% CI 1.063–7.450, P = 0.037) were independent predictors of mortality in CA. For all amyloid patients, log NT-proBNP (HR 3.412; 95% CI 1.484–7.845; P = 0.004) and RV-LGE (HR 4.149; 95% CI 1.623–10.607; P = 0.003) were identified as independent predictors. RVESVi and RV-LGE are independent predictors of survival and evaluation of RV by CMR enables risk stratification in patients with CA.
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Clemmensen TS, Mølgaard H, Sörensen J, Eiskjaer H, Andersen NF, Mellemkjaer S, Andersen MJ, Tolbod LP, Harms HJ, Poulsen SH. Inotropic myocardial reserve deficiency is the predominant feature of exercise haemodynamics in cardiac amyloidosis. Eur J Heart Fail 2017; 19:1457-1465. [PMID: 28836315 DOI: 10.1002/ejhf.899] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/20/2017] [Accepted: 05/02/2017] [Indexed: 11/06/2022] Open
Abstract
AIMS This study aimed to characterize invasive haemodynamics during exercise in subjects with cardiac amyloidosis (CA). METHODS AND RESULTS The study population numbered 44 subjects. Group A (CA-positive, n = 24) comprised wild-type transthyretin patients (n = 10), familial transthyretin amyloidosis mutation carriers (ATTRm) with cardiac involvement (n = 5), and light-chain amyloidosis patients with cardiac involvement (n = 9). Group B (CA-negative, n = 20) comprised four healthy ATTRm subjects without cardiac involvement documented by 11 C-PIB positron emission tomography and 16 healthy controls. All subjects underwent a symptom-limited, semi-supine exercise test with expired gas analysis and simultaneous right heart catheterization. CA patients had lower peak oxygen consumption [15 ± 6 mL/min/kg bodyweight (bwt) vs. 33 ± 7 mL/min/kg bwt; P < 0.0001] than controls. Myocardial reserve during exercise was significantly reduced in CA patients as reflected in a small increase in stroke volume index (SVI) and cardiac index (CI) compared with controls [ΔSVI: 4 mL/m2 (range: -1 to 8) vs. 14 mL/m2 (range: 5-25); P < 0.0001; ΔCI: 2 ± 2 L/min vs. 7 ± 2 L/min; P < 0.0001]. During exercise, CA patients had significantly higher left and right ventricular filling pressures than controls. Furthermore, CA patients had severely impaired pulmonary arterial compliance (PAC) compared with controls [2.9 mL/mmHg (range: 2.1-4.5) vs. 7.5 mL/mmHg (range: 5.7-10.4); P < 0.0001]. CONCLUSIONS Cardiac amyloid deposits are associated with severely reduced inotropic myocardial reserve and increased left and right ventricular filling pressures during exercise. Furthermore, CA subjects have severely reduced PAC, which may contribute to right heart failure and reduced exercise capacity.
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Affiliation(s)
| | - Henning Mølgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Sörensen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Mellemkjaer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Poulsen Tolbod
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Hendrik J Harms
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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Shah R, Nucifora G, Perry R, Selvanayagam JB. Noninvasive imaging in cardiac deposition diseases. J Magn Reson Imaging 2017; 47:44-59. [DOI: 10.1002/jmri.25720] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/16/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ranjit Shah
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park Adelaide Australia
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
| | - Gaetano Nucifora
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
- School of Medicine; Flinders University; Bedford Park Adelaide Australia
| | - Rebecca Perry
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park Adelaide Australia
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
- School of Medicine; Flinders University; Bedford Park Adelaide Australia
| | - Joseph B. Selvanayagam
- Department of Cardiovascular Medicine; Flinders Medical Centre; Bedford Park Adelaide Australia
- Department of Heart Health; South Australian Health & Medical Research Institute; Adelaide Australia
- School of Medicine; Flinders University; Bedford Park Adelaide Australia
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Cappelli F, Baldasseroni S, Bergesio F, Spini V, Fabbri A, Angelotti P, Grifoni E, Attanà P, Tarantini F, Marchionni N, Moggi Pignone A, Perfetto F. Liver dysfunction as predictor of prognosis in patients with amyloidosis: utility of the Model for End-stage Liver disease (MELD) scoring system. Intern Emerg Med 2017; 12:23-30. [PMID: 27480755 DOI: 10.1007/s11739-016-1500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/01/2016] [Indexed: 11/30/2022]
Abstract
Amyloidosis prognosis is often related to the onset of heart failure and a worsening that is concomitant with kidney-liver dysfunction; thus the Model for End-stage Liver disease (MELD) may be an ideal instrument to summarize renal-liver function. Our aim has been to test the MELD score as a prognostic tool in amyloidosis. We evaluated 128 patients, 46 with TTR-related amyloidosis and 82 with AL amyloidosis. All patients had a complete clinical and echocardiography evaluation; overall biohumoral assessment included troponin I, NT-proBNP, creatinine, total bilirubin and INR ratio. The study population was dichotomized at the 12 cut-off level of MELD scores; those with MELD score >12 had a lower survival compared to controls in the study cohort (40.7 vs 66.3 %; p = 0.006). Either as a continuous and dichotomized variable, MELD shows its independent prognostic value at multivariable analysis (HR = 1.199, 95 % CI 1.082-1.329; HR = 2.707, 95 % CI 1.075-6.817, respectively). MELD shows a lower prognostic sensitivity/specificity ratio than troponin I and NT-proBNP in the whole study population and AL subgroup, while in TTR patients MELD has a higher sensitivity/specificity ratio compared to troponin and NT-proBNP (ROC analysis-AUC: 0.853 vs 0.726 vs 0.659). MELD is able to predict prognosis in amyloidosis. A MELD score >12 selects a subgroup of patients with a higher risk of death. The predictive accuracy seems to be more evident in TTR patients in whom currently no effective scoring systems have been validated.
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Affiliation(s)
- Francesco Cappelli
- Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy.
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Samuele Baldasseroni
- Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Franco Bergesio
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Valentina Spini
- Intensive Cardiac Unit, Department of Heart and Vessels, University of Florence and Azienda Ospedaliero-Universitaria Careggi [AOUC], Largo Brambilla 3, 50134, Florence, Italy
| | - Alessia Fabbri
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Paola Angelotti
- Department of Heart and Vessels, University of Florence, Florence, Italy
| | - Elisa Grifoni
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - Paola Attanà
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - Francesca Tarantini
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Federico Perfetto
- Regional Amyloid Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Internal Medicine, University of Florence, Florence, Italy
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Graziani F, Laurito M, Pieroni M, Pennestrì F, Lanza GA, Coluccia V, Camporeale A, Pedicino D, Verrecchia E, Manna R, Crea F. Right Ventricular Hypertrophy, Systolic Function, and Disease Severity in Anderson-Fabry Disease: An Echocardiographic Study. J Am Soc Echocardiogr 2017; 30:282-291. [PMID: 28069318 DOI: 10.1016/j.echo.2016.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Right ventricular (RV) involvement has been described in Anderson-Fabry disease (AFD), especially in patients with established Fabry cardiomyopathy (FC). However, few and controversial data on RV systolic function are available, and there are no specific tissue Doppler studies. METHODS Detailed echocardiographic examinations were performed in 45 patients with AFD. FC, defined as maximal left ventricular wall thickness ≥ 15 mm, was present in 12. The Mainz Severity Score Index was calculated for each patient. Pulsed tissue Doppler was applied to the RV free wall at the tricuspid annular level and at the septal and lateral corners at the mitral annular level to obtain systolic tissue Doppler velocities (RV Sa, septal Sa, and lateral Sa, respectively). Twelve patients with amyloid light-chain cardiac amyloidosis were studied as a control group. RESULTS Echocardiography revealed RV hypertrophy (RVH) in 31% of patients with AFD, all but one of whom were male and all of whom had concomitant left ventricular hypertrophy (LVH). All patients with AFD had normal RV fractional area change (47.9 ± 6.5%) and tricuspid annular plane systolic excursion (21.7 ± 3.2 mm) and all but one also had normal RV Sa (13.2 ± 2.2 cm/sec). RVH positively correlated with indices of LVH (r = 0.8, P = .0001, for all parameters evaluated), as well as with Mainz Severity Score Index (r = 0.70, P = .0001). Septal and lateral Sa were decreased in almost all patients (means, 7.7 ± 1.8 and 7.9 ± 1.9 cm/sec, respectively), irrespective of the presence of LVH. Compared with control subjects with cardiac amyloidosis, patients with FC showed better indices of RV systolic function (P < .001 for all: tricuspid annular plane systolic excursion, RV fractional area change, and RV Sa) despite similar RV wall thickness (6.2 ± 1.2 vs 6.9 ± 1.9 mm, P = NS). CONCLUSIONS RVH is common in patients with AFD and correlates with disease severity and LVH. RVH, however, does not significantly affect RV systolic function. Patients with FC have better RV systolic function compared with those with cardiac amyloidosis with similar levels of RV thickness. The combination of low LV Sa values and normal RV Sa values might be helpful in the differential diagnosis of infiltrative heart disease.
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Affiliation(s)
- Francesca Graziani
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
| | - Marianna Laurito
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | | | - Faustino Pennestrì
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Valentina Coluccia
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging, San Donato Milanese Hospital, San Donato Milanese, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Elena Verrecchia
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Raffaele Manna
- Department of Internal Medicine, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Rocha AM, Ferreira SG, Nacif MS, Ribeiro ML, Freitas MRGD, Mesquita CT. Speckle Tracking and Transthyretin Amyloid Cardiomyopathy. Arq Bras Cardiol 2016; 108:21-30. [PMID: 27992035 PMCID: PMC5245844 DOI: 10.5935/abc.20160191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/13/2016] [Indexed: 12/12/2022] Open
Abstract
Background Amyloidosis is a disease caused by deposits of insoluble fibrils in
extracellular spaces. The most common type of familial amyloidosis is
mediated by mutation of transthyretin, especially Val30Met. Symptoms and
ejection fraction decrease may occur in cardiac amyloidosis only in case of
poor prognosis. Myocardial strain detected by two-dimensional speckle
tracking echocardiography can indicate changes in myocardial function at
early stages of the disease. Objective To determine the accuracy of left ventricular longitudinal strain by
two-dimensional speckle tracking echocardiography in patients with familial
amyloidosis caused by Val30Met transthyretin mutation. Methods Eighteen consecutive patients, carriers of transthyretin mutation, were
evaluated by two-dimensional speckle tracking echocardiography, by which
myocardial strain curves were obtained, following the American Society of
Echocardiography recommendations. Results Patients were divided into three groups: 1- Val30Met with cardiac
amyloidosis; 2-Val30Met with extracardiac amyloidosis; 3 - Val30Met without
evidence of disease. As the three groups were compared by the Mann-Whitney
test, we found a statistically significant difference between groups 1 and 2
in the mean longitudinal tension (p=0.01), mean basal longitudinal strain
(p=0.014); in mean longitudinal tension and mean longitudinal strain between
groups 1 and 3 (p=0.005); and in the ratio of longitudinal strain of apical
septum segment to longitudinal strain of basal septum (p=0.041) between
groups 2 and 3. Conclusion Left ventricular longitudinal strain detected by two-dimensional speckle
tracking echocardiography is able to diagnose left ventricular dysfunction
in early stages of familial amyloidosis caused by transthyretin Val30Met
mutation.
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Perlini S, Mussinelli R, Salinaro F. New and Evolving Concepts Regarding the Prognosis and Treatment of Cardiac Amyloidosis. Curr Heart Fail Rep 2016; 13:267-272. [PMID: 27900617 DOI: 10.1007/s11897-016-0311-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Systemic amyloidoses are rare and proteiform diseases, caused by extracellular accumulation of insoluble misfolded fibrillar proteins. Prognosis is dictated by cardiac involvement, which is especially frequent in light chain (AL) and in transthyretin variants (ATTR, both mutated, (ATTRm), and wild-type, (ATTRwt)). Recently, ATTRwt has emerged as a potentially relevant cause of a heart failure with preserved ejection fraction (HFpEF). Cardiac amyloidosis is an archetypal example of restrictive cardiomyopathy, with signs and symptoms of global heart failure and diastolic dysfunction. Independent of the aetiology, cardiac amyloidosis is associated with left ventricular concentric "hypertrophy" (i.e. increased wall thickness), preserved (or mildly depressed) ejection fraction, reduced midwall fractional shortening and global longitudinal function, as well as evident diastolic dysfunction, up to an overly restrictive pattern of the left ventricular filling. Cardiac biomarkers such as troponins and natriuretic peptides are very robust and widely accepted diagnostic as well as prognostic tools. Owing to its dismal prognosis, accurate and early diagnosis is mandatory and potentially life-saving. Although pathogenesis is still not completely understood, direct cardiomyocyte toxicity of the amyloidogenic precursor proteins and/or oligomer aggregates adds on tissue architecture disruption caused by amyloid deposition. The clarification of mechanisms of cardiac damage is offering new potential therapeutic targets, and several treatment options with a relevant impact on prognosis are now available.
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Affiliation(s)
- Stefano Perlini
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy.
- Amyloidosis Research and Treatment Center, Fondazione Policlinico IRCCS San Matteo, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy.
| | - Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy
| | - Francesco Salinaro
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100, Pavia, Italy
- Experimental Medicine PhD Program, University of Pavia, Pavia, Italy
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Bodez D, Ternacle J, Guellich A, Galat A, Lim P, Radu C, Guendouz S, Bergoend E, Couetil JP, Hittinger L, Dubois-Randé JL, Plante-Bordeneuve V, Deux JF, Mohty D, Damy T. Prognostic value of right ventricular systolic function in cardiac amyloidosis. Amyloid 2016; 23:158-167. [PMID: 27348696 DOI: 10.1080/13506129.2016.1194264] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Right ventricular (RV) dysfunction is a strong predictor of poor outcomes in heart failure. Its prognostic meaning in cardiac amyloidosis (CA) is under-investigated. METHODS Hundred and twenty nine patients with suspected CA and an interventricular septum thickness (IVST) ≥ 12 mm underwent echocardiography with measurement of left ventricular (LV) and RV longitudinal strain (LS), late gadolinium-enhancement (LGE) cardiac MRI, and standard evaluation. RESULTS Among 82 confirmed CA, types were immunoglobulin light chain (AL, n = 26), hereditary transthyretin (m-TTR, n = 37) and senile (WT-TTR, n = 19). Compared to those without, CA patients had significantly lower RV fractional shortening (RV-FS), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler systolic velocity, and global RV-LS, without any difference among the CA types. RV-LGE, observed in 62% of CA patients, was associated with lower global and basal RV-FS. Median follow-up was 8(2; 16) months. Using multivariate analysis, NYHA-class and low TAPSE independently predicted major adverse cardiac event (MACE) defined as death, heart transplantation and acute heart failure. Independent determinants of TAPSE < 14 mm, the best cut-off value, were LV ejection fraction (LVEF), estimated filling pressure (E/E'), NT-proBNP and pulmonary artery pressure, but not RV-LGE. CONCLUSIONS RV dysfunction is common in CA. Its routine evaluation by a simple TAPSE may be an aid in assessing the prognosis of CA patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jean-François Deux
- d Department of Radiology, AP-HP, Henri-Mondor Teaching Hospital, UPEC; IMRB-GRC Amyloid Research Institute , DHU A-TVB and Mondor Amyloidosis Network, Inserm U955, Inserm Clinical Investigation Center 1430 , Créteil , France , and
| | - Dania Mohty
- e Department of Cardiology, Dupuytren Hospital, CHU Limoges , Pôle Cœur-Poumon-Rein, Limoges , France
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Damy T, Jaccard A, Guellich A, Lavergne D, Galat A, Deux JF, Hittinger L, Dupuis J, Frenkel V, Rigaud C, Plante-Bordeneuve V, Bodez D, Mohty D. Identification of prognostic markers in transthyretin and AL cardiac amyloidosis. Amyloid 2016; 23:194-202. [PMID: 27647161 DOI: 10.1080/13506129.2016.1221815] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The prognosis of amyloidosis is known to depend heavily on cardiac function and may be improved by identifying patients at highest risk for adverse cardiac events. AIMS Identify predictors of mortality in patients with cardiac light-chain amyloidosis (AL), hereditary transthyretin amyloidosis (m-TTR), or wild-type transthyretin amyloidosis (WT-TTR) to prompt physician to refer these patients to dedicated centers. METHODS AND RESULTS Observational study. About 266 patients referred for suspected cardiac amyloidosis (CA) in two French university centers were included. About 198 patients had CA (AL = 118, m-TTR = 57, and WT-TTR = 23). Their median (25th-75th percentile) age, NT-proBNP left ventricular ejection fraction were, respectively, 68 years (59-76), 2339 pg mL-1 (424-5974), and 60% (48-66). About 31% were in NYHA class III-IV. Interventricular septal thickness was greater in the m-TTR and WT-TTR groups than in the AL group (p < 0.0001). Median follow-up in survivor was 26 months (15-44) and 87 (44%) patients died. By multivariate analysis, independent predictors of mortality for AL amyloidosis were the following: age, cardiac output and NT-proBNP; for TTR amyloidosis was: NT-proBNP. When all amyloidosis were combined NT-proBNP, low cardiac output and pericardial effusion were independently associated with mortality. CONCLUSION NT-proBNP is a strong prognosticator in the three types of cardiac amyloidosis. High NT-proBNP, low cardiac output, and pericardial effusion at the time of screening should prompt physician to refer the patients to amyloidosis referral center.
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Affiliation(s)
- Thibaud Damy
- a Department of Cardiology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,d Mondor Amyloidosis Network, Henri Mondor Teaching Hospital , Créteil , France.,e AP-HP, INSERM, Clinical Investigations Center 1430, Henri Mondor Teaching Hospital , Créteil , France.,f Department of Clinical Research and Public Health , Clinical Investigations Center 006, Henri Mondor Teaching Hospital , Créteil , France
| | - Arnaud Jaccard
- g Department of Cardiology , Dupuytren Teaching Hospital , Limoges , France.,h Dupuytren Teaching Hospital, AL Amyloidosis Referral Center , Limoges , France
| | - Aziz Guellich
- a Department of Cardiology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,d Mondor Amyloidosis Network, Henri Mondor Teaching Hospital , Créteil , France
| | - David Lavergne
- g Department of Cardiology , Dupuytren Teaching Hospital , Limoges , France.,h Dupuytren Teaching Hospital, AL Amyloidosis Referral Center , Limoges , France
| | - Arnault Galat
- a Department of Cardiology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,d Mondor Amyloidosis Network, Henri Mondor Teaching Hospital , Créteil , France
| | - Jean-François Deux
- a Department of Cardiology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,i Department of Radiology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France
| | - Luc Hittinger
- a Department of Cardiology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,d Mondor Amyloidosis Network, Henri Mondor Teaching Hospital , Créteil , France
| | - Jehan Dupuis
- b University Paris-East (UPEC) School of Medicine , Créteil , France.,d Mondor Amyloidosis Network, Henri Mondor Teaching Hospital , Créteil , France.,e AP-HP, INSERM, Clinical Investigations Center 1430, Henri Mondor Teaching Hospital , Créteil , France.,j Department of Hematology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France
| | - Valérie Frenkel
- b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,l Department of Immunohematolgy , AP-HP, Henri Mondor Teaching Hospital , Créteil , France
| | - Charlotte Rigaud
- g Department of Cardiology , Dupuytren Teaching Hospital , Limoges , France.,h Dupuytren Teaching Hospital, AL Amyloidosis Referral Center , Limoges , France
| | - Violaine Plante-Bordeneuve
- b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,d Mondor Amyloidosis Network, Henri Mondor Teaching Hospital , Créteil , France.,e AP-HP, INSERM, Clinical Investigations Center 1430, Henri Mondor Teaching Hospital , Créteil , France.,f Department of Clinical Research and Public Health , Clinical Investigations Center 006, Henri Mondor Teaching Hospital , Créteil , France.,k Department of Neurology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France , and
| | - Diane Bodez
- a Department of Cardiology , AP-HP, Henri Mondor Teaching Hospital , Créteil , France.,b University Paris-East (UPEC) School of Medicine , Créteil , France.,c GRC Amyloid Research Institute, IMRB INSERM U955 , Créteil , France.,d Mondor Amyloidosis Network, Henri Mondor Teaching Hospital , Créteil , France
| | - Dania Mohty
- g Department of Cardiology , Dupuytren Teaching Hospital , Limoges , France.,h Dupuytren Teaching Hospital, AL Amyloidosis Referral Center , Limoges , France
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Clemmensen TS, Eiskjaer H, Løgstrup BB, Andersen MJ, Mellemkjaer S, Poulsen SH. Echocardiographic assessment of right heart function in heart transplant recipients and the relation to exercise hemodynamics. Transpl Int 2016; 29:909-20. [DOI: 10.1111/tri.12793] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/26/2016] [Accepted: 05/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Hans Eiskjaer
- Department of Cardiology; Aarhus University Hospital; Skejby Denmark
| | | | | | - Søren Mellemkjaer
- Department of Cardiology; Aarhus University Hospital; Skejby Denmark
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69
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Surkova E, Muraru D, Iliceto S, Badano LP. The use of multimodality cardiovascular imaging to assess right ventricular size and function. Int J Cardiol 2016; 214:54-69. [DOI: 10.1016/j.ijcard.2016.03.074] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/07/2016] [Accepted: 03/19/2016] [Indexed: 12/13/2022]
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Mereles D, Aurich M, Greiner S, Riffel J, Buss SJ, Kristen AV, Katus HA. Diagnosis of cardiac involvement in systemic amyloidosis by state-of-the-art echocardiography: where are we now? Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1179573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Aurich
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Greiner
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian J. Buss
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Arnt V. Kristen
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
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Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16:233-70. [PMID: 25712077 DOI: 10.1093/ehjci/jev014] [Citation(s) in RCA: 4978] [Impact Index Per Article: 553.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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Affiliation(s)
- Roberto M Lang
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Luigi P Badano
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Victor Mor-Avi
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Jonathan Afilalo
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Anderson Armstrong
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Laura Ernande
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Frank A Flachskampf
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Elyse Foster
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Steven A Goldstein
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Tatiana Kuznetsova
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Patrizio Lancellotti
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Denisa Muraru
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Michael H Picard
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Ernst R Rietzschel
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Lawrence Rudski
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Kirk T Spencer
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Wendy Tsang
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
| | - Jens-Uwe Voigt
- Chicago, Illinois; Padua, Italy; Montreal, Quebec and Toronto, Ontario, Canada; Baltimore, Maryland; Créteil, France; Uppsala, Sweden; San Francisco, California; Washington, District of Columbia; Leuven, Liège, and Ghent, Belgium; Boston, Massachusetts
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Labombarda F, Barigou A, Legallois D, Campbell K, Bergot E, Milliez P, Saloux E. Tricuspid systolic peak velocity is a prognostic factor in patients with cystic fibrosis. Int J Cardiol 2015; 199:435-6. [DOI: 10.1016/j.ijcard.2015.07.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 07/29/2015] [Indexed: 11/28/2022]
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73
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Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1-39.e14. [PMID: 25559473 DOI: 10.1016/j.echo.2014.10.003] [Citation(s) in RCA: 8379] [Impact Index Per Article: 931.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.
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Affiliation(s)
| | | | | | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Laura Ernande
- INSERM U955 and Hôpital Henri Mondor, Créteil, France
| | | | - Elyse Foster
- University of California, San Francisco, California
| | | | | | | | | | - Michael H Picard
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Lawrence Rudski
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
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Urbano-Moral JA, Gangadharamurthy D, Comenzo RL, Pandian NG, Patel AR. Ecocardiografía speckle tracking (rastreo de marcas) tridimensional en la amiloidosis cardiaca de cadenas ligeras: estudio de los parámetros de mecánica miocárdica ventricular izquierda y derecha. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Urbano-Moral JA, Gangadharamurthy D, Comenzo RL, Pandian NG, Patel AR. Three-dimensional Speckle Tracking Echocardiography in Light Chain Cardiac Amyloidosis: Examination of Left and Right Ventricular Myocardial Mechanics Parameters. ACTA ACUST UNITED AC 2015; 68:657-64. [PMID: 26092748 DOI: 10.1016/j.rec.2015.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/30/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES The study of myocardial mechanics has a potential role in the detection of cardiac involvement in patients with amyloidosis. This study aimed to characterize 3-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics in light chain amyloidosis and examine their relationship with brain natriuretic peptide. METHODS In patients with light chain amyloidosis, left ventricular longitudinal and circumferential strain (n=40), and right ventricular longitudinal strain and radial displacement (n=26) were obtained by 3-dimensional-speckle tracking echocardiography. Brain natriuretic peptide levels were determined. RESULTS All myocardial mechanics measurements showed differences when compared by brain natriuretic peptide level tertiles. Left and right ventricular longitudinal strain were highly correlated (r=0.95, P<.001). Left ventricular longitudinal and circumferential strain were reduced in patients with cardiac involvement (-9±4 vs -16±2; P<.001, and -24±6 vs -29±4; P=.01, respectively), with the most prominent impairment at the basal segments. Right ventricular longitudinal strain and radial displacement were diminished in patients with cardiac involvement (-9±3 vs -17±3; P<.001, and 2.7±0.8 vs 3.8±0.3; P=.002). On multivariate analysis, left ventricular longitudinal strain was associated with the presence of cardiac involvement (odds ratio = 1.6; 95% confidence interval, 1.04 to 2.37; P=.03) independent of the presence of brain natriuretic peptide and troponin I criteria for cardiac amyloidosis. CONCLUSIONS Three-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics are increasingly altered as brain natriuretic peptide increases in light chain amyloidosis. There appears to be a strong association between left ventricular longitudinal strain and cardiac involvement, beyond biomarkers such as brain natriuretic peptide and troponin I.
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Affiliation(s)
- Jose Angel Urbano-Moral
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston Massachusetts, United States.
| | - Dakshin Gangadharamurthy
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston Massachusetts, United States
| | - Raymond L Comenzo
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston Massachusetts, United States
| | - Natesa G Pandian
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston Massachusetts, United States
| | - Ayan R Patel
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston Massachusetts, United States
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Lambert J, Lim SP, Dwivedi G, Beanlands R, Chih S. Cardiac Imaging of Infiltrative Cardiomyopathies. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cappelli F, Baldasseroni S, Bergesio F, Perlini S, Salinaro F, Padeletti L, Attanà P, Paoletti Perini A, Moggi Pignone A, Grifoni E, Fabbri A, Marchionni N, Gensini GF, Perfetto F. Echocardiographic and biohumoral characteristics in patients with AL and TTR amyloidosis at diagnosis. Clin Cardiol 2015; 38:69-75. [PMID: 25645201 DOI: 10.1002/clc.22353] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Few studies have analyzed the clinical and echocardiographic differences between light-chain (AL) and transthyretin (TTR) amyloidosis. HYPOTHESIS The aim of the present research was to compare, in a real-world setting, the clinical and echocardiographic profiles of these kinds of amyloidosis, at the time of diagnosis, using new-generation echocardiography. METHODS Seventy-nine patients with AL and 48 patients with TTR amyloidosis were studied. RESULTS According to the criterion of mean left ventricular (LV) thickness >12 mm, 45 AL (C-AL) and all TTR patients had cardiac amyloidotic involvement, whereas 34 AL patients did not. TTR patients had increased right ventricular (RV) and LV chambers with increased RV and LV wall thickness and reduced LV ejection fraction and fractional shortening. Furthermore, TTR patients showed lower N-terminal pro Brain Natriuretic Peptide concentrations and New York Heart Association functional class when compared with C-AL. CONCLUSIONS Our data show that at time of first diagnosis, TTR patients have a more advanced amyloidotic involvement of the heart, despite less severe symptoms and biohumoral signs of heart failure. We can hypothesize that we observed different diseases at different stages. In fact, AL amyloidosis is a multiorgan disease with quick progression rate, that becomes rapidly symptomatic, whereas TTR amyloidosis might have a slow progression rate and might remain poorly symptomatic for a greater amount of time.
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Affiliation(s)
- Francesco Cappelli
- Intensive Cardiac Care Unit, Heart and Vessel Department, University Hospital Careggi, Florence, Italy; Tuscan Regional Amyloid Center, University Hospital Careggi, Florence, Italy
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Yuda S, Hayashi T, Yasui K, Muranaka A, Ohnishi H, Hashimoto A, Ishida T, Tsuchihashi K, Shinomura Y, Watanabe N, Miura T. Pericardial Effusion and Multiple Organ Involvement Are Independent Predictors of Mortality in Patients with Systemic Light Chain Amyloidosis. Intern Med 2015; 54:1833-40. [PMID: 26234222 DOI: 10.2169/internalmedicine.54.3500] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Left ventricular (LV) functions assessed by echocardiography and cardiac biomarkers are strong predictors of mortality in patients with systemic light chain (AL) amyloidosis. However, most previous studies have been conducted in Western countries, and the predictors of mortality in Asian patients with AL amyloidosis have not been characterized. To address this issue, we aimed to determine the predictors of mortality in Asian patients with biopsy-confirmed AL amyloidosis. METHODS We retrospectively enrolled 31 patients (59±11 years, 55% men) in whom AL amyloidosis was confirmed by biopsies from cardiac or non-cardiac tissues. Of these patients, 15 (48%) met the international echocardiographic criteria for cardiac amyloidosis (mean LV wall thickness >12 mm without other causes of LV hypertrophy). RESULTS During a mean follow-up period of 21±20 months, 15 patients died. Non-survivors had a higher number of involved organs, lower e', and higher rates of E/e' >15, pericardial effusion (PE), low voltage on an electrocardiogram and a New York Heart Association (NYHA) functional class ≥ III, compared with survivors. In multivariate analysis, a NYHA functional class ≥ III (p=0.024) and cardiac involvement (p=0.032) were independent predictors of PE in patients with AL amyloidosis. Multivariate Cox proportional hazard analysis indicated that PE (hazard ratio: 21.9, p=0.025) and the number of involved organs (hazard ratio: 2.8, p=0.015), but not LV diastolic parameters of tissue Doppler echocardiography, independently predict mortality in patients with AL amyloidosis. CONCLUSION PE and multiple organ involvement, compared with e' and E/e', are stronger predictors of mortality in patients with AL amyloidosis. The advanced disease stage of AL amyloidosis might underlie the strong association between PE and a poor outcome.
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Affiliation(s)
- Satoshi Yuda
- Department of Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, Japan
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81
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Limongelli G, Rea A, Masarone D, Francalanci MP, Anastasakis A, Calabro' R, Giovanna RM, Bossone E, Elliott PM, Pacileo G. Right ventricular cardiomyopathies: a multidisciplinary approach to diagnosis. Echocardiography 2014; 32 Suppl 1:S75-94. [PMID: 25234203 DOI: 10.1111/echo.12399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The physiological importance of the right ventricle (RV) has been underestimated over the past years. Finally in the early 1950s through the 1970s, cardiac surgeons recognized the importance of RV function. Since then, the importance of RV function has been recognized in many acquired cardiac heart disease. RV can be mainly or together with left ventricle (LV) affected by inherited or acquired cardiomyopathy. In fact, RV morphological and functional remodeling occurs more common during cardiomyopathies than in ischemic cardiomyopathies and more closely parallels LV dysfunction. Moreover, there are some cardiomyopathy subtypes showing a predominant or exclusive involvement of the RV, and they are probably less known by cardiologists. The clinical approach to right ventricular cardiomyopathies is often challenging. Imaging is the first step to raise the suspicion and to guide the diagnostic process. In the differential diagnosis, cardiologists should consider athlete's heart, congenital heart diseases, multisystemic disorders, and inherited arrhythmias. However, a multiparametric and multidisciplinary approach, involving cardiologists, experts in imaging, geneticists, and pathologists with a specific expertise in these heart muscle disorders is required.
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Affiliation(s)
- Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
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82
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Di Bella G, Pizzino F, Minutoli F, Zito C, Donato R, Dattilo G, Oreto G, Baldari S, Vita G, Khandheria BK, Carerj S. The mosaic of the cardiac amyloidosis diagnosis: role of imaging in subtypes and stages of the disease. Eur Heart J Cardiovasc Imaging 2014; 15:1307-15. [PMID: 25190073 DOI: 10.1093/ehjci/jeu158] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cardiac amyloidosis is a rare, infiltrative cardiomyopathy that presents with thickened ventricular walls and progressive heart failure. The morphological findings and clinical features are shared with many other diseases (i.e. hypertrophic cardiomyopathy, 'athlete's heart,' Fabry disease, and hypertensive cardiomyopathy), and misdiagnosis occurs frequently. Cardiologists have many instruments that can help reach a correct diagnosis in a relatively short time. As tiles of a mosaic are placed to create an image, thoughtful and smart use of the different diagnostic tools available allows the opportunity to identify amyloid infiltration of the myocardium. When the myocardium is involved, prognosis is poor, so identification of its involvement is crucial for disease management. The diagnostic process begins with an accurate evaluation of clinical elements and includes cardiovascular imaging (echocardiography, magnetic resonance, and nuclear medicine), electrocardiography, serological assays, and myocardial biopsy; only the appropriate integration of these instruments can reveal the diagnosis to an expert physician. The latest improvements in non-invasive diagnostic techniques with increased diagnostic power have reduced the need for biopsy.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Fausto Pizzino
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Fabio Minutoli
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Concetta Zito
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Rocco Donato
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Giuseppe Dattilo
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Giuseppe Oreto
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Giuseppe Vita
- Department of Neurosciences, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - Scipione Carerj
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
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Affiliation(s)
- Rodney H Falk
- From the Noninvasive Cardiovascular Imaging Program, Division of Cardiology, Departments of Radiology and Medicine (S.D.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (S.D.), and Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine (C.Q., R.F., S.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Candida C Quarta
- From the Noninvasive Cardiovascular Imaging Program, Division of Cardiology, Departments of Radiology and Medicine (S.D.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (S.D.), and Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine (C.Q., R.F., S.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sharmila Dorbala
- From the Noninvasive Cardiovascular Imaging Program, Division of Cardiology, Departments of Radiology and Medicine (S.D.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (S.D.), and Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine (C.Q., R.F., S.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Cappelli F, Baldasseroni S, Bergesio F, Padeletti L, Attanà P, Pignone AM, Grifoni E, Ciuti G, Fabbri A, Tarantini F, Marchionni N, Gensini GF, Perfetto F. Biohumoral markers as predictor of right ventricular dysfunction in AL Amyloidosis. Amyloid 2014; 21:97-102. [PMID: 24517408 DOI: 10.3109/13506129.2014.884971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM In AL amyloidosis, the importance of right ventricle (RV) involvement has recently been underlined and its role in predicting prognosis has been emphasized. Little is known about the relationship between RV involvement, N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin levels. Aim of our study was to clarify the relationship between NT-proBNP and troponin and RV involvement and analyze their independent value as predictors of RV dysfunction. METHODS AND RESULTS We examined 76 consecutive patients with biopsy-proven AL amyloidosis. Each patient received complete clinical evaluation, troponin I, NT-proBNP assay and comprehensive echocardiographic evaluation. Considering a tricuspidal annulus plane systolic excursion (TAPSE) value <16 mm, 23 patients (30%) presented RV systolic dysfunction, whereas 53 (70%) did not. Patient with reduced TAPSE had thicker left ventricle (LV) walls and RV free walls, reduced LV fractional shortening, impaired LV diastolic function and worse LV and RV myocardial performance index. For RV dysfunction the best predictive value for NT-proBNP was identified as 2977 ng/l with sensitivity and specificity of 87% and 84%, respectively; best cut-off for troponin I was identified as 0.085 ng/l, with sensitivity and specificity of 85% and 90% respectively. At multivariable logistic regression analysis, both NT-proBNP and troponin I emerged as independent predictors of RV dysfunction presence but troponin appears to have a higher predictive power. CONCLUSION Our study demonstrated that cut-off values of 2977 ng/ml for NT-proBNP and 0.085 ng/l for troponin were able to identify a subgroup of AL patients with RV dysfunction. Troponin I is more accurate and seems to be the best biohumoral marker of RV dysfunction.
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Affiliation(s)
- Francesco Cappelli
- Department of Heart and Vessel, Intensive Cardiac Care Unit, AOUC , Florence , Italy
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Perlini S, Salinaro F, Cappelli F, Perfetto F, Bergesio F, Alogna A, Mussinelli R, Boldrini M, Raimondi A, Musca F, Palladini G, Merlini G. Prognostic value of fragmented QRS in cardiac AL amyloidosis. Int J Cardiol 2013; 167:2156-61. [DOI: 10.1016/j.ijcard.2012.05.097] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/16/2012] [Accepted: 05/27/2012] [Indexed: 11/16/2022]
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Cappelli F, Perlini S, Attanà P, Ciuti G, Salinaro F, Perfetto F. As we cannot afford to renounce to new generation echocardiography in systemic amyloidosis. Amyloid 2013; 20:195-6. [PMID: 23786581 DOI: 10.3109/13506129.2013.808993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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87
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Plein S, Knuuti J, Edvardsen T, Saraste A, Piérard LA, Maurer G, Lancellotti P. The year 2012 in the European Heart Journal-Cardiovascular Imaging. Part II. Eur Heart J Cardiovasc Imaging 2013; 14:613-7. [PMID: 23729757 DOI: 10.1093/ehjci/jet084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The part II of the best of the European Heart Journal - Cardiovascular Imaging in 2012 specifically focuses on studies of valvular heart diseases, heart failure, cardiomyopathies, and congenital heart diseases.
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Boldrini M, Salinaro F, Mussinelli R, Raimondi A, Alogna A, Musca F, Palladini G, Merlini G, Perlini S. Prevalence and prognostic value of conduction disturbances at the time of diagnosis of cardiac AL amyloidosis. Ann Noninvasive Electrocardiol 2013; 18:327-35. [PMID: 23879272 DOI: 10.1111/anec.12032] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the prevalence and the prognostic implications of conduction delays in a large cohort of cardiac AL patients. METHODS Echo Doppler and 12-lead ECG were collected in 344 consecutive patients in whom diagnosis of AL amyloidosis was concluded between 2008 and 2010. Patients were subdivided according to the presence (n = 240) or absence (n = 104) of cardiac involvement. RESULTS When compared with patients without myocardial involvement, cardiac AL was associated with prolonged PQ, QRS, QT and QTc intervals (P < 0.05), and with higher prevalence of intraventricular blocks (27.5% vs. 16.5%, P < 0.05), that was associated with higher wall thickness, worse diastolic and regional systolic function, higher NT-proBNP values (all P < 0.05), and higher mortality (P = 0.0001; median follow-up: 402 days). CONCLUSION Intraventricular conduction delays have a negative prognostic impact in patients with cardiac AL amyloidosis. Their presence should not be overlooked in the diagnostic workup, prompting a more accurate cardiological support.
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Affiliation(s)
- Michele Boldrini
- Clinica Medica II Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
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Mussinelli R, Salinaro F, Alogna A, Boldrini M, Raimondi A, Musca F, Palladini G, Merlini G, Perlini S. Diagnostic and prognostic value of low QRS voltages in cardiac AL amyloidosis. Ann Noninvasive Electrocardiol 2013; 18:271-80. [PMID: 23714086 DOI: 10.1111/anec.12036] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In cardiac AL amyloidosis, myocardial infiltration is typically associated with "low QRS voltages" at the 12-lead electrocardiogram (ECG). Although considered as one of the hallmarks of the disease, its reported prevalence varies from 45% to 70%, mainly because of nonhomogeneous definitions. METHODS To identify the "low QRS voltage" parameter having the best diagnostic value in identifying cardiac amyloidosis, and to assess its possible prognostic role, ECG and echocardiographic data were collected at diagnosis in 337 consecutive never-treated AL patients (233 with, 104 without cardiac involvement). Prognosis was assessed after a median follow-up of 14.5 months. RESULTS "Low QRS voltage" prevalence varied from 84.12% when using Sokolow-Lyon index ≤15 mm to 27.04% with the definition of low total voltages (QRS amplitude ≤5 mm in each peripheral and ≤10 mm in each precordial lead), the widely used definition of low peripheral voltages (≤5 mm in each peripheral lead) being able to identify 66.52% cardiac AL patients. The presence of "low peripheral voltages" was associated with a more severe cardiac involvement, and was able to differentiate Mayo stage II patients' survival (i.e., AL patients with intermediate prognosis). According to receiver operator characteristic (ROC) curve analysis, sensitivity and specificity were 58.72% and 80.00%, for a peripheral QRS amplitude ≤24.5 mm (the sum of QRS in all the 6 peripheral leads), and 76.26% and 65.00% for a Sokolow-Lyon index ≤11 mm. CONCLUSIONS In cardiac AL amyloidosis the prevalence of low QRS voltages is highly dependent on the method used for defining this ECG alteration.
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Affiliation(s)
- Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100 Pavia, Italy.
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Mussinelli R, Salinaro F, Alogna A, Boldrini M, Raimondi A, Musca F, Palladini G, Merlini G, Perlini S. Diagnostic and prognostic value of low QRS voltages in cardiac AL amyloidosis. Ann Noninvasive Electrocardiol 2013. [PMID: 23714086 DOI: 10.1111/anec.12036;10.1111/anec.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In cardiac AL amyloidosis, myocardial infiltration is typically associated with "low QRS voltages" at the 12-lead electrocardiogram (ECG). Although considered as one of the hallmarks of the disease, its reported prevalence varies from 45% to 70%, mainly because of nonhomogeneous definitions. METHODS To identify the "low QRS voltage" parameter having the best diagnostic value in identifying cardiac amyloidosis, and to assess its possible prognostic role, ECG and echocardiographic data were collected at diagnosis in 337 consecutive never-treated AL patients (233 with, 104 without cardiac involvement). Prognosis was assessed after a median follow-up of 14.5 months. RESULTS "Low QRS voltage" prevalence varied from 84.12% when using Sokolow-Lyon index ≤15 mm to 27.04% with the definition of low total voltages (QRS amplitude ≤5 mm in each peripheral and ≤10 mm in each precordial lead), the widely used definition of low peripheral voltages (≤5 mm in each peripheral lead) being able to identify 66.52% cardiac AL patients. The presence of "low peripheral voltages" was associated with a more severe cardiac involvement, and was able to differentiate Mayo stage II patients' survival (i.e., AL patients with intermediate prognosis). According to receiver operator characteristic (ROC) curve analysis, sensitivity and specificity were 58.72% and 80.00%, for a peripheral QRS amplitude ≤24.5 mm (the sum of QRS in all the 6 peripheral leads), and 76.26% and 65.00% for a Sokolow-Lyon index ≤11 mm. CONCLUSIONS In cardiac AL amyloidosis the prevalence of low QRS voltages is highly dependent on the method used for defining this ECG alteration.
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Affiliation(s)
- Roberta Mussinelli
- Clinica Medica II, Department of Internal Medicine, University of Pavia, P. le Golgi 19, 27100 Pavia, Italy.
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