51
|
Fine NM, White JA, Jimenez-Zepeda V, Howlett JG. Determinants and Prognostic Significance of Serial Right Heart Function Changes in Patients With Cardiac Amyloidosis. Can J Cardiol 2020; 36:432-440. [DOI: 10.1016/j.cjca.2020.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
|
52
|
|
53
|
Pradel S, Brun S, Victor G, Pascal P, Fournier P, Ribes D, Lavie-Badie Y, Galinier M, Carrié D, Berry I, Lairez O. Pattern of myocardial 99mTc-HMDP uptake and impact on myocardial function in patients with transthyretin cardiac amyloidosis. J Nucl Cardiol 2020; 27:96-105. [PMID: 29881913 DOI: 10.1007/s12350-018-1316-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/16/2018] [Indexed: 01/15/2023]
Abstract
AIMS The purpose of the study was to describe the pattern of 99mTc-labeled phosphate agents myocardial uptake by scintigraphy and explore its impact on left ventricular (LV) functions in transthyretin cardiac amyloidosis (TTR-CA). METHODS Fifty patients with TTR-CA underwent 99mTc- hydroxymethylene-diphosphonate (99mTc-HMDP) scintigraphy and echocardiography with measure of LV thickness, longitudinal strain (LS), systolic and diastolic functions. Cardiac retention by scintigraphy was assessed by visual scoring and the heart/whole body (H/WB) ratio was calculated by dividing counts in the heart by counts in late whole-body images. RESULTS The mean population age was 79 ± 10 years. Mean H/WB ratio was 12 ± 7. Myocardial 99mTc-HMDP uptake on segments 5, 6, 7, 8, 11, 12, 13, 14, 16, and 17 was correlated with H/WB ratio. Mean LVEF and global LS were 51 ± 10% and - 10 ± 3%, respectively. H/WB ratio was correlated with global LS (R = 0.408, P = .003), Ea (R = - 0.566, P < .001) and mean left ventricular wall thickness (R = 0.476, P < .001) but not with LVEF (R = - 0.109, P = .453). Segmental myocardial uptake was slightly correlated with segmental LS (R = 0.152, P < .001). H/WB ratio was not correlated with NT-proBNP levels (R = 0.219, P = .148) neither E/Ea ratio (R = 0.204, P = .184). CONCLUSION These findings show the relationship between bone tracer myocardial uptake and LV functions in patients with TTR cardiac amyloidosis.
Collapse
Affiliation(s)
- Sarah Pradel
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Brun
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Gérard Victor
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Pierre Pascal
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - David Ribes
- Department of Nephrology and Organ Transplantation, Rangueil University Hospital, Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Isabelle Berry
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
| |
Collapse
|
54
|
Subclinical myocardial disease in patients with primary hyperoxaluria and preserved left ventricular ejection fraction: a two-dimensional speckle-tracking imaging study. Pediatr Nephrol 2019; 34:2591-2600. [PMID: 31440827 DOI: 10.1007/s00467-019-04330-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Primary hyperoxaluria (PH) is characterized by progressive chronic kidney disease (CKD) and systemic oxalate deposition. Myocardial dysfunction might be present early in the course of the disease. However, this hypothesis has not yet been tested in the PH population. Therefore, we aimed to determine whether strain imaging using two-dimensional speckle tracking echocardiography (2D-STE) might detect subclinical myocardial disease in otherwise asymptomatic PH patients. METHODS Prospective study of pediatric and adolescent PH patients with preserved LV ejection fraction (LV EF) and without renal replacement therapy. Subjects underwent conventional echocardiography and 2D-STE. Global (GLS) and segmental peak systolic LV longitudinal strain (LS) measurements were obtained. Data were compared with age- and gender-matched controls, and Z-scores were calculated as appropriate. RESULTS Fifteen PH patients (age 14.1 ± 5.9 years; 13/15 in CKD stages 1-2) were studied. Although LV EF was preserved (63 ± 6%) in patients, GLS was significantly impaired (GLS - 17.1 ± 2.2% vs - 22.4 ± 1.9%, p < 0.001). This was mainly due to decreased LS values in the apical segments (p < 0.05). Echocardiographic indices of ventricular wall thickness were significantly increased in patients compared to controls (all p < 0.03). GLS correlated significantly with Z-scores of diastolic interventricular wall thickness (r = - 0.57, p = 0.025) and moderately with serum creatinine levels (r = 0.53, p = 0.044). No correlation was found between GLS and blood pressure measurements. CONCLUSIONS Subclinical myocardial disease is already present early in the course of disease in PH patients with preserved LV EF and some degree of renal dysfunction, but without overt systemic oxalosis. Current recommendations to screen only PH patients with advanced CKD for cardiac disease should be revised accordingly.
Collapse
|
55
|
Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol 2019; 26:2065-2123. [PMID: 31468376 DOI: 10.1007/s12350-019-01760-6] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
56
|
Traynor BP, Shamsi A, Voon V. Multi-modality imaging in transthyretin amyloid cardiomyopathy. World J Cardiol 2019; 11:266-276. [PMID: 31798793 PMCID: PMC6885447 DOI: 10.4330/wjc.v11.i11.266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 09/08/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023] Open
Abstract
Transthyretin amyloid (TTR) cardiomyopathy is a disease of insidious onset, which is often accompanied by debilitating neurological and/or cardiac complications. The true prevalence is not fully known due to its elusive presentation, being often under-recognized and usually diagnosed only late in its natural history and in older patients. Because of this, effective treatment options are usually precluded by multiple comorbidities and frailty associated with such patients. Therefore, high clinical suspicion with earlier and better detection of this disease is needed. In this review, the novel applications of multimodality imaging in the diagnostic pathway of TTR cardiomyopathy are explored. These include the complimentary roles of transthoracic echocardiography, cardiac magnetic resonance, nuclear scintigraphy and positron emission tomography in quantifying cardiac dysfunction, diagnosis and risk stratification. Recent advances in novel therapeutic options for TTR have further enhanced the importance of a timely and accurate diagnosis of this disease.
Collapse
Affiliation(s)
- Bryan Paul Traynor
- Department of Cardiology, Connolly Hospital Blanchardstown, Abbottstown, Dublin D15X40D, Ireland
| | - Aamir Shamsi
- Department of Cardiology, St George’s University Hospital NHS Foundation Trust, London SW170QT, United Kingdom
| | - Victor Voon
- Department of Cardiology, St George’s University Hospital NHS Foundation Trust, London SW170QT, United Kingdom
| |
Collapse
|
57
|
Myocardial Amyloidosis. JACC Cardiovasc Imaging 2019; 12:2345-2356. [DOI: 10.1016/j.jcmg.2019.06.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/27/2022]
|
58
|
Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging. J Card Fail 2019; 25:e1-e39. [PMID: 31473268 DOI: 10.1016/j.cardfail.2019.08.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
59
|
Prognostic impact of light-chain and transthyretin-related categories in cardiac amyloidosis: A systematic review and meta-analysis. Hellenic J Cardiol 2019; 60:375-383. [DOI: 10.1016/j.hjc.2019.01.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 12/24/2022] Open
|
60
|
Sawada N, Daimon M, Abe H, Ushiku T, Kato TS, Morita H, Komuro I. An Autopsy Case of Cardiac Amyloidosis with Heterogeneous Deposition of Amyloid Protein: A Possible Mechanism for Relative Apical Sparing of Longitudinal Strain. ACTA ACUST UNITED AC 2019; 4:54-56. [PMID: 32337388 PMCID: PMC7175792 DOI: 10.1016/j.case.2019.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Relative apical sparing of LS is useful for diagnosis of CA. Amyloid protein was greater in the basal than apical wall in a patient with ATTR-CA. Differences in amyloid load may contribute to the apical sparing phenomenon.
Collapse
Affiliation(s)
- Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masao Daimon
- Department of Clinical Laboratory, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroyuki Abe
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tomoko S Kato
- Department of Cardiovascular Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
61
|
Dorbala S, Cuddy S, Falk RH. How to Image Cardiac Amyloidosis: A Practical Approach. JACC Cardiovasc Imaging 2019; 13:1368-1383. [PMID: 31607664 DOI: 10.1016/j.jcmg.2019.07.015] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/21/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Abstract
Cardiac amyloidosis (CA) is one of the most rapidly progressive forms of heart disease, with a median survival from diagnosis, if untreated, ranging from <6 months for light chain amyloidosis to 3 to 5 years for transthyretin amyloidosis. Early diagnosis and accurate typing of CA are necessary for optimal management of these patients. Emerging novel disease modifying therapies increase the urgency to diagnose CA at an early stage and identify patients who may benefit from these life-saving therapies. The goal of this review is to provide a practical approach to echocardiography, cardiac magnetic resonance, and radionuclide imaging in patients with known or suspected CA.
Collapse
Affiliation(s)
- Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; CV Imaging Program, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sarah Cuddy
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; CV Imaging Program, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
62
|
Torii Y, Kusunose K, Yamada H, Nishio S, Hirata Y, Amano R, Yamao M, Zheng R, Saijo Y, Yamada N, Ise T, Yamaguchi K, Yagi S, Soeki T, Wakatsuki T, Sata M. Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization. J Am Soc Echocardiogr 2019; 32:1286-1297.e2. [DOI: 10.1016/j.echo.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/27/2022]
|
63
|
Tenosynovial and Cardiac Amyloidosis in Patients Undergoing Carpal Tunnel Release. J Am Coll Cardiol 2019; 72:2040-2050. [PMID: 30336828 DOI: 10.1016/j.jacc.2018.07.092] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with cardiac amyloidosis often have carpal tunnel syndrome that precedes cardiac manifestations by several years. However, the prevalence of cardiac involvement at the time of carpal tunnel surgery has not been established. OBJECTIVES The authors sought to identify the prevalence and type of amyloid deposits in patients undergoing carpal tunnel surgery and evaluate for cardiac involvement. The authors also sought to determine if patients with soft tissue transthyretin (TTR) amyloid had abnormal TTR tetramer kinetic stability. METHODS This was a prospective, cross-sectional, multidisciplinary study of consecutive men age ≥50 years and women ≥60 years undergoing carpal tunnel release surgery. Biopsy specimens of tenosynovial tissue were obtained and stained with Congo red; those with confirmed amyloid deposits were typed with mass spectrometry and further evaluated for cardiac involvement with biomarkers, electrocardiography, echocardiography with longitudinal strain, and technetium pyrophosphate scintigraphy. Additionally, serum TTR concentration and tetramer kinetic stability were examined. RESULTS Of 98 patients enrolled (median age 68 years, 51% male), 10 (10.2%) had a positive biopsy for amyloid (7 ATTR, 2 light chain [AL], 1 untyped). Two patients were diagnosed with hereditary ATTR (Leu58His and Ala81Thr), 2 were found to have cardiac involvement (1 AL, 1 ATTR wild-type), and 3 were initiated on therapy. In those patients who had biopsy-diagnosed ATTR, there was no difference in plasma TTR concentration or tetramer kinetic stability. CONCLUSIONS In a cohort of patients undergoing carpal tunnel release surgery, Congo red staining of tenosynovial tissue detected amyloid deposits in 10.2% of patients. Concomitant cardiac evaluation identified patients with involvement of the myocardium, allowing for implementation of disease-modifying therapy. (Carpal Tunnel Syndrome and Amyloid Cardiomyopathy; NCT02792790).
Collapse
|
64
|
Esposito R, Galderisi M, Santoro C, Imbriaco M, Riccio E, Maria Pellegrino A, Sorrentino R, Lembo M, Citro R, Angela Losi M, Spinelli L, Trimarco B, Pisani A. Prominent longitudinal strain reduction of left ventricular basal segments in treatment-naïve Anderson-Fabry disease patients. Eur Heart J Cardiovasc Imaging 2019; 20:438-445. [PMID: 30085001 DOI: 10.1093/ehjci/jey108] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/20/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS Little is known about regional longitudinal strain (LS) distribution in early stages of Anderson-Fabry disease (AFD) cardiomyopathy. We investigated regional left ventricular (LV) patterns of LS strain and base-to-apex behaviour of LS in treatment-naïve AFD patients. METHODS AND RESULTS Twenty-three consecutive AFD patients at diagnosis and 23 healthy controls without cardiovascular risk factors and matched for age and sex to the patients, underwent a comprehensive evaluation of target organs. An echo-Doppler exam, including determination of regional and global LS strain (GLS) was obtained. The average LS of 6 basal (BLS), 6 middle (MLS), and 5 apical (ALS) segments and relative regional strain ratio [ALS/(BLS + MLS)] were also calculated. Ejection fraction and diastolic indices did not differ between the two groups. LV mass index was greater in AFD (P < 0.01). GLS (P = 0.006), BLS (P < 0.0001), and MLS (P = 0.003), but not ALS, were lower in AFD patients and relative regional strain ratio was higher in AFD (P < 0.01) than in controls. These analyses were confirmed separately in the two genders and even after excluding patients with wall hypertrophy. By subdividing AFD patients according to lysoGB3 levels, 9 patients with lysoGB3 ≥ 1.8 ng/L had lower ALS compared to 11 patients with lysoGB3 < 1.8 ng/L (P < 0.01). CONCLUSION In naïve AFD patients, we observed an early reduction of LV LS, involving mainly LV basal myocardial segments. Nevertheless, the association found between the higher lysoGB3 levels and the lower apical cap LS demonstrates that apical segments LS, despite still normal, is not spared at diagnosis.
Collapse
Affiliation(s)
- Roberta Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Eleonora Riccio
- Department of Public Medicine, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | | | - Regina Sorrentino
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Rodolfo Citro
- Division of Cardiology, San Giovanni e Ruggi D'Aragona Hospital, Via San Leonardo, 1, Salerno, Italy
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Antonio Pisani
- Department of Public Medicine, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| |
Collapse
|
65
|
Fava AM, Meredith D, Desai MY. Clinical Applications of Echo Strain Imaging: a Current Appraisal. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:50. [PMID: 31473859 DOI: 10.1007/s11936-019-0761-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent advances in echocardiographic strain imaging, particularly in its ability to prognosticate in cardiovascular outcomes and impact clinical decision making. RECENT FINDINGS Strain has been proposed as a sensitive tool in detecting early ventricular dysfunction. Left ventricular global longitudinal strain (LV-GLS) detects subtle changes in myocardial function, often not quantifiable by ejection fraction alone. Thus, LV-GLS provides the opportunity for early decision-making, and the implementation of more effective treatments, improving outcomes in a variety of diseases such as valvular heart diseases, cardio-oncology, ischemic heart disease, cardiomyopathies, heart transplantation, and pericardial diseases and cardiomyopathies. Strain is a promising tool for the early detection of myocardial dysfunction in patients with preserved left ventricular ejection fraction and can prognosticate long-term outcomes.
Collapse
Affiliation(s)
- Agostina M Fava
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Dane Meredith
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
| |
Collapse
|
66
|
Sperry BW, Sato K, Phelan D, Grimm R, Desai MY, Hanna M, Jaber WA, Popović ZB. Regional Variability in Longitudinal Strain Across Vendors in Patients With Cardiomyopathy Due to Increased Left Ventricular Wall Thickness. Circ Cardiovasc Imaging 2019; 12:e008973. [PMID: 31412719 DOI: 10.1161/circimaging.119.008973] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cardiomyopathies with increased left ventricular wall thickness such as cardiac amyloidosis, septal hypertrophic cardiomyopathy (HCM), and apical HCM exhibit characteristic regional longitudinal strain (LS) patterns. However, between-vendor agreement of segmental and regional LS has not been tested in these diseases. We sought to assess LS values among vendors in specific cardiomyopathies that exhibit regional strain variation: cardiac amyloidosis, septal HCM, and apical HCM. METHODS This was a prospective, cross-sectional study of 69 patients (18 amyloidosis, 30 septal HCM, 6 apical HCM, and 15 controls) who underwent clinically indicated outpatient echocardiography at the Cleveland Clinic. Peak systolic segmental, regional (basal, mid, and apical), and global LS were evaluated using GE (EchoPAC), Siemens (Velocity Vector Imaging), and Phillips (QLab) systems in the same imaging session. Between-vendor, differences were analyzed using correlation coefficients, Bland Altman plots, and a mixed model. RESULTS Global LS was highly correlated among the 3 software packages and most abnormal in patients with amyloidosis (P<0.001). Regional LS analysis demonstrated that QLab software tended to produce more negative LS values, driven by differences in apical strains. EchoPAC had the greatest ability to discriminate patients with amyloidosis using regional strain values (area under the curve, 0.932) as compared with Velocity Vector Imaging and QLab (P<0.001). CONCLUSIONS Global and regional variations in LS exist between-vendors in patients with cardiomyopathies with increased left ventricular wall thickness (amyloidosis, septal HCM, and apical HCM). It is important to be aware of these differences for diagnosis, prognosis, and serial examinations in these conditions.
Collapse
Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P).,Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO (B.W.S.)
| | - Kimi Sato
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Richard Grimm
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (B.W.S., K.S., D.P., R.G., M.Y.D., M.H., W.A.J., Z.B.P)
| |
Collapse
|
67
|
Abstract
PURPOSE OF REVIEW We summarize key features pertaining to the two most commonly encountered types of cardiac amyloidosis (CA), monoclonal immunoglobulin light chain (AL) and transthyretin type (ATTR), expanding upon the clinical application and utility of various imaging techniques in diagnosing CA. RECENT FINDINGS Advances in imaging have led to earlier identification, improved diagnosis of CA and higher discriminatory power to differentiate CA from other hypertrophic phenocopies. The application of cardiac magnetic resonance imaging (CMR) has led to a deeper understanding of underlying pathophysiological processes in CA, owing largely to its intrinsic tissue characterization properties. The widespread adoption of bone scintigraphy algorithms has reduced the need for cardiac biopsy and improved diagnostic confidence in ATTR CA. As new treatments for CA are rapidly developing, there will be even greater reliance on imaging, as the requirement to diagnose disease earlier, monitor response and amend treatment strategies accordingly intensifies.
Collapse
Affiliation(s)
- Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, Rowland Hill Street, NW3 2PF, London, UK
| | - Raffaele Martone
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Center, Careggi University Hospital, Florence, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, Rowland Hill Street, NW3 2PF, London, UK
| |
Collapse
|
68
|
Park JH. Two-dimensional Echocardiographic Assessment of Myocardial Strain: Important Echocardiographic Parameter Readily Useful in Clinical Field. Korean Circ J 2019; 49:908-931. [PMID: 31456367 PMCID: PMC6753023 DOI: 10.4070/kcj.2019.0200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 01/14/2023] Open
Abstract
Echocardiography is the first and is the most-available imaging modality for many cardiovascular diseases, and echocardiographic parameters can give much important information for diagnosis, treatment, and prognostic evaluations. Left ventricular ejection fraction (LVEF) is the most commonly used echocardiographic parameter for left ventricular (LV) systolic function. Although LVEF is used routinely in daily practice, it is calculated from volumetric change without representing true myocardial properties. Recently, strain echocardiography has been used to objectively measure myocardial deformation. Myocardial strain can give accurate information about intrinsic myocardial function, and it can be used to detect early-stage cardiovascular diseases, monitor myocardial changes with specific therapies, differentiate cardiomyopathies, and predict the prognosis of several cardiovascular diseases. Although strain echocardiography has been applied to measure the right ventricle and left atrium, in addition to analyzing the LV, many cardiologists who are not imaging specialists are unaware of its clinical use and importance. Therefore, this review describes the measurement and clinical utility of 2-dimensional strain analysis in various cardiovascular diseases.
Collapse
Affiliation(s)
- Jae Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
| |
Collapse
|
69
|
Jaimes CP, Arcos LC, Carrero NE, Gelves J, Sánchez L. Miocardiopatías infiltrativas. Aporte de la ecocardiografía. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
70
|
Relative Left Ventricular Apical Sparing of Longitudinal Strain in Cardiac Amyloidosis. JACC Cardiovasc Imaging 2019; 12:1174-1176. [DOI: 10.1016/j.jcmg.2018.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 01/01/2023]
|
71
|
Moñivas Palomero V, Durante-Lopez A, Sanabria MT, Cubero JS, González-Mirelis J, Lopez-Ibor JV, Navarro Rico SM, Krsnik I, Dominguez F, Mingo AM, Hernandez-Perez FJ, Cavero G, Santos SM. Role of Right Ventricular Strain Measured by Two-Dimensional Echocardiography in the Diagnosis of Cardiac Amyloidosis. J Am Soc Echocardiogr 2019; 32:845-853.e1. [PMID: 31078369 DOI: 10.1016/j.echo.2019.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiac amyloidosis (CA) causes restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic light-chain CA (ALCA) and transthyretin-derived CA (either wild type transthyretin amyloidosis [TTRwt] or mutant transthyretin amyloidosis [TTRm]). Left ventricular (LV) apical sparing has been extensively studied using speckle-tracking echocardiography for diagnosis, but the right ventricular (RV) deformation pattern has not been described. The aims of this study were to characterize RV involvement in patients with CA and to identify parameters that may help in the differential diagnosis between ALCA and transthyretin-derived CA subtypes. METHODS Seventy-eight patients with CA (47 with ALCA, 20 with TTRwt, and 11 with TTRm) and 24 healthy control subjects were included. Global longitudinal strain (GLS) was analyzed in 16 LV and six RV segments. LV and RV apical ratios (ARs) were obtained. GLS was expressed as an absolute value. RESULTS LV GLS and free-wall RV longitudinal strain were impaired in all patients (LV GLS: 11.9 ± 2.9% in ALCA, 12.5 ± 3.8% in TTRwt, 14.9 ± 2.7% in TTRm, and 21.9 ± 2.6% in control subjects [P < .01]; free-wall RV longitudinal strain: 13.1 ± 6.8%, 14.9 ± 4.5%, 17.2 ± 3.4%, and 22.1 ± 3.1%, respectively [P < .01]). LV and RV ARs were higher in ALCA compared with both TTRwt, TTRm, and control subjects (LV AR: 1.1 ± 0.2, 0.8 ± 0.2, 0.9 ± 0.1, and 0.7 ± 0.1, respectively [P < .001]; RV AR: 1.1 ± 0.2, 0.6 ± 0.2, 0.6 ± 0.1, and 0.6 ± 0.1, respectively [P < .001]). Cutoff values of LV AR > 0.96 and RV AR > 0.8 showed high accuracy to differentiate between ALCA and transthyretin-derived CA. CONCLUSIONS RV dysfunction is common in patients with CA. Analysis of RV strain showed an apical sparing pattern, as previously described in the left ventricle, with a higher AR as a specific finding in patients with ALCA. RV AR may be a parameter that can differentiate the subtypes of amyloidosis on the basis of speckle-tracking echocardiographic analysis.
Collapse
Affiliation(s)
- Vanessa Moñivas Palomero
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | | | - Mario Torres Sanabria
- Cardiology Department, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Javier Segovia Cubero
- Department of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Jesús González-Mirelis
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Jorge Vazquez Lopez-Ibor
- Department of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Sara M Navarro Rico
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Isabel Krsnik
- Hematology, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Alejandro Martinez Mingo
- Methodology and Statistics, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Francisco J Hernandez-Perez
- Department of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Gibanel Cavero
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Susana Mingo Santos
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain.
| |
Collapse
|
72
|
Abstract
Heart failure is a clinical syndrome with a broad spectrum of presentations. Cardiovascular imaging techniques such as echocardiography, cardiovascular magnetic resonance, computed tomography, and nuclear imaging play a crucial role in diagnosis, guiding management, and providing prognostic information. Each of these imaging modalities has their own respective strengths and weaknesses. Cardiac imaging can help differentiate between ischemic and nonischemic cardiomyopathies. Additionally, imaging techniques can display disease-specific findings, aiding in diagnosis of nonischemic cardiomyopathies and can provide a means to monitor response to therapy. The choice of imaging modality in the workup of cardiomyopathy should be based on the specific clinical question and the knowledge of the strengths and limitations of each imaging modality.
Collapse
Affiliation(s)
- Kate Rankin
- Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
| | - Babitha Thampinathan
- Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
| | - Paaladinesh Thavendiranathan
- Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, University of Toronto, 4N-490, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada.
| |
Collapse
|
73
|
|
74
|
Wan K, Li W, Sun J, Xu Y, Wang J, Liu H, Dong Y, Cheng W, Zhang Q, Zeng Z, Zhou X, Han Y, Chen Y. Regional amyloid distribution and impact on mortality in light-chain amyloidosis: a T1 mapping cardiac magnetic resonance study. Amyloid 2019; 26:45-51. [PMID: 30931628 DOI: 10.1080/13506129.2019.1578742] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND T1 mapping allows quantitative assessment of "diffuse" deposition of amyloid protein in the myocardium. Early detection of cardiac involvement and potential prognostic improvement could benefit patients with AL amyloidosis. OBJECTIVES This study aims to evaluate the regional variation of amyloid infiltration in the left ventricle and the prognostic value of T1 mapping in patients with AL amyloidosis. METHODS We prospectively enrolled 77 patients with AL amyloidosis who underwent cardiac magnetic resonance on a 3.0-T scanner. Native T1 and extracellular volume (ECV) were quantitated on the basal, mid, and apical levels of the left ventricle. Late gadolinium enhancement (LGE) pattern (no or non-specific LGE, sub-endocardial LGE, and transmural LGE) was also assessed. Forty healthy subjects served as controls. The primary end point was all-cause mortality. RESULTS Basal ECV (26.9 ± 2.8% versus 31.1 ± 4.9%, p < .001) were lower than apical ECV in the healthy controls; however, basal ECV (60.6 ± 11.5% versus 53.0 ± 9.6%, p = .003) were significantly higher than apical ECV in patients with transmural LGE. During the follow-up period (median duration, 28 months; 25th-75th percentile, 13.5-38.0 months), 46 patients died. Basal ECV has the largest area under the curve of 0.845 (95% CI, 0.747-0.917) to predict all-cause mortality. Multivariable Cox analysis indicated that basal ECV was an independent prognostic factor and showed incremental prognostic value beyond NYHA class, Mayo stage, and LGE pattern. CONCLUSION We demonstrated that T1 mapping may have the potential to detect a characteristic amyloid deposition with a decreasing gradient from base to apex. Furthermore, myocardial ECV indicated that basal amyloid infiltration provided robust and incremental prognostic value in patients with AL amyloidosis.
Collapse
Affiliation(s)
- Ke Wan
- a Department of Geriatrics , West China Hospital, Sichuan University , Chengdu , China
| | - Weihao Li
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Jiayu Sun
- c Department of Radiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Yuanwei Xu
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Jie Wang
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Hong Liu
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Yang Dong
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Wei Cheng
- c Department of Radiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Qing Zhang
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Zhi Zeng
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| | - Xiaoyue Zhou
- d Northeast Asia MR Collaboration , Siemens Healthcare , Shanghai , China
| | - Yuchi Han
- e Cardiovascular Division, Department of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | - Yucheng Chen
- b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China
| |
Collapse
|
75
|
Correction to: Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation: A Single-Center Study of Over 7000 Cases. Circ Cardiovasc Imaging 2019; 12:e000025. [PMID: 30866649 DOI: 10.1161/hci.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
76
|
Tang CX, Petersen SE, Sanghvi MM, Lu GM, Zhang LJ. Cardiovascular magnetic resonance imaging for amyloidosis: The state-of-the-art. Trends Cardiovasc Med 2019; 29:83-94. [DOI: 10.1016/j.tcm.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 01/01/2023]
|
77
|
Agha AM, Parwani P, Guha A, Durand JB, Iliescu CA, Hassan S, Palaskas NL, Gladish G, Kim PY, Lopez-Mattei J. Role of cardiovascular imaging for the diagnosis and prognosis of cardiac amyloidosis. Open Heart 2018; 5:e000881. [PMID: 30305910 PMCID: PMC6173267 DOI: 10.1136/openhrt-2018-000881] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/01/2018] [Accepted: 08/31/2018] [Indexed: 12/26/2022] Open
Abstract
Cardiac amyloidosis (CA) describes the pathological process of amyloid protein deposition in the extracellular space of the myocardium. Unfortunately, the diagnosis of CA is often made late and when the disease process is advanced. However, advances in cardiovascular imaging have allowed for better prognostication and establishing diagnostic pathways with high sensitivity and specificity. This review discusses the role of echocardiography, cardiac MRI and nuclear cardiology in current clinical practice for diagnosis and prognosis of CA.
Collapse
Affiliation(s)
- Ali M Agha
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Purvi Parwani
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Avirup Guha
- Division of Cardiovascular Medicine, Ohio State University, Columbus, Ohio, USA
| | - Jean B Durand
- Cardiology Department, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cezar A Iliescu
- Cardiology Department, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Saamir Hassan
- Cardiology Department, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolas L Palaskas
- Cardiology Department, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Greg Gladish
- Diagnostic Radiology Department, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Peter Y Kim
- Cardiology Department, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Juan Lopez-Mattei
- Cardiology Department, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Diagnostic Radiology Department, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
78
|
Fikrle M, Palecek T, Marek J, Kuchynka P, Linhart A. Simplified apical four-chamber view evaluation of relative apical sparing of longitudinal strain in diagnosing AL amyloid cardiomyopathy. Echocardiography 2018; 35:1764-1771. [PMID: 30225879 DOI: 10.1111/echo.14132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/20/2018] [Accepted: 08/05/2018] [Indexed: 01/20/2023] Open
Abstract
AIM OF THE STUDY To assess the diagnostic utility of a simplified approach to relative apical sparing of longitudinal strain (RAS LS) using only an apical four-chamber view (A4C) in patients with AL amyloid cardiomyopathy (ALAC). METHODS We retrospectively evaluated echocardiographic recordings of 20 patients with ALAC, 20 patients with Fabry disease-related cardiomyopathy (FD), and 20 patients with concentric hypertensive left ventricular hypertrophy (HLVH) matched for mean LV mean thickness. Peak segmental LS values of the interventricular septum and lateral LV wall were measured in the A4C using two-dimensional speckle-tracking echocardiography. RAS LS was calculated as average apical LS/(average basal LS + average midventricular LS). RESULTS Relative apical sparing of longitudinal strain values in patients with ALAC (1.23 ± 0.64) were significantly higher than those in FD patients (0.75 ± 0.19, P < 0.05) as well as in individuals with HLVH (0.75 ± 0.23, P < 0.05), but with a significant overlap. The optimal RAS LS value differentiating ALAC from FD and HLVH with 70% sensitivity and 75% specificity was 0.88 (AUC 0.79). In multivariate modeling, RAS LS was significantly additive to traditional predictors of ALAC (low QRS voltage and pseudoinfarct ECG patterns, pericardial effusion, E/e' ratio, E-wave deceleration time; P < 0.05 for all models). CONCLUSIONS Simplified RAS LS evaluation represents an attractive approach for diagnostics of ALAC. However, because of considerable overlap with other disorders with hypertrophic phenotype, the analysis of RAS LS in the A4C should be combined with other traditional echocardiographic and ECG predictors in differentiating ALAC from other forms of concentric LV wall thickening.
Collapse
Affiliation(s)
- Michal Fikrle
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Palecek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Josef Marek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Kuchynka
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| |
Collapse
|
79
|
Loncaric F, Bijnens B, Sitges M. Added value of cardiac deformation imaging in differential diagnosis of left ventricular hypertrophy. Glob Cardiol Sci Pract 2018; 2018:21. [PMID: 30393633 PMCID: PMC6209440 DOI: 10.21542/gcsp.2018.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Filip Loncaric
- Cardiovascular Institute, Hospital Clínic, University of Barcelona & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
| | - Bart Bijnens
- Universitat Pompeu Fabra, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, University of Barcelona & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
| |
Collapse
|
80
|
Vranian MN, Sperry BW, Hanna M, Hachamovitch R, Ikram A, Brunken RC, Jaber WA. Technetium pyrophosphate uptake in transthyretin cardiac amyloidosis: Associations with echocardiographic disease severity and outcomes. J Nucl Cardiol 2018; 25:1247-1256. [PMID: 28050864 DOI: 10.1007/s12350-016-0768-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/05/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Quantitative uptake of Technetium 99 m-pyrophosphate (TcPYP) is sensitive and specific for diagnosing transthyretin cardiac amyloidosis (ATTR). We sought to examine the association between TcPYP uptake intensity and echocardiographic measures of disease severity and clinical outcomes. METHODS AND RESULTS A retrospective analysis was performed of 75 patients who underwent TcPYP scintigraphy. Planar images were evaluated semiquantitatively and using heart-to-contralateral lung (H/CL) ratio. The associations between H/CL ratio and echocardiographic parameters and outcomes were evaluated using linear regression and Cox models, respectively. There were 48 patients diagnosed with ATTR with mean H/CL ratio 1.58 ± 0.22 (vs 1.08 ± 0.09 if semiquantitative score = 0). The H/CL ratio was not associated with any measured echocardiographic parameter. Both semiquantitative uptake grade and H/CL ratio were associated with all-cause mortality (P = 0.009 and 0.007, respectively) and all-cause mortality or heart failure hospitalization (P = 0.001 and 0.020, respectively); however, neither were associated with outcomes when limited to patients with confirmed ATTR (P = 0.18 and 0.465, respectively). CONCLUSION In patients with suspected ATTR, quantitative and semiquantitative uptake intensity of TcPYP is associated with all-cause mortality as well as all-cause mortality or heart failure hospitalization. However, in those with confirmed ATTR, there is no association with echocardiographic disease severity or outcomes.
Collapse
Affiliation(s)
- Michael N Vranian
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Brett W Sperry
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Asad Ikram
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Richard C Brunken
- Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| |
Collapse
|
81
|
Kusunose K, Okushi Y, Yamada H, Nishio S, Torii Y, Hirata Y, Saijo Y, Ise T, Yamaguchi K, Yagi S, Soeki T, Wakatsuki T, Sata M. Prognostic Value of Frailty and Diastolic Dysfunction in Elderly Patients. Circ J 2018; 82:2103-2110. [DOI: 10.1253/circj.cj-18-0017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Yuichiro Okushi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Susumu Nishio
- Ultrasound Examination Center, Tokushima University Hospital
| | - Yuta Torii
- Ultrasound Examination Center, Tokushima University Hospital
| | - Yukina Hirata
- Ultrasound Examination Center, Tokushima University Hospital
| | - Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital
| |
Collapse
|
82
|
Wan K, Sun J, Yang D, Liu H, Wang J, Cheng W, Zhang Q, Zeng Z, Zhang T, Greiser A, Jolly MP, Han Y, Chen Y. Left Ventricular Myocardial Deformation on Cine MR Images: Relationship to Severity of Disease and Prognosis in Light-Chain Amyloidosis. Radiology 2018; 288:73-80. [PMID: 29664336 DOI: 10.1148/radiol.2018172435] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose To measure left ventricular (LV) myocardial strain with cine magnetic resonance (MR) imaging and a deformable registration algorithm (DRA) and to assess the prognostic value of myocardial strain in patients with light-chain (AL) amyloidosis. Materials and Methods In this prospective study, 78 consecutive patients with AL amyloidosis who underwent contrast material-enhanced cardiac MR imaging were enrolled at West China Hospital. LV myocardial strains and late gadolinium enhancement (LGE) were evaluated. Association between myocardial strain and all-cause mortality was analyzed with the stepwise Cox regression model. Results Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly lower in the no or nonspecific LGE group compared with the subendocardial LGE and transmural LGE groups (mean GLS, -10% ± 3 [standard deviation] vs -7% ± 3 vs -4% ± 1; P < .001) (mean GCS, -13% ± 3 vs -11% ± 3 vs -7% ± 2; P < .001). GLS and GCS were reduced in patients without clinical cardiac amyloidosis (mean GLS, -13% ± 3 vs -16% ± 2; P = .005) (mean GCS, -16% ± 1 vs -19% ± 2; P = .02). Circumferential and radial strains were impaired in basal segments in accordance with the distribution of LGE. Multivariate Cox analysis revealed that GCS (hazard ratio [HR] = 1.16 per 1% absolute decrease; 95% confidence interval [CI]: 1.03, 1.31; P = .02) and the presence of transmural LGE (HR = 1.75; 95% CI: 1.10, 2.80; P = .02) were independent predictors of all-cause mortality after adjustment for LV ejection fraction, right ventricular ejection fraction, LV mass index, GLS, and global radial strain. Conclusion Strain parameters derived with cine MR imaging-based DRA may be a new noninvasive imaging marker with which to evaluate the extent of cardiac amyloid infiltration and may offer independent prognostic information for all-cause mortality in patients with AL amyloidosis.
Collapse
Affiliation(s)
- Ke Wan
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Jiayu Sun
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Dan Yang
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Hong Liu
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Jie Wang
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Wei Cheng
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Qing Zhang
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Zhi Zeng
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Tianjing Zhang
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Andreas Greiser
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Marie-Pierre Jolly
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yuchi Han
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| | - Yucheng Chen
- From the Departments of Cardiology (K.W., D.Y., H.L., J.W., Q.Z., Z.Z., Y.C.) and Radiology (J.S., W.C.), West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan 610041, P. R. China; Siemens Healthineers Northeast Asia Collaboration, Beijing, China (T.Z.); Siemens Healthineers, Erlangen, Germany (A.G.); Siemens Healthineers, Medical Imaging Technologies, Princeton, NJ (M.P.J.); and Department of Medicine, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pa (Y.H.)
| |
Collapse
|
83
|
|
84
|
Abstract
The heart, like any organ in the body, is susceptible to amyloid deposition. Although more than 30 types of protein can cause amyloidosis, only two types commonly deposit in the ventricular myocardium: amyloid light chain and amyloid transthyretin. Amyloid cardiomyopathy is usually a major determinant of patient outcomes, and the diagnosis of heart involvement can be often relatively under-diagnosed, owing to nonspecific presenting symptoms and signs at a subclinical stage. The diagnosis of cardiac amyloidosis is usually performed by endomyocardial biopsy; however, the invasive nature and related high-risk complications restrict its wide use in clinical settings. Recently, with the advent of innovative techniques used for evaluating cardiac amyloidosis, noninvasive methods become increasingly important, especially in earlier diagnosis, distinguishing typing, risk prediction and response to treatment. Here, we will review recent developments in the noninvasive methods used in the assessment of cardiac amyloidosis, focused on the laboratory biomarkers and imaging modalities.
Collapse
Affiliation(s)
- Lei Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China.
| |
Collapse
|
85
|
Predictors of Prognosis in Light-Chain Amyloidosis and Chronological Changes in Cardiac Morphology and Function. Am J Cardiol 2017; 120:2041-2048. [PMID: 28947306 DOI: 10.1016/j.amjcard.2017.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 11/22/2022]
Abstract
Immune light-chain (AL) amyloidosis with cardiac involvement is associated with a high mortality despite improved therapeutic regimens, but there are few reports on prognostic predictors and chronological changes in cardiac morphology and function. Prognosis and its predictors were evaluated in 36 consecutive patients with cardiac AL amyloidosis. Chronological changes in cardiac morphology and function were also evaluated. The median follow-up period was 0.95 years. The median survival time and the 3-year death-free rate after diagnosis in all-cause and cardiac deaths were 0.85 and 1.06 years and 26% and 36%, respectively. Differences in the median survival time due to left ventricular (LV) wall thickness at diagnosis were not evident. Being female and diastolic wall strain (DWS), as a measure of diastolic stiffness, were independent predictors of all-cause death in the multivariable analysis. The receiver operating characteristic analysis revealed that a DWS cut-off value of 0.189 had a sensitivity of 78% and a specificity of 72% for predicting all-cause death within 1 year after diagnosis (area under the curve = 0.726). The LV size and the stroke volume decreased and DWS worsened during the short-term follow-up period in patients who died within 1 year compared with patients who were alive after 1 year. The prognosis for patients with cardiac AL amyloidosis was poor, and DWS may be a significant predictor of prognosis. Narrowing of the LV cavity and progressive diastolic dysfunction were evident in patients with a poor prognosis.
Collapse
|
86
|
Sperry BW, Vranian MN, Tower-Rader A, Hachamovitch R, Hanna M, Brunken R, Phelan D, Cerqueira MD, Jaber WA. Regional Variation in Technetium Pyrophosphate Uptake in Transthyretin Cardiac Amyloidosis and Impact on Mortality. JACC Cardiovasc Imaging 2017; 11:234-242. [PMID: 28917675 DOI: 10.1016/j.jcmg.2017.06.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/12/2017] [Accepted: 06/16/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to investigate the regional uptake of technetium 99m-pyrophosphate (TcPYP) in transthyretin cardiac amyloidosis (ATTR) and its association with mortality. BACKGROUND TcPYP nuclear scintigraphy is a diagnostic and prognostic tool in ATTR. Echocardiography has identified a pattern of regional variation in longitudinal strain (LS) with a gradient of improved strain from base to apex in ATTR. METHODS Consecutive patients with ATTR were evaluated who underwent TcPYP nuclear scintigraphy with planar and attenuation corrected single-photon emission computed tomography (SPECT). Heart-to-contralateral lung (H/CL) ratio was calculated on planar images, and left ventricular (LV) uptake was determined in each of the 17 segments using SPECT. A measure of apical-sparing of myocardial TcPYP uptake, termed the apical-sparing ratio (ASR), was calculated as basal + mid / apical counts. RESULTS Overall, 54 patients with ATTR (age 78 ± 9 years, 76% male, 31% hereditary ATTR) were analyzed. There was increased TcPYP uptake in basal and mid relative to apical LV segments, and an apical-sparing LS pattern on echocardiography. The right ventricle similarly showed greater uptake in basal segments. There were 26 deaths over 1.8 years median follow-up. The ASR of TcPYP uptake was associated with age-adjusted all-cause mortality (p = 0.013) with worse prognosis seen at levels <2.75. Global LS was also prognostic (p = 0.01), whereas H/CL ratio and total LV uptake indexed to blood pool were not (p = 0.772 and p = 0.850, respectively). The prognostic utility of the ASR persisted in multivariable modeling (p = 0.003), whereas global LS did not. CONCLUSIONS There is decreased TcPYP uptake in apical as compared to mid and basal segments in the LV, mimicking apical-sparing LS seen on echocardiography. Regional distribution of LV TcPYP uptake is associated with mortality, whereas overall amount of uptake as measured by H/CL ratio and indexed LV SPECT uptake is not.
Collapse
Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Michael N Vranian
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Albree Tower-Rader
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Richard Brunken
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manuel D Cerqueira
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
87
|
Siepen FAD, Bauer R, Voss A, Hein S, Aurich M, Riffel J, Mereles D, Röcken C, Buss SJ, Katus HA, Kristen AV. Predictors of survival stratification in patients with wild-type cardiac amyloidosis. Clin Res Cardiol 2017; 107:158-169. [DOI: 10.1007/s00392-017-1167-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/19/2017] [Indexed: 11/28/2022]
|
88
|
Falk RH, Dorbala S. Apical to Base Gradient of Technetium-99m Pyrophosphate Myocardial Counts in Cardiac Amyloidosis: An Insight Into the Mechanism of Myocardial Strain Gradient, or Merely "Clouds That Mimic Land Before the Sailor's Eye?". JACC Cardiovasc Imaging 2017; 11:243-246. [PMID: 28917690 DOI: 10.1016/j.jcmg.2017.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Rodney H Falk
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, Massachusetts; Cardiovascular Imaging Program, Departments of Medicine and Radiology, and Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
89
|
Ritts AJ, Cornell RF, Swiger K, Singh J, Goodman S, Lenihan DJ. Current Concepts of Cardiac Amyloidosis: Diagnosis, Clinical Management, and the Need for Collaboration. Heart Fail Clin 2017; 13:409-416. [PMID: 28279425 DOI: 10.1016/j.hfc.2016.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiac amyloidosis is a complex and vexing clinical condition that requires a high degree of suspicion for the diagnosis with a substantial amount of discipline to discern the extent of disease and the best available therapy. There is a complex interplay between multiple organ systems, and the clinical presentation may involve a myriad of confusing clinical symptoms. The diagnosis of cardiac amyloidosis can be confirmed with a combination of physical findings, cardiac biomarkers, noninvasive testing, and, if necessary, myocardial biopsy. Genetic testing is critical to establish the type of amyloidosis.
Collapse
Affiliation(s)
- Alexandra J Ritts
- Department of Internal Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, Suite 5209, Nashville, TN 37232, USA
| | - Robert F Cornell
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, Suite 5209, Nashville, TN 37232, USA
| | - Kris Swiger
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, Suite 5209, Nashville, TN 37232, USA
| | - Jai Singh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, Suite 5209, Nashville, TN 37232, USA
| | - Stacey Goodman
- Division of Hematology and Oncology, Department of Internal Medicine, Vanderbilt University School of Medicine, 1215 21st Avenue South, Suite 5209, Nashville, TN 37232, USA
| | - Daniel J Lenihan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 5209, Nashville, TN 37232, USA.
| |
Collapse
|
90
|
Williams LK, Forero JF, Popovic ZB, Phelan D, Delgado D, Rakowski H, Wintersperger BJ, Thavendiranathan P. Patterns of CMR measured longitudinal strain and its association with late gadolinium enhancement in patients with cardiac amyloidosis and its mimics. J Cardiovasc Magn Reson 2017; 19:61. [PMID: 28784140 PMCID: PMC5545847 DOI: 10.1186/s12968-017-0376-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/18/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Regional variability of longitudinal strain (LS) has been previously described with echocardiography in patients with cardiac amyloidosis (CA), however, the reason for this variability is not completely evident. We sought to describe regional patterns in LS using feature-tracking software applied to cardiovascular magnetic resonance (CMR) cine images in patients with CA, hypertrophic cardiomyopathy (HCM), and Anderson-Fabry's disease (AFD) and to relate these patterns to the distribution of late gadolinium enhancement (LGE). METHODS Patients with CA (n = 45) were compared to LV mass indexed matched patients with HCM (n = 19) and AFD (n = 19). Peak systolic LS measurements were obtained using Velocity Vector Imaging (VVI) software on CMR cine images. A relative regional LS ratio (RRSR) was calculated as the ratio of the average of the apical segmental LS divided by the sum of the average basal and mid-ventricular segmental LS. LGE was quantified for the basal, mid, and apical segments using a threshold of 5SD above remote myocardium. A regional LGE ratio was calculated similar to RRSR. RESULTS Patients with CA had significantly had worse global LS (-15.7 ± 4.6%) than those with HCM (-18.0 ± 4.6%, p = 0.046) and AFD (-21.9 ± 5.1%, p < 0.001). The RRSR was higher in patients with CA (1.00 ± 0.31) than in AFD (0.79 ± 0.24; p = 0.018) but not HCM (0.84 ± 0.32; p = 0.114). In CA, a regional difference in LGE burden was noted, with lower LGE in the apex (31.5 ± 19.1%) compared to the mid (38.2 ± 19.0%) and basal (53.7 ± 22.7%; p < 0.001 for both) segments. The regional LGE ratio was not significantly different between patients with CA (0.33 ± 0.15) and AFD (0.47 ± 0.58; p = 0.14) but lower compared to those with HCM (0.72 ± 0.43; p < 0.0001). LGE percentage showed a significant impact on LS (p < 0.0001), with a 0.9% decrease in absolute LS for every 10% increase in LGE percentage. CONCLUSION The presence of marked "relative apical sparing" of LS along with a significant reduction in global LS seen in patients with CA on CMR cine analysis may provide an additional tool to differentiate CA from other cause of LVH. The concomitant presence of a base to apex gradient in quantitative LGE burden suggests that the regional strain gradient may be at least partially explained by the burden of amyloid deposition and fibrosis.
Collapse
MESH Headings
- Adult
- Aged
- Amyloidosis/diagnostic imaging
- Amyloidosis/pathology
- Amyloidosis/physiopathology
- Biomechanical Phenomena
- Cardiomyopathies/diagnostic imaging
- Cardiomyopathies/pathology
- Cardiomyopathies/physiopathology
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/pathology
- Cardiomyopathy, Hypertrophic/physiopathology
- Contrast Media/administration & dosage
- Fabry Disease/diagnostic imaging
- Fabry Disease/pathology
- Fabry Disease/physiopathology
- Female
- Fibrosis
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/physiopathology
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Observer Variation
- Organometallic Compounds/administration & dosage
- Predictive Value of Tests
- Reproducibility of Results
- Retrospective Studies
- Software
- Stress, Mechanical
- Ventricular Function, Left
- Ventricular Remodeling
Collapse
Affiliation(s)
- Lynne K. Williams
- Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Julian F. Forero
- Department of Radiology and Diagnostic Imaging, Center for Excellence in Cardiovascualr Imaging, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
- Department of Medical Imaging, University Health Network, Toronto, Canada
| | - Zoran B. Popovic
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Dermot Phelan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH USA
| | - Diego Delgado
- Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | | | - Paaladinesh Thavendiranathan
- Division of Cardiology, Peter Munk Cardiac Center, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
- Department of Medical Imaging, University Health Network, Toronto, Canada
| |
Collapse
|
91
|
Siddiqi OK, Ruberg FL. Cardiac amyloidosis: An update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med 2017; 28:10-21. [PMID: 28739313 DOI: 10.1016/j.tcm.2017.07.004] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 12/20/2022]
Abstract
The amyloidoses are a group of systemic diseases characterized by organ deposition of misfolded protein fragments of diverse origins. The natural history of the disease, involvement of other organs, and treatment options vary significantly based on the protein of origin. In AL amyloidosis, amyloid protein is derived from immunoglobulin light chains, and most often involves the kidneys and the heart. ATTR amyloidosis is categorized as mutant or wild-type depending on the genetic sequence of the transthyretin (TTR) protein produced by the liver. Wild-type ATTR amyloidosis mainly involves the heart, although the reported occurrence of bilateral carpal tunnel syndrome, spinal stenosis and biceps tendon rupture in these patients speaks to more generalized protein deposition. Mutant TTR is marked by cardiac and/or peripheral nervous system involvement. Cardiac involvement is associated with symptoms of heart failure, and dictates the clinical course of the disease. Cardiac amyloidosis can be diagnosed noninvasively by echocardiography, cardiac MRI, or nuclear scintigraphy. Endomyocardial biopsy may be needed in the case of equivocal imaging findings or discordant data. Treatment is aimed at relieving congestive symptoms and targeting the underlying amyloidogenic process. This includes anti-plasma cell therapy in AL amyloidosis, and stabilization of the TTR tetramer or inhibition of TTR protein production in ATTR amyloidosis. Cardiac transplantation can be considered in highly selected patients in tandem with therapy aimed at suppressing the amyloidogenic process, and appears associated with durable long-term survival.
Collapse
Affiliation(s)
- Omar K Siddiqi
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 88 East Newton Street, Boston, MA; Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 88 East Newton Street, Boston, MA; Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA; Department of Radiology, Boston University School of Medicine, Boston Medical Center, Boston, MA.
| |
Collapse
|
92
|
Cariou E, Bennani Smires Y, Victor G, Robin G, Ribes D, Pascal P, Petermann A, Fournier P, Faguer S, Roncalli J, Rousseau H, Chauveau D, Carrié D, Berry I, Galinier M, Lairez O. Diagnostic score for the detection of cardiac amyloidosis in patients with left ventricular hypertrophy and impact on prognosis. Amyloid 2017; 24:101-109. [PMID: 28553897 DOI: 10.1080/13506129.2017.1333956] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Among diagnosis associated with left ventricular hypertrophy (LVH), cardiac amyloidosis (CA) is a progressive disease with poor prognosis. Early noninvasive identification is of growing clinical importance. The objective of our study was to integrate clinical, biologic, electrocardiographic and echocardiographic parameters to build a diagnostic score in patients with LVH. METHODS AND RESULTS One hundred and fourteen patients with LVH underwent a cardiac magnetic resonance (CMR) and a 99mTc-hydroxymethylene-diphosphonate scintigraphy (99mTc-HMDP) allowing to discriminate three groups of diagnoses: CA (n = 50 including 31, 18 and 1 ATTR, AL and AA amyloidosis), hypertrophic cardiomyopathy (n = 19) and unspecific cardiomyopathy (n = 45). Seven continuous variables associated with CA (systolic arterial pressure <130 mmHg; PR duration >200 ms; Sokolow index <12 mV; diastolic left ventricular posterior thickness >13 mm; E/Ea ratio >10; global longitudinal strain > -12% and sum of basal longitudinal strain > -47%) were selected and dichotomized according to the best cutoff value to build the diagnostic score, which was validated in an independent cohort of 34 patients with LVH from aortic stenosis. The area under the ROC curve for the diagnosis of CA using the score was 0.933 (95%CI 0.889-0.978). The best cut off value for the score was 3 leading to a sensitivity of 90% and specificity of 81%. Area under the ROC curve for the score was 0.932 in the validation cohort. A diagnostic score >3 was associated with a poorest prognosis. CONCLUSION An integrated evaluation of 6 diagnostic factors including arterial blood pressure, ECG and echocardiographic parameters to build a diagnostic score is a simple and easily method to discriminate the 3 main CA in patients with LVH.
Collapse
Affiliation(s)
- Eve Cariou
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France
| | | | - Gérard Victor
- c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France
| | - Guillaume Robin
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France
| | - David Ribes
- d Department of Nephrology and Referral Center for Rare Diseases , University Hospital of Rangueil , Toulouse , France
| | - Pierre Pascal
- b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France
| | - Antoine Petermann
- b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,e Department of Radiology , University Hospital of Rangueil , Toulouse , France
| | - Pauline Fournier
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France
| | - Stanislas Faguer
- d Department of Nephrology and Referral Center for Rare Diseases , University Hospital of Rangueil , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Jérôme Roncalli
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Hervé Rousseau
- e Department of Radiology , University Hospital of Rangueil , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
| | - Dominique Chauveau
- d Department of Nephrology and Referral Center for Rare Diseases , University Hospital of Rangueil , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Didier Carrié
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,f Medical School of Purpan , University Paul Sabatier , Toulouse , France
| | - Isabelle Berry
- b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
| | - Michel Galinier
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
| | - Olivier Lairez
- a Department of Cardiology , University Hospital of Rangueil , Toulouse , France.,b Cardiac Imaging Center Toulouse University Hospital , Toulouse , France.,c Department of Nuclear Medicine , Toulouse University Hospital , Toulouse , France.,g Medical School of Rangueil , University Paul Sabatier , Toulouse , France
| | | |
Collapse
|
93
|
Castaño A, Manson DK, Maurer MS, Bokhari S. Transthyretin Cardiac Amyloidosis in Older Adults: Optimizing Cardiac Imaging to the Corresponding Diagnostic and Management Goal. CURRENT CARDIOVASCULAR RISK REPORTS 2017; 11:17. [PMID: 29057029 PMCID: PMC5648026 DOI: 10.1007/s12170-017-0541-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Transthyretin cardiac amyloidosis is increasingly recognized as an important cause of heart failure in older adults. Many cardiac imaging modalities have evolved to evaluate transthyretin cardiac amyloidosis and include 2D echocardiography with tissue Doppler and speckle-strain imaging, nuclear scintigraphy, cardiac magnetic resonance imaging, and positron emission tomography. The purpose of this review is to highlight the optimal selection of advanced cardiac imaging techniques with corresponding diagnostic goals including raising suspicion, making an early diagnosis, and subtyping transthyretin cardiac amyloid, as well as management goals including assessment of ventricular impairment, prognosticating, and monitoring disease progression. Potential benefits of optimizing cardiac imaging in the elderly patient with transthyretin cardiac amyloidosis may include enhanced and earlier diagnosis and refined long-term management. RECENT FINDINGS Advances in cardiac imaging techniques are changing diagnostic and management algorithms for transthyretin cardiac amyloidosis. SUMMARY With a new era of novel therapeutics, enhanced recognition, and earlier diagnosis approaching, selecting the appropriate non-invasive cardiac imaging modality will be essential for optimal care in the elderly patient with transthyretin cardiac amyloidosis.
Collapse
Affiliation(s)
- Adam Castaño
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, Laboratory of Nuclear Cardiology, New York, NY 10032-3784, USA,
| | - Daniel K Manson
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, New York, NY 10032-3784, USA
| | - Mathew S Maurer
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Center for Advanced Cardiac Care, New York, NY 10032-3784, USA
| | - Sabahat Bokhari
- Columbia University College of Physicians & Surgeons, Division of Cardiology, Laboratory of Nuclear Cardiology, New York, NY 10032-3784, USA
| |
Collapse
|
94
|
Maurer MS, Elliott P, Comenzo R, Semigran M, Rapezzi C. Addressing Common Questions Encountered in the Diagnosis and Management of Cardiac Amyloidosis. Circulation 2017; 135:1357-1377. [PMID: 28373528 PMCID: PMC5392416 DOI: 10.1161/circulationaha.116.024438] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Advances in cardiac imaging have resulted in greater recognition of cardiac amyloidosis in everyday clinical practice, but the diagnosis continues to be made in patients with late-stage disease, suggesting that more needs to be done to improve awareness of its clinical manifestations and the potential of therapeutic intervention to improve prognosis. Light chain cardiac amyloidosis, in particular, if recognized early and treated with targeted plasma cell therapy, can be managed very effectively. For patients with transthyretin amyloidosis, there are numerous therapies that are currently in late-phase clinical trials. In this review, we address common questions encountered in clinical practice regarding etiology, clinical presentation, diagnosis, and management of cardiac amyloidosis, focusing on recent important developments in cardiac imaging and biochemical diagnosis. The aim is to show how a systematic approach to the evaluation of suspected cardiac amyloidosis can impact the prognosis of patients in the modern era.
Collapse
Affiliation(s)
- Mathew S Maurer
- From Columbia University Medical Center, New York, NY (M.S.M.); University College London and St. Bartholomew's Hospital, UK (P.E.); Tufts Medical Center, Boston, MA (R.C.); Massachusetts General Hospital, Harvard University, Boston (M.S.); and Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.R.).
| | - Perry Elliott
- From Columbia University Medical Center, New York, NY (M.S.M.); University College London and St. Bartholomew's Hospital, UK (P.E.); Tufts Medical Center, Boston, MA (R.C.); Massachusetts General Hospital, Harvard University, Boston (M.S.); and Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.R.)
| | - Raymond Comenzo
- From Columbia University Medical Center, New York, NY (M.S.M.); University College London and St. Bartholomew's Hospital, UK (P.E.); Tufts Medical Center, Boston, MA (R.C.); Massachusetts General Hospital, Harvard University, Boston (M.S.); and Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.R.)
| | - Marc Semigran
- From Columbia University Medical Center, New York, NY (M.S.M.); University College London and St. Bartholomew's Hospital, UK (P.E.); Tufts Medical Center, Boston, MA (R.C.); Massachusetts General Hospital, Harvard University, Boston (M.S.); and Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.R.)
| | - Claudio Rapezzi
- From Columbia University Medical Center, New York, NY (M.S.M.); University College London and St. Bartholomew's Hospital, UK (P.E.); Tufts Medical Center, Boston, MA (R.C.); Massachusetts General Hospital, Harvard University, Boston (M.S.); and Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.R.)
| |
Collapse
|
95
|
Sperry BW, Tang WHW. Amyloid heart disease: genetics translated into disease-modifying therapy. Heart 2017; 103:812-817. [DOI: 10.1136/heartjnl-2016-309914] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 11/04/2022] Open
|
96
|
Abstract
OPINION STATEMENT Infiltrative heart disease is caused by the deposition of abnormal substances in the heart and can lead to abnormalities in cardiac function and electrical conduction. Advances in non-invasive cardiovascular imaging have allowed for improved diagnosis of infiltrative heart disease, as well as ways to track disease progression or regression, thus enabling a mechanism to follow response to therapy. In this review, we provide an overview of the role of imaging in the diagnosis and management of cardiac sarcoidosis (CS) and cardiac amyloidosis (CA), as well as outline a proposed algorithm for using non-invasive cardiovascular imaging for evaluating these conditions.
Collapse
|
97
|
Collier P, Phelan D, Klein A. A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography. J Am Coll Cardiol 2017; 69:1043-1056. [DOI: 10.1016/j.jacc.2016.12.012] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 12/22/2022]
|
98
|
Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Justin L Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|