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Hu K, Liu D, Salinger T, Oder D, Knop S, Ertl G, Weidemann F, Frantz S, Störk S, Nordbeck P. Value of cardiac biomarker measurement in the differential diagnosis of infiltrative cardiomyopathy patients with preserved left ventricular systolic function. J Thorac Dis 2018; 10:4966-4975. [PMID: 30233871 DOI: 10.21037/jtd.2018.07.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to explore the value of cardiac biomarker [serum high sensitive troponin T (hs-TNT) and N-terminal pro-brain natriuretic peptide (NT-proBNP)] measurement in the differential diagnosis of infiltrative cardiomyopathy patients [Friedreich's ataxia (FA), Fabry disease (FD) and light-chain (AL) cardiac amyloidosis (CA)] with preserved left ventricular (LV) systolic function. Methods Between 2012 and 2014, all consecutive patients presenting at our center with infiltrative cardiomyopathy and concomitant symmetrical LV hypertrophy as well as preserved LV systolic function were included in this study. Serum hs-TNT and NT-proBNP, morphologic and functional features derived from echocardiography and cardiac magnetic resonance imaging (cMRI) examinations were compared among these patients. Results A total of 57 patients (FA 20, FD 23 and CA 14) were included. Hs-TNT and NT-proBNP levels were significantly higher in the CA group [median: hs-TNT 98 pg/mL, NT-proBNP 4,110 pg/mL] than in the FA group [hs-TNT 14 pg/mL, NT-proBNP 40 pg/mL] and FD group [hs-TNT 18 pg/mL, NT-proBNP 131 pg/mL, both P<0.001]. There was a negative correlation between NT-proBNP and estimated glomerular filtration rate (eGFR) in CA patients (r=-0.72, P=0.012). Both hs-TNT >60 pg/mL (sensitivity 0.79, specificity 0.93) and NT-proBNP >1,000 pg/mL (sensitivity 0.91, specificity 0.93) excellently differentiated CA from FA and FD. Conclusions Increased hs-TNT and NT-proBNP levels are suggestive of CA diagnosis among patients with infiltrative cardiomyopathy and preserved LV ejection fraction.
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Affiliation(s)
- Kai Hu
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Dan Liu
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Tim Salinger
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Knop
- Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Medizinische Klinik I des Klinikum Vest, Recklinghausen, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
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Pagourelias ED, Mirea O, Vovas G, Duchenne J, Michalski B, Van Cleemput J, Bogaert J, Vassilikos VP, Voigt JU. Relation of regional myocardial structure and function in hypertrophic cardiomyopathy and amyloidois: a combined two-dimensional speckle tracking and cardiovascular magnetic resonance analysis. Eur Heart J Cardiovasc Imaging 2018; 20:426-437. [DOI: 10.1093/ehjci/jey107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/12/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Efstathios D Pagourelias
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, University County Hospital of Craiova, 1 Tabaci Str, Craiova, Romania
| | - Georgios Vovas
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Blazej Michalski
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Van Cleemput
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
| | - Vasilios P Vassilikos
- Third Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Str, Thessaloniki, Greece
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Catholic University Leuven, Herestraat 49, Leuven, Belgium
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Salinaro F, Meier-Ewert HK, Miller EJ, Pandey S, Sanchorawala V, Berk JL, Seldin DC, Ruberg FL. Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis. Eur Heart J Cardiovasc Imaging 2018; 18:1057-1064. [PMID: 27965280 DOI: 10.1093/ehjci/jew298] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/07/2016] [Indexed: 11/14/2022] Open
Abstract
Aims To determine whether echocardiographic longitudinal systolic strain (LS) parameters identify short-term improvement following chemotherapy for light-chain (AL) cardiac amyloidosis (CA). Among patients with CA, standard echocardiographic measures are commonly unchanged at 1 year following successful chemotherapy, despite observed reductions in cardiac biomarkers. Methods and results We retrospectively identified 61 patients with AL-CA treated with high-dose melphalan or bortezomib-based regimens. Patients were classified by hematologic response at 1 year into two groups: complete response (CR; n = 18, or 30%) or non-CR (non-CR; n = 43, or 70%), and followed for 20 months. Serum free light chains (FLC), B-type natriuretic peptide (BNP), troponin I (TnI), and echocardiography including LS, were acquired at baseline and 1 year. Seven patients died (11.5%), all in the non-CR group (P < 0.01). At 1 year, while reductions were observed in BNP (44% CR, 18% non-CR) and FLC (94% CR, 73% non-CR), both P < 0.05 from baseline, there were no differences in wall thickness, EF, or diastolic function in either group. LS improved only in the CR group with notable improvement in apical to basal strain ratio (P < 0.05). Strain improvement and BNP reduction were correlated (R = 0.6, P < 0.01). Baseline global LS < -10.2% was associated with survival and proved superior to BNP and TnI. The addition of global LS to biomarkers identified the patients at highest risk of mortality. Conclusion These data suggest that LS is a sensitive measure of pre-treatment cardiac functional impairment in AL-CA, can predict survival over and above that of cardiac biomarkers, and detect early cardiac functional improvement following chemotherapy.
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Affiliation(s)
- Francesco Salinaro
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Department of Internal Medicine, Experimental Medicine PhD program, University of Pavia School of Medicine, Pavia, Italy
| | - Hans K Meier-Ewert
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine Boston, Boston Medical Center, 88 E Newton St., Boston, MA 02118, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shivda Pandey
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Vaishali Sanchorawala
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - John L Berk
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - David C Seldin
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Frederick L Ruberg
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine Boston, Boston Medical Center, 88 E Newton St., Boston, MA 02118, USA
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104
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Gual-Capllonch F, Teis A, Ferrer E, Bayes-Genis A. Evolutive echocardiographic changes in cardiac amyloidosis: Look at the whole picture. Echocardiography 2018; 35:1042-1044. [DOI: 10.1111/echo.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Albert Teis
- Heart Institute; Hospital Universitari Germans Trias i Pujol; Badalona Spain
| | - Elena Ferrer
- Heart Institute; Hospital Universitari Germans Trias i Pujol; Badalona Spain
| | - Antoni Bayes-Genis
- Heart Institute; Hospital Universitari Germans Trias i Pujol; Badalona Spain
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105
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Siddiqi OK, Sanchorawala V, Ruberg FL. Echocardiography and Survival in Light Chain Cardiac Amyloidosis: Back to Basics. Circ Cardiovasc Imaging 2018; 11:e007826. [PMID: 29752394 DOI: 10.1161/circimaging.118.007826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Omar K Siddiqi
- Section of Cardiovascular Medicine, Department of Medicine (O.K.S., F.L.R.).,Amyloidosis Center (O.K.S., V.S., F.L.R.)
| | - Vaishali Sanchorawala
- Amyloidosis Center (O.K.S., V.S., F.L.R.).,Division of Hematology and Oncology, Department of Medicine (V.S)
| | - Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine (O.K.S., F.L.R.) .,Amyloidosis Center (O.K.S., V.S., F.L.R.).,and Department of Radiology (F.L.R.), Boston University School of Medicine, Boston Medical Center, MA
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Tuzovic M, Yang EH, Baas AS, Depasquale EC, Deng MC, Cruz D, Vorobiof G. Cardiac Amyloidosis: Diagnosis and Treatment Strategies. Curr Oncol Rep 2018; 19:46. [PMID: 28528458 DOI: 10.1007/s11912-017-0607-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac amyloidosis in the United States is most often due to myocardial infiltration by immunoglobulin protein, such as in AL amyloidosis, or by the protein transthyretin, such as in hereditary and senile amyloidosis. Cardiac amyloidosis often portends a poor prognosis especially in patients with systemic AL amyloidosis. Despite better understanding of the pathophysiology of amyloid, many patients are still diagnosed late in the disease course. This review investigates the current understanding and new research on the diagnosis and treatment strategies in patients with cardiac amyloidosis. Myocardial amyloid infiltration distribution occurs in a variety of patterns. Structural and functional changes on echocardiography can suggest presence of amyloid, but CMR and nuclear imaging provide important complementary information on amyloid burden and the amyloid subtype, respectively. While for AL amyloid, treatment success largely depends on early diagnosis, for ATTR amyloid, new investigational agents that reduce production of transthyretin protein may have significant impact on clinical outcomes. Advancements in the non-invasive diagnostic detection and improvements in early disease recognition will undoubtedly facilitate a larger proportion of patients to receive early therapy when it is most effective.
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Affiliation(s)
- Mirela Tuzovic
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Arnold S Baas
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Eugene C Depasquale
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Mario C Deng
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Daniel Cruz
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. .,Cardiovascular Center, 100 Medical Plaza, Suite 545, 100 UCLA Medical Plaza, Los Angeles, CA, 90095, USA.
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108
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Inciardi RM, Galderisi M, Nistri S, Santoro C, Cicoira M, Rossi A. Echocardiographic advances in hypertrophic cardiomyopathy: Three-dimensional and strain imaging echocardiography. Echocardiography 2018; 35:716-726. [DOI: 10.1111/echo.13878] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Riccardo M. Inciardi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
| | - Maurizio Galderisi
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | - Stefano Nistri
- Cardiology Service; CMSR-Veneto Medica; Altavilla Vicentina Italy
| | - Ciro Santoro
- Departement of Advanced Biomedical Science; Federico II University; Naples Italy
| | | | - Andrea Rossi
- Division of Cardiology; Department of Medicine; University of Verona; Verona Italy
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109
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Potter E, Marwick TH. Assessment of Left Ventricular Function by Echocardiography. JACC Cardiovasc Imaging 2018; 11:260-274. [DOI: 10.1016/j.jcmg.2017.11.017] [Citation(s) in RCA: 279] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 12/13/2022]
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Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment-A Systematic Review. Radiol Res Pract 2017; 2017:2874902. [PMID: 29270320 PMCID: PMC5705874 DOI: 10.1155/2017/2874902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/02/2017] [Indexed: 12/19/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.
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111
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White JA, Fine NM. Recent Advances in Cardiovascular Imaging Relevant to the Management of Patients with Suspected Cardiac Amyloidosis. Curr Cardiol Rep 2017; 18:77. [PMID: 27319007 DOI: 10.1007/s11886-016-0752-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiac amyloidosis is a form of infiltrative cardiomyopathy typically presenting with progressive heart failure. The clinical presentation and morphological findings often overlap with other cardiovascular diseases, and frequently results in misdiagnosis and consequent under-reporting. Cardiovascular imaging is playing an increasingly important diagnostic and prognostic role in this referral population, and is reducing the reliance on endomyocardial biopsy as a confirmatory testing. Advancements across multiple cardiac imaging modalities, including echocardiography, magnetic resonance imaging, nuclear imaging, and computed tomography, are improving diagnostic accuracy and offering novel approaches to sub-type differentiation and prognostication. This review explores recent advancements in cardiac imaging for the diagnosis, typing, and staging of cardiac amyloidosis, with a focus on new and evolving techniques. Emphasis is also placed on the promise of non-invasive cardiac imaging to provide value across the spectrum of this clinical disease, from early disease identification (prior to the development of increased wall thickness) through to markers of advanced disease associated with early mortality.
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Affiliation(s)
- James A White
- Stephenson Cardiovascular Imaging Center, University of Calgary, Calgary, Alberta, Canada. .,Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Stephenson Cardiovascular Imaging Center, Foothills Medical Centre Suite #0700, SSB, 1403-29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada.,South Health Campus, 4448 Front Street SE, Calgary, Alberta, T3M 1M4, Canada
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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.
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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.
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113
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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.
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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
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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.
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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
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Pagourelias ED, Mirea O, Duchenne J, Van Cleemput J, Delforge M, Bogaert J, Kuznetsova T, Voigt JU. Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis: A Head-to-Head Comparison of Deformation and Nondeformation Parameters. Circ Cardiovasc Imaging 2017; 10:e005588. [PMID: 28298286 DOI: 10.1161/circimaging.116.005588] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND A plethora of echo parameters has been suggested for distinguishing cardiac amyloidosis (CA) from other causes of myocardial thickening with, however, scarce data on their head-to-head comparison. This study aimed at comparing the diagnostic accuracy of various deformation and conventional echo parameters in differentiating CA from other hypertrophic substrates, especially in the gray zone of mild hypertrophy (maximum wall thickness ≤16 mm) or normal ejection fraction (EF). METHODS AND RESULTS =0.0002, respectively) independent of the CA type. CONCLUSIONS Our study demonstrated that in patients with thickened hearts, EF global longitudinal strain ratio has the best accuracy in detecting CA, even among the most "challenging" patient subgroups as those with mild hypertrophy and normal EF.
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Affiliation(s)
- Efstathios D Pagourelias
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Oana Mirea
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Jürgen Duchenne
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Johan Van Cleemput
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Michel Delforge
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Jan Bogaert
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Tatyana Kuznetsova
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium
| | - Jens-Uwe Voigt
- From the Departments of Cardiovascular Diseases (E.D.P., O.M., J.D., J.V.C., J.-U.V.), Hematology (M.D.), Radiology (J.B.), Cardiovascular Sciences (T.K.), University Hospital Leuven, Catholic University Leuven, Belgium.
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116
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Liu D, Hu K, Herrmann S, Cikes M, Ertl G, Weidemann F, Störk S, Nordbeck P. Value of tissue Doppler-derived Tei index and two-dimensional speckle tracking imaging derived longitudinal strain on predicting outcome of patients with light-chain cardiac amyloidosis. Int J Cardiovasc Imaging 2017; 33:837-845. [PMID: 28265790 PMCID: PMC5406485 DOI: 10.1007/s10554-017-1075-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/13/2017] [Indexed: 12/29/2022]
Abstract
Prognosis of patients with light-chain cardiac amyloidosis (AL-CA) is poor. Speckle tracking imaging (STI) derived longitudinal deformation parameters and Doppler-derived left ventricular (LV) Tei index are valuable predictors of outcome in patients with AL-CA. We estimated the prognostic utility of Tei index and deformation parameters in 58 comprehensively phenotyped patients with AL-CA after a median follow-up of 365 days (quartiles 121, 365 days). The primary end point was all-cause mortality. 19 (33%) patients died during follow-up. Tei index (0.89 ± 0.29 vs. 0.61 ± 0.16, p < 0.001) and E to global early diastolic strain rate ratio (E/GLSRdias) were higher while global longitudinal systolic strain (GLSsys) was lower in non-survivors than in survivors (all p < 0.05). Tei index, NYHA functional class, GLSsys and E/GLSRdias were independent predictors of all-cause mortality risk, and Tei index ≥0.9 (HR 7.01, 95% CI 2.43–20.21, p < 0.001) was the best predictor of poor outcome. Combining Tei index and GLSsys yielded the best results on predicting death within 1 year (100% with Tei index ≥0.9 and GLSsys ≤13%) or survival (95% with Tei index ≤0.9 and GLSsys ≥13%). We conclude that 1-year mortality risk in AL-CA patients can be reliably predicted using Tei index or deformation parameters, with combined analysis offering best performance.
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Affiliation(s)
- Dan Liu
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Kai Hu
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Sebastian Herrmann
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Maja Cikes
- Department for Cardiovascular Diseases, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | | | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. .,Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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117
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Labombarda F, Saloux E, Milesi G, Bienvenu B. Loss of base-to-apex circumferential strain gradient: A specific pattern of Fabry cardiomyopathy? Echocardiography 2017; 34:504-510. [DOI: 10.1111/echo.13496] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Eric Saloux
- Department of Cardiology; Caen CHU; Caen France
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118
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Affiliation(s)
- Frederick L. Ruberg
- From the Section of Cardiovascular Medicine, Department of Medicine, and Department of Radiology, Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, MA
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119
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Ono K, Ishimaru G, Hayashi M, Bae Y, Ito T, Izumo T, Murata K. The Imaging Diagnosis of Less Advanced Cases of Cardiac Amyloidosis: The Relative Apical Sparing Pattern. Intern Med 2017; 56:315-319. [PMID: 28154276 PMCID: PMC5348456 DOI: 10.2169/internalmedicine.56.7610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
An early diagnosis is important for improving the prognosis of cardiac amyloidosis (CA). We herein describe the utility of two-dimensional speckle tracking echocardiography (2-D STE) in diagnosing CA at a less advanced stage. A 63-year-old woman with exertional dyspnea was suspected of having CA based on her echocardiographic and electrocardiographic findings. A myocardial biopsy was negative for amyloid deposits, while the relative apical sparing pattern was detected on 2-D STE, which was highly suggestive of CA. Chemotherapy was initiated as a treatment for CA, and the patient's symptoms were immediately relieved. Thereafter, amyloid deposits were detected in a skin biopsy specimen.
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Affiliation(s)
- Koya Ono
- Department of Hematology, Soka Municipal Hospital, Japan
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120
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Liu D, Hu K, Nordbeck P, Ertl G, Störk S, Weidemann F. Longitudinal strain bull's eye plot patterns in patients with cardiomyopathy and concentric left ventricular hypertrophy. Eur J Med Res 2016; 21:21. [PMID: 27165726 PMCID: PMC4862218 DOI: 10.1186/s40001-016-0216-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/02/2016] [Indexed: 02/06/2023] Open
Abstract
Despite substantial advances in the imaging techniques and pathophysiological understanding over the last decades, identification of the underlying causes of left ventricular hypertrophy by means of echocardiographic examination remains a challenge in current clinical practice. The longitudinal strain bull’s eye plot derived from 2D speckle tracking imaging offers an intuitive visual overview of the global and regional left ventricular myocardial function in a single diagram. The bull’s eye mapping is clinically feasible and the plot patterns could provide clues to the etiology of cardiomyopathies. The present review summarizes the longitudinal strain, bull’s eye plot features in patients with various cardiomyopathies and concentric left ventricular hypertrophy and the bull’s eye plot features might serve as one of the cardiac workup steps on evaluating patients with left ventricular hypertrophy.
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Affiliation(s)
- Dan Liu
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Kai Hu
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Comprehensive Heart Failure Center, Würzburg, Germany. .,Innere Klinik II, Medical Clinic II, Katharinen-Hospital, Obere Husemannstraße 2, 59423, Unna, Germany.
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121
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Mereles D, Aurich M, Greiner S, Riffel J, Buss SJ, Kristen AV, Katus HA. Diagnosis of cardiac involvement in systemic amyloidosis by state-of-the-art echocardiography: where are we now? Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1179573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Aurich
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian Greiner
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Sebastian J. Buss
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Arnt V. Kristen
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Heidelberg, Germany
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122
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Pagourelias ED, Duchenne J, Mirea O, Vovas G, Van Cleemput J, Delforge M, Kuznetsova T, Bogaert J, Voigt JU. The Relation of Ejection Fraction and Global Longitudinal Strain in Amyloidosis: Implications for Differential Diagnosis. JACC Cardiovasc Imaging 2016; 9:1358-1359. [PMID: 26897665 DOI: 10.1016/j.jcmg.2015.11.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/29/2022]
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123
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Wang Q, Gao Y, Tan K, Xia H, Li P. Assessment of left ventricular function by three-dimensional speckle-tracking echocardiography in well-treated type 2 diabetes patients with or without hypertension. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:502-511. [PMID: 25801852 DOI: 10.1002/jcu.22268] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 01/19/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The aims of this study were to investigate the myocardial deformation in well-treated type 2 diabetes patients with or without hypertension using three-dimensional speckle-tracking echocardiography and to explore variables that could affect myocardial deformation. METHODS We studied 82 patients with type 2 diabetes and controlled blood glucose, including 46 subjects with diabetes alone and 36 subjects with diabetes and well-controlled hypertension, and 40 age- and gender-matched controls. Left ventricular real-time three-dimensional (3D) full-volume images were recorded and analyzed using online software. The left ventricular ejection fraction, global longitudinal strain (GLS), global circumferential strain, global area strain, and global radial strain were measured and compared. RESULTS Despite a similar three-dimensional left ventricular ejection fraction, GLS was significantly lower in patients with diabetes only than in controls (p < 0.001). Patients with diabetes and hypertension showed significantly lower systolic strains in all directions than controls and patients with diabetes only (p < 0.001 and p < 0.05, respectively). Multiple regression analysis revealed that fasting plasma glucose and left ventricular end-diastolic volume were significant factors influencing GLS in both diabetic groups. CONCLUSIONS Early-stage diabetic patients showed an impaired left ventricular strain that was worsened by coexistent hypertension, although blood glucose and blood pressure were well controlled. Three-dimensional speckle-tracking echocardiography was able to detect these subclinical changes.
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Affiliation(s)
- Qingqing Wang
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Yunhua Gao
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Kaibin Tan
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Hongmei Xia
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
| | - Peijing Li
- Department of Ultrasound, Xinqiao Hospital, The Third Military Medical University, Chongqing, China
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124
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Danhof S, Schreder M, Rasche L, Strifler S, Einsele H, Knop S. ‘Real-life’ experience of preapproval carfilzomib-based therapy in myeloma - analysis of cardiac toxicity and predisposing factors. Eur J Haematol 2015; 97:25-32. [DOI: 10.1111/ejh.12677] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Sophia Danhof
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Wuerzburg University Medical Center; Wuerzburg Germany
| | - Martin Schreder
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Wuerzburg University Medical Center; Wuerzburg Germany
| | - Leo Rasche
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Wuerzburg University Medical Center; Wuerzburg Germany
| | - Susanne Strifler
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Wuerzburg University Medical Center; Wuerzburg Germany
| | - Hermann Einsele
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Wuerzburg University Medical Center; Wuerzburg Germany
| | - Stefan Knop
- Division of Hematology and Medical Oncology; Department of Internal Medicine; Wuerzburg University Medical Center; Wuerzburg Germany
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125
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Kwong RY, Heydari B, Abbasi S, Steel K, Al-Mallah M, Wu H, Falk RH. Characterization of Cardiac Amyloidosis by Atrial Late Gadolinium Enhancement Using Contrast-Enhanced Cardiac Magnetic Resonance Imaging and Correlation With Left Atrial Conduit and Contractile Function. Am J Cardiol 2015; 116:622-9. [PMID: 26076990 DOI: 10.1016/j.amjcard.2015.05.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 12/25/2022]
Abstract
The diagnosis of cardiac amyloidosis (CA) often necessitates invasive myocardial biopsy. We sought to evaluate whether late gadolinium enhancement (LGE) of the atrial myocardium by cardiac magnetic resonance imaging was associated with impaired left atrial (LA) function and whether the extent of LA LGE may enhance diagnostic differentiation of CA from other cardiomyopathies. Twenty-two patients with biopsy-proven CA, 37 with systemic hypertension (SH), and 22 with nonischemic dilated cardiomyopathy (NIDC) underwent cardiac magnetic resonance imaging and echocardiographic evaluation. Patients with CA had greater minimal LA volume (57 ± 53 vs 24 ± 18 in SH and 19 ± 25% in NIDC, p = 0.003), and significantly lower total LA emptying function (19 ± 14 vs 40 ± 14 in SH and 33 ± 20% in NIDC, p = 0.0006). The mean proportion of atrial enhancement (LGELA%) was significantly greater in patients with CA than with SH and NIDC (59 ± 36% vs 7.4 ± 2.1 and 2.9 ± 9.0%, p <0.0001, respectively). There was also a strong inverse correlation between both active and total atrial emptying (r = -0.69, p = 0.001; r = -0.67, p = 0.01, respectively) with LGELA% for patients with CA. In multivariate regression analysis, LGELA% was the strongest adjusted predictor for CA diagnosis. Using receiver operating characteristic analysis, LGELA% ≥33% produced the greatest diagnostic utility for CA (sensitivity 76%, specificity 94%). Patients with CA may have extensive LGE of the LA myocardium, which is associated with marked reduction in LA emptying function. The extent of LA LGE was highly predictive for the diagnosis of CA.
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126
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Impact of monitoring longitudinal systolic strain changes during serial echocardiography on outcome in patients with AL amyloidosis. Int J Cardiovasc Imaging 2015; 31:1401-12. [DOI: 10.1007/s10554-015-0711-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
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127
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Abstract
Amyloidosis refers to a group of rare but potentially fatal, protein misfolding diseases. The heart is frequently involved in the most common types, that is, immunoglobulin light chain and transthyretin amyloidosis and is the single most important predictor of patient outcomes. A major limitation in improving patient outcomes, in addition to developing novel therapeutics, is the late diagnosis of the disease. Once suspected, an organ for biopsy should be targeted and the amyloid type should be identified by mass spectrometry. An endomyocardial biopsy should be offered if cardiac involvement is in doubt. Echocardiography, MRI and nuclear imaging can provide valuable diagnostic and prognostic information and can secure the diagnosis if amyloid has been identified in an extracardiac tissue.
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128
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Lambert J, Lim SP, Dwivedi G, Beanlands R, Chih S. Cardiac Imaging of Infiltrative Cardiomyopathies. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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129
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Affiliation(s)
- Sherif F Nagueh
- From the Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
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130
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Lee GY, Kim HK, Choi JO, Chang SA, Oh JK, Jeon ES, Sohn DW. Visual Assessment of Relative Apical Sparing Pattern Is More Useful Than Quantitative Assessment for Diagnosing Cardiac Amyloidosis in Borderline or Mildly Increased Left Ventricular Wall Thickness. Circ J 2015; 79:1575-84. [PMID: 25854713 DOI: 10.1253/circj.cj-14-1328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Relative apical sparing pattern of longitudinal strain (RapSP-LS) was suggested in advanced cardiac amyloidosis (CA). It is unclear whether it is present in less advanced CA. METHODS AND RESULTS Patients with presumptive diagnosis of CA and mean left ventricular wall thickness (LVWT) ≤14 mm were recruited. Apart from RapSP-LS visually identified, relative apical longitudinal strain index (RapLSI) was defined as [average apical LS/(average basal LS+average mid-ventricle LS)]. Among 119 patients included, 47 were finally diagnosed with CA. RapLSI was higher in the CA group compared to other causes of increased mean LVWT (P<0.001), but with a significant range of overlap noted. In contrast, RapSP-LS visually assessed was noted in most CA patients (31/47, 66.0%) except in those with preserved LV ejection fraction, normal LVWT, and mildly decreased global LS, suggesting least advanced CA. On multivariate analysis of the added diagnostic role of RapSP-LS or RapLSI on top of clinical, electrocardiographic, and conventional echocardiographic parameters, addition of RapLSI produced only borderline increase in area under the curve of the multivariate model (P=0.05), whereas addition of RapSP-LS significantly increased it (P<0.001). CONCLUSIONS Visual identification of RapSP-LS is useful in terms of added diagnostic value compared with quantitative calculation of RapLSI. Its clinical application, however, should be used with caution in patients with less advanced CA.
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Affiliation(s)
- Ga Yeon Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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131
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Abstract
Cardiac amyloidosis is a cardiomyopathy characterized by increased left ventricular (LV) wall thickness and normal or decreased LV cavity size. Congestive heart failure in cardiac amyloidosis is generally considered a predominantly diastolic phenomenon, with systolic dysfunction only occurring in late-stage disease. Echocardiography is a noninvasive, reproducible method of assessing cardiac features and function in cardiac amyloidosis, and some echocardiographic indices are prognostic for the amyloidoses, with M-mode and 2-dimensional echocardiography able to detect increased LV wall thickness. Moreover, Doppler flow measurements can incrementally assess diastolic LV dysfunction, which is characteristic of cardiac amyloidosis, and provide important prognostic information. Additionally, tissue Doppler imaging can detect subtle changes in both systolic and diastolic LV function, which cannot be detected by Doppler flow measurements, and LV longitudinal strain assessed by color tissue Doppler and speckle tracking echocardiography can provide more accurate LV functional and prognostic information than tissue Doppler imaging. This review describes the advances in echocardiography and its crucial role in the diagnosis and management of cardiac amyloidosis.
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Affiliation(s)
- Jun Koyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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132
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133
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134
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Echocardiographic Deformation Imaging for the Assessment of Left Ventricular Function: Clinical Implications and Perspectives— Update 2014. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9297-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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135
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Stankovic I, Putnikovic B, Cvjetan R, Milicevic P, Panic M, Kalezic-Radmili T, Mandaric T, Vidakovic R, Cvorovic V, Neskovic AN. Visual assessment vs. strain imaging for the detection of critical stenosis of the left anterior descending coronary artery in patients without a history of myocardial infarction. Eur Heart J Cardiovasc Imaging 2014; 16:402-9. [PMID: 25336543 DOI: 10.1093/ehjci/jeu206] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We sought to determine the prevalence of overt and subclinical LV dysfunction in patients with critical left anterior descending coronary artery (LAD) stenosis but without a history of myocardial infarction and to compare diagnostic value of routine echocardiographic parameters with myocardial strain analysis for detection of critical LAD stenosis. METHODS AND RESULTS We retrospectively studied 269 patients with suspected coronary artery disease (CAD)-209 consecutive patients with critical LAD stenosis and 60 consecutive patients with atypical chest pain and without CAD. Conventional visual assessment of LV asynergy in the LAD territory was compared with global, regional, and segmental peak systolic longitudinal strain (PSLS) parameters derived by two-dimensional speckle tracking echocardiography (2D STE). Wall motion abnormalities in the LAD territory were found in 41% of patients with critical LAD stenosis, whereas, depending on the cut-off value, global longitudinal strain (GLS) was impaired in 42-69% of patients. GLS with an area under the receiver operating characteristic curve (AUC) of 0.85 showed better discriminative power for detecting critical LAD stenosis than conventional wall motion score index (AUC 0.73, P < 0.05, for the difference between the AUCs). PSLS values were significantly lower in basal and midventricular segments supplied by critically narrowed LAD, particularly if they also appeared dysfunctional on visual assessment. CONCLUSIONS Detection of subclinical LV dysfunction by 2D STE might improve identification of patients with critical LAD stenosis, although visually apparent regional LV dysfunction in the LAD territory is not uncommon finding in this subset of patients.
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Affiliation(s)
- Ivan Stankovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Biljana Putnikovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Radosava Cvjetan
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Predrag Milicevic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Milos Panic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Tijana Kalezic-Radmili
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Tijana Mandaric
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Radosav Vidakovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Vojkan Cvorovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Centre Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, Belgrade 11070, Serbia
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Di Bella G, Pizzino F, Minutoli F, Zito C, Donato R, Dattilo G, Oreto G, Baldari S, Vita G, Khandheria BK, Carerj S. The mosaic of the cardiac amyloidosis diagnosis: role of imaging in subtypes and stages of the disease. Eur Heart J Cardiovasc Imaging 2014; 15:1307-15. [PMID: 25190073 DOI: 10.1093/ehjci/jeu158] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cardiac amyloidosis is a rare, infiltrative cardiomyopathy that presents with thickened ventricular walls and progressive heart failure. The morphological findings and clinical features are shared with many other diseases (i.e. hypertrophic cardiomyopathy, 'athlete's heart,' Fabry disease, and hypertensive cardiomyopathy), and misdiagnosis occurs frequently. Cardiologists have many instruments that can help reach a correct diagnosis in a relatively short time. As tiles of a mosaic are placed to create an image, thoughtful and smart use of the different diagnostic tools available allows the opportunity to identify amyloid infiltration of the myocardium. When the myocardium is involved, prognosis is poor, so identification of its involvement is crucial for disease management. The diagnostic process begins with an accurate evaluation of clinical elements and includes cardiovascular imaging (echocardiography, magnetic resonance, and nuclear medicine), electrocardiography, serological assays, and myocardial biopsy; only the appropriate integration of these instruments can reveal the diagnosis to an expert physician. The latest improvements in non-invasive diagnostic techniques with increased diagnostic power have reduced the need for biopsy.
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Affiliation(s)
- Gianluca Di Bella
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Fausto Pizzino
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Fabio Minutoli
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Concetta Zito
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Rocco Donato
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Giuseppe Dattilo
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Giuseppe Oreto
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Sergio Baldari
- Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Giuseppe Vita
- Department of Neurosciences, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - Scipione Carerj
- Clinical and Experimental Medicine Department, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria 'Policlinico G. Martino', Via Consolare Valeria 1, Messina 98125, Italy
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Affiliation(s)
- Rodney H Falk
- From the Noninvasive Cardiovascular Imaging Program, Division of Cardiology, Departments of Radiology and Medicine (S.D.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (S.D.), and Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine (C.Q., R.F., S.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Candida C Quarta
- From the Noninvasive Cardiovascular Imaging Program, Division of Cardiology, Departments of Radiology and Medicine (S.D.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (S.D.), and Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine (C.Q., R.F., S.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sharmila Dorbala
- From the Noninvasive Cardiovascular Imaging Program, Division of Cardiology, Departments of Radiology and Medicine (S.D.), Division of Nuclear Medicine and Molecular Imaging, Department of Radiology (S.D.), and Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine (C.Q., R.F., S.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Nucifora G, Muser D, Morocutti G, Piccoli G, Zanuttini D, Gianfagna P, Proclemer A. Disease-specific differences of left ventricular rotational mechanics between cardiac amyloidosis and hypertrophic cardiomyopathy. Am J Physiol Heart Circ Physiol 2014; 307:H680-8. [PMID: 24993044 DOI: 10.1152/ajpheart.00251.2014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Left ventricular (LV) twist (LVT) and untwisting (LVUT) rate are global and thorough parameters of LV function. The aim of the present study was to investigate the differences in LV rotational mechanics between patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM). Twenty consecutive patients with CA, 20 consecutive patients with HCM, and 20 consecutive subjects without evidence of structural heart disease were included. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) imaging was performed to evaluate biventricular function, LV mass index, and presence/extent of LGE. Feature-tracking analysis was applied to LV basal and apical short-axis images to determine peak LVT, time to peak LVT, peak LVUT rate, and time to peak LVUT rate. Peak LVT and peak LVUT rate were significantly impaired in patients with CA compared with controls (P < 0.05 for both). In patients with HCM, peak LVT was increased (P < 0.05) compared with controls, whereas peak LVUT rate was preserved (P > 0.05). Time to peak LVUT rate was significantly prolonged in patients with CA and in patients with HCM compared with controls (ANOVA P < 0.001). At multivariate analysis, age (P = 0.007), LV ejection fraction (P = 0.035) and extent of LGE (P < 0.001) were independently related to peak LVT, and LV mass index (P = 0.015) and extent of LGE (P = 0.004) were independently related to peak LVUT rate, whereas extent of LGE (P < 0.001) was the only variable independently related to time to peak LVUT rate. In conclusion, CA and HCM have specific behavior of LV rotational mechanics. The extent of LGE significantly influences the LV rotational mechanics.
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Affiliation(s)
| | - Daniele Muser
- Cardiothoracic Department and Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | | | - Gianluca Piccoli
- Department of Diagnostic Imaging, University Hospital Santa Maria della Misericordia, Udine, Italy
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Letter by Di Bella et al Regarding Article, “Effect of Combined Systolic and Diastolic Functional Parameter Assessment for Differentiation of Cardiac Amyloidosis From Other Causes of Concentric Left Ventricular Hypertrophy”. Circ Cardiovasc Imaging 2014; 7:215. [DOI: 10.1161/circimaging.113.001478] [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]
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