P971 The echocardiographic phenotype in patients with cardiac amyloidosis and heart failure with preserved ejection fraction

BACKGROUND

New echocardiographic phenotypes of heart failure (HF) are focused on myocardial systolic involvement of the left ventricle (LV), either endocardial and/or transmural.

PURPOSE.

To study the pattern of myocardial involvement in patients (p) with HF with preserved left ventricular ejection fraction (pLVEF) and cardiac amyloidosis (CA).

METHODS.

Comparative study of 16 p with CA and HF with pLVEF, considering as cut point LVEF > 50%, in NYHA class ≥ II / IV, and a control group of 16 healthy people. Longitudinal Strain (LS) and Circumferential Strain (CS) were calculated using 2D speckle-tracking echocardiography, along with Mitral Annulus Plane Systolic Excursion (MAPSE) and Base-Apex distance (B-A). Also, the following indexes were calculated: Twist (apical rotation + basal rotation, º); Classic Torsion (TorC): (twist/B-A, º/cm); Torsion Index (Tor.I): (twist/MAPSE, º/cm) and Deformation Index (Def.I): (twist/LS, º).

We suggest the introduction of these dynamic torsion indexes as Tor.I and Def.I that include twist per unit of longitudinal systolic shortening of the LV instead of using TorC which is the normalisation of twist to the end-diastolic longitudinal diameter of the LV.

RESULTS

There were no differences of age between the groups (68.2 ± 11.5 vs 63.7 ± 2.8 years, p = 0.14). Global values of LS and CS were lower in p with CA indicating endocardial and transmural deterioration during systole, while TorC and Twist of the LV remained conserved in p with CA.

However, there is an increase of dynamic torsion parameters such as Tor.I and Def.I that show an increased Twist per unit of longitudinal shortening of the LV in the CA group (Table).

CONCLUSIONS

In p with CA and HF with pLVEF, the impairment of LS and CS indicates endocardial and transmural systolic dysfunction. In these conditions, LVEF would be preserved at the expense of a greater dynamic torsion of the LV.

Table LS (%) CS (%) Twist (º) TorC (º/cm) Tor.I (º/cm) Def.I (º/%) CA pLVEF (n = 16) -11.7 ± 4.2 17.2 ± 4.8 19.8 ± 8.3 2.5 ± 1.1 27.7 ± 13.5 -1.8 ± 0.9 Control Group (n = 15) -20.6 ± 2.5 22.7 ± 4.9 21.7 ± 6.1 2.7 ± 0.8 16.4 ± 4.7 -1.0 ± 0.3 p < 0.001 < 0.01 0.46 0.46 < 0.01 < 0.01 Dynamic Torsion Indexes and Classic Torion Parameters in pLVEF CA patients vs Control group.

P308 Changes in the echocardiographic phenotype during the evolution of cardiac amyloidosis from preserved to reduced left ventricle ejection fraction

Introduction

Cardiomyopaties like Cardiac Amyloidosis (CA), are an important cause of Heart Failure (HF). They can cause endocardial or transmural involvement. It is possible to characterize the kind of affectation thanks to different phenotypes identified by 2D speckle tracking echocardiography. Purpose: To study the pattern of myocardial involvement in patients (p) affected by CA and HF. Methods: Comparative study of 30 p with CA and HF, in NYHA class ≥II/IV, of which 16 had preseved left ventricle ejection fraction (pLVEF) and 14 had reduced LVEF (rLVEF), considering as cut point a LVEF > 50%. There was a control group (CG) of 16 healthy subjects. Twist, radial strain (RS), circunferential strain (CS) and longitudinal strain (LS) were determined using 2D speckle-tracking echocardiography, along with mitral annulus plane systolic excursion (MAPSE) and basal-apex distance (B-A). The following indexes were calculated: Twist (apical rotation + basal rotation, °); Torsion (twist/B-A, °/cm); Torsion Index (TorI: twist/MAPSE, °/cm), and Deformation Index (DefI:twist/LS,°). The last indexes are dynamic parameters that allow for a more realistic assessment of LV torsion, since they include longitudinal shortening measures such as MAPSE and LS, describing in a more complete and physiological way the global LV systolic movement.

Results

There were differences of age between the three gropus, being older the p with rLVEF and younger the ones in the CG (63,7 ± 2,8; 68,2 ± 11,5; y 73,9 ± 12,9 years respectively). LS and CS were lower in rLVEF group when compared with pLVEF group, as well as in pLVEF group compared with the CG. The p with pLVEF showed increased values of the dynamic torsion parameters (DefI and TorI), indicating a compensatory increase of LV twist that disappears in p with rLVEF. Twist and Torsion are significantly lower only in the rLVEF group (see table).

Conclusions

In both CA groups, LS and CS deterioration indicates endocardial and transmural involvement. The loss of compensation given by the increased LV twist, reflected by DefI and TorI, marks the transition to the deterioration of LVEF.

Results Table LVEF (%) LS (%) CS (%) TWIST (°) Torsion (°/cm) TorI (°/cm) DefI (°/%) Control Group (n = 15) 68.2 ± 6.3 -20.6 ± 2.5 -22.7 ± 4.9 21.7 ± 6.1 2.7± 0.8 16.4 ± 4.7 -1.0 ± 0.3 CA pLVEF (n = 16) 60,6 ± 5.4* -11.7 ± 4.2* -17.2 ± 4.8* 19.8 ± 8.3 2.5± 1.1 27.7 ±13.5* -1.8 ± 0.9* CA rLVEF (n = 14) 37.2 ± 8.8** -8.7 ± 3.2** -13.0 ± 3.4** 8.3 ± 5.6** 1.0 ± 1.7** 13.4 ± 9.6** -1.0 ± 0.7** *:p value <0,01 between CG and pLVEF group; **:p value <0,01 between pLVEF and rLVEF

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