Prevalence of Right Atrial Impairment and Association with Outcomes in Cardiac Amyloidosis.

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Citation: Journal of the American Society of Echocardiography. 2022 Apr 07PMID: 35398489Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2022ISSN:
  • 0894-7317
Name of journal: Journal of the American Society of Echocardiography : official publication of the American Society of EchocardiographyAbstract: BACKGROUND: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy in which abnormally folded proteins deposit within the myocardium and the atrial walls. While left atrial dysfunction has been previously reported, the impact of CA on right atrial (RA) structure and function is unknown.DISCUSSION: In CA, abnormalities in RA size and strain are highly prevalent and associated with worse prognosis, suggesting the presence of intrinsic RA atriopathy. RA strain appears to be a potentially useful marker in the diagnosis, subtype differentiation and risk stratification of CA. Copyright © 2022. Published by Elsevier Inc.METHODS: We retrospectively studied 118 patients (67 immunoglobulin light chain [AL-CA], 51 transthyretin [ATTR-CA]; age 70+/-12, 57% male) who underwent transthoracic echocardiogram (TTE) in sinus rhythm. RA reservoir, conduit, and booster strain were quantified using speckle tracking and compared between CA and 50 healthy age, sex-, and race-matched controls using chi-squared or Mann-Whitney test. The relationship between RA parameters and mortality was assessed using Cox regression.RESULTS: RA volume was significantly larger in CA compared to controls: 29[22 - 37] vs 21[15 - 25] mL/m2, p<0.001. RA reservoir (21[14 - 35] vs 37[34 - 43]%, p<0.001), conduit 11[18 - 6] vs 14[11 - 17]%, p<0.001) and booster (10[17 - 5] vs 23[20 - 27]%, p<0.001) strains were all significantly more impaired in the CA group compared with controls. Compared with AL-CA, ATTR-CA patients had significantly larger RA volume (34[26 - 44] vs 28[20 - 35] mL/m2, p=0.005) and significantly more impaired RA reservoir (17[10 - 30] vs 27[17 - 37]%, p=0.007), conduit (8[13 - 6] vs 13[20 - 8]%, p=0.031), and booster (7[14 - 4] vs 11[18 - 6]%, p=0.030) strain. Among CA patients, RA reservoir (HR 0.97 per %, p=0.006) and RA conduit (HR 1.05 per %, p=0.004) were significantly associated with mortality, while RA volume (p=0.362) and RA booster strain (p=0.180) were not.All authors: Addetia K, Asch F, Lang RM, Mor-Avi V, Sarswat N, Singulane CC, Slivnick JA, Soulat-Dufour LFiscal year: FY2022Digital Object Identifier: Date added to catalog: 2022-05-11
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Journal Article MedStar Authors Catalog Article 35398489 Available 35398489

BACKGROUND: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy in which abnormally folded proteins deposit within the myocardium and the atrial walls. While left atrial dysfunction has been previously reported, the impact of CA on right atrial (RA) structure and function is unknown.

DISCUSSION: In CA, abnormalities in RA size and strain are highly prevalent and associated with worse prognosis, suggesting the presence of intrinsic RA atriopathy. RA strain appears to be a potentially useful marker in the diagnosis, subtype differentiation and risk stratification of CA. Copyright © 2022. Published by Elsevier Inc.

METHODS: We retrospectively studied 118 patients (67 immunoglobulin light chain [AL-CA], 51 transthyretin [ATTR-CA]; age 70+/-12, 57% male) who underwent transthoracic echocardiogram (TTE) in sinus rhythm. RA reservoir, conduit, and booster strain were quantified using speckle tracking and compared between CA and 50 healthy age, sex-, and race-matched controls using chi-squared or Mann-Whitney test. The relationship between RA parameters and mortality was assessed using Cox regression.

RESULTS: RA volume was significantly larger in CA compared to controls: 29[22 - 37] vs 21[15 - 25] mL/m2, p<0.001. RA reservoir (21[14 - 35] vs 37[34 - 43]%, p<0.001), conduit 11[18 - 6] vs 14[11 - 17]%, p<0.001) and booster (10[17 - 5] vs 23[20 - 27]%, p<0.001) strains were all significantly more impaired in the CA group compared with controls. Compared with AL-CA, ATTR-CA patients had significantly larger RA volume (34[26 - 44] vs 28[20 - 35] mL/m2, p=0.005) and significantly more impaired RA reservoir (17[10 - 30] vs 27[17 - 37]%, p=0.007), conduit (8[13 - 6] vs 13[20 - 8]%, p=0.031), and booster (7[14 - 4] vs 11[18 - 6]%, p=0.030) strain. Among CA patients, RA reservoir (HR 0.97 per %, p=0.006) and RA conduit (HR 1.05 per %, p=0.004) were significantly associated with mortality, while RA volume (p=0.362) and RA booster strain (p=0.180) were not.

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