Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis.

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Citation: Journal of the American Society of Echocardiography. 2023 Aug 11PMID: 37574149Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2023Local holdings: Available online from MWHC library: 1995 - presentISSN:
  • 0894-7317
Name of journal: Journal of the American Society of Echocardiography : official publication of the American Society of EchocardiographyAbstract: BACKGROUND: In patients with cardiac amyloidosis (CA), left ventricular ejection fraction (LVEF) is frequently preserved, despite commonly reduced global longitudinal strain (GLS). We hypothesized that non-longitudinal contraction may initially serve as a mitigating mechanism to maintain cardiac output, and studied the relationship between global circumferential (GCS) and radial (GRS) strain with LVEF and extracellular volume (ECV), a marker of amyloid burden.CONCLUSIONS: Among CA patients with preserved LVEF, preserved GCS and GRS despite near-universally impaired GLS may be explained by an initial predominantly subendocardial involvement, where mostly longitudinal fibers are located. If confirmed in future studies, these findings may facilitate identification of patients with early stages of CA, when treatments may be most effective. Copyright © 2023. Published by Elsevier Inc.METHODS: CA patients who underwent cardiac magnetic resonance (CMR) (n=140, 70.7+/-11.5 years, 66% male) or echocardiography (n=67, 71+/-13 years, 66% male), and normal controls (CMR: n=20; echocardiography: n=45) were retrospectively identified. GCS, GLS, and GRS were quantified using feature-tracking CMR or speckle-tracking echocardiography, and compared between CA patients with preserved and reduced LVEF (CAHFpEF, CAHFrEF) and controls. The prevalence of impaired strain (magnitudes <2.5th percentiles of the controls) was compared between CAHFpEF and CAHFrEF, and between ECV quartiles.RESULTS: While echocardiography-derived GLS was impaired in both CAHFpEF (-13.4+/-3.1%, p<0.003) and CAHFrEF (-9.1+/-3.2%, p<0.003), compared to controls (-20.8+/-2.4%), GCS was more impaired in CAHFrEF compared to both controls (-15.6+/-5.0% vs -32.3+/-3.3%, p<0.003) and CAHFpEF (-30.4+/-5.7%, p<0.003), and did not differ between CAHFpEF and controls (p=0.24). The prevalence of abnormal CMR-derived GCS (p<0.0001) and GRS (p<0.0001) but not GLS (p=0.054) varied significantly across ECV quartiles.All authors: Addetia K, Asch FM, Cody B, Eshun D, Goyal A, Husain A, Kwon JW, Lang RM, Mazzone S, Mor-Avi V, Narang A, Patel AR, Sarswat N, Scheetz S, Singulane C, Slivnick JA, Smart S, Sun D, Zareba KMFiscal year: FY2024Digital Object Identifier: Date added to catalog: 2023-10-04
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 37574149 Available 37574149

Available online from MWHC library: 1995 - present

BACKGROUND: In patients with cardiac amyloidosis (CA), left ventricular ejection fraction (LVEF) is frequently preserved, despite commonly reduced global longitudinal strain (GLS). We hypothesized that non-longitudinal contraction may initially serve as a mitigating mechanism to maintain cardiac output, and studied the relationship between global circumferential (GCS) and radial (GRS) strain with LVEF and extracellular volume (ECV), a marker of amyloid burden.

CONCLUSIONS: Among CA patients with preserved LVEF, preserved GCS and GRS despite near-universally impaired GLS may be explained by an initial predominantly subendocardial involvement, where mostly longitudinal fibers are located. If confirmed in future studies, these findings may facilitate identification of patients with early stages of CA, when treatments may be most effective. Copyright © 2023. Published by Elsevier Inc.

METHODS: CA patients who underwent cardiac magnetic resonance (CMR) (n=140, 70.7+/-11.5 years, 66% male) or echocardiography (n=67, 71+/-13 years, 66% male), and normal controls (CMR: n=20; echocardiography: n=45) were retrospectively identified. GCS, GLS, and GRS were quantified using feature-tracking CMR or speckle-tracking echocardiography, and compared between CA patients with preserved and reduced LVEF (CAHFpEF, CAHFrEF) and controls. The prevalence of impaired strain (magnitudes <2.5th percentiles of the controls) was compared between CAHFpEF and CAHFrEF, and between ECV quartiles.

RESULTS: While echocardiography-derived GLS was impaired in both CAHFpEF (-13.4+/-3.1%, p<0.003) and CAHFrEF (-9.1+/-3.2%, p<0.003), compared to controls (-20.8+/-2.4%), GCS was more impaired in CAHFrEF compared to both controls (-15.6+/-5.0% vs -32.3+/-3.3%, p<0.003) and CAHFpEF (-30.4+/-5.7%, p<0.003), and did not differ between CAHFpEF and controls (p=0.24). The prevalence of abnormal CMR-derived GCS (p<0.0001) and GRS (p<0.0001) but not GLS (p=0.054) varied significantly across ECV quartiles.

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