Assessing Left Atrial Dysfunction in Cardiac Amyloidosis Using LA-LV Strain Slope

Overview

Journal Eur Heart J Imaging Methods Pract

Specialty Cardiology & Vascular Diseases

Date 2024 Nov 12

PMID 39530018

Authors

Fredrik Edbom

Per Lindqvist

Urban Wiklund

Bjorn Pilebro

Intissar Anan

Frank A Flachskampf

Sandra Arvidsson

Affiliations

Soon will be listed here.

Abstract

Aims: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an infiltrative disease of the myocardium in which extracellular deposits of amyloid cause progressive cardiac impairment. We aimed to evaluate left atrial (LA) deformation and its association with left ventricular (LV) deformation using LA-LV strain loops in patients with ATTR-CM and patients with LV hypertrophy (LVH). We hypothesized that LA strain in ATTR-CM patients is abnormal and more independent of LV strain, compared to LVH patients.

Methods And Results: Retrospective study based on echocardiographic data including 30 patients diagnosed with ATTR-CM based on an end-diastolic interventricular septal (IVSd) thickness of ≥14 mm, and 29 patients with LVH (IVSd ≥ 14 mm and no ATTR-CM diagnosis) together with 30 controls. LV global longitudinal strain (LV-GLS) and LA strain, assessed as peak atrial longitudinal strain (PALS), were acquired and plotted to construct LA-LV strain loops and used regression line to determine a LA-LV strain slope. Significantly lower PALS and LA-LV strain slope values were detected in ATTR-CM patients compared to LVH patients ( = 0.004 and = 0.014, respectively). A receiver operating characteristic (ROC) curve demonstrated similar area under the curve (AUC) using PALS (AUC 0.72) and LA-LV slope (AUC 0.71), with both resulting in higher values than recorded for LV-GLS (AUC 0.62).

Conclusion: LA deformation demonstrates an independent ability to differentiate ATTR-CM from LVH. Combining LV strain and LA deformation analysis displays the mechanical LA-LV dissociation in ATTR cardiac amyloidosis and potentially unmasks LA amyloid infiltration; this could potentially enable quicker diagnosis and initiation of treatment for ATTR-CM.

References

de Gregorio C, Dattilo G, Casale M, Terrizzi A, Donato R, Di Bella G . Left Atrial Morphology, Size and Function in Patients With Transthyretin Cardiac Amyloidosis and Primary Hypertrophic Cardiomyopathy　- Comparative Strain Imaging Study. Circ J. 2016; 80(8):1830-7. DOI: 10.1253/circj.CJ-16-0364. View

Karlsen S, Dahlslett T, Grenne B, Sjoli B, Smiseth O, Edvardsen T . Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovasc Ultrasound. 2019; 17(1):18. PMC: 6720884. DOI: 10.1186/s12947-019-0168-9. View

Falk R, Quarta C . Echocardiography in cardiac amyloidosis. Heart Fail Rev. 2015; 20(2):125-31. DOI: 10.1007/s10741-014-9466-3. View

Steiner I, Hajkova P . Patterns of isolated atrial amyloid: a study of 100 hearts on autopsy. Cardiovasc Pathol. 2006; 15(5):287-290. DOI: 10.1016/j.carpath.2006.01.005. View

Ruberg F, Grogan M, Hanna M, Kelly J, Maurer M . Transthyretin Amyloid Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019; 73(22):2872-2891. PMC: 6724183. DOI: 10.1016/j.jacc.2019.04.003. View

Donnelly J, Hanna M . Cardiac amyloidosis: An update on diagnosis and treatment. Cleve Clin J Med. 2017; 84(12 Suppl 3):12-26. DOI: 10.3949/ccjm.84.s3.02. View

Siddiqi O, Ruberg F . Cardiac amyloidosis: An update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med. 2017; 28(1):10-21. PMC: 5741539. DOI: 10.1016/j.tcm.2017.07.004. View

Malaescu G, Mirea O, Capota R, Petrescu A, Duchenne J, Voigt J . Left Atrial Strain Determinants During the Cardiac Phases. JACC Cardiovasc Imaging. 2021; 15(3):381-391. DOI: 10.1016/j.jcmg.2021.09.009. View

Muchtar E, Dispenzieri A, Magen H, Grogan M, Mauermann M, McPhail E . Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med. 2020; 289(3):268-292. DOI: 10.1111/joim.13169. View

10.

Oghina S, Bougouin W, Bezard M, Kharoubi M, Komajda M, Cohen-Solal A . The Impact of Patients With Cardiac Amyloidosis in HFpEF Trials. JACC Heart Fail. 2021; 9(3):169-178. DOI: 10.1016/j.jchf.2020.12.005. View

11.

Jin F, Kakkad V, Bradway D, LeFevre M, Kisslo J, Khouri M . Evaluation of Myocardial Stiffness in Cardiac Amyloidosis Using Acoustic Radiation Force Impulse and Natural Shear Wave Imaging. Ultrasound Med Biol. 2023; 49(8):1719-1727. PMC: 10330400. DOI: 10.1016/j.ultrasmedbio.2023.03.016. View

12.

Benjamin M, Arora P, Munir M, Darki A, Liebo M, Yu M . Association of Left Atrial Hemodynamics by Magnetic Resonance Imaging With Long-Term Outcomes in Patients With Cardiac Amyloidosis. J Magn Reson Imaging. 2022; 57(4):1275-1284. DOI: 10.1002/jmri.28320. View

13.

Papathanasiou M, Jakstaite A, Oubari S, Siebermair J, Wakili R, Hoffmann J . Clinical features and predictors of atrial fibrillation in patients with light-chain or transthyretin cardiac amyloidosis. ESC Heart Fail. 2022; 9(3):1740-1748. PMC: 9065861. DOI: 10.1002/ehf2.13851. View

14.

Usuku H, Takashio S, Yamamoto E, Yamada T, Egashira K, Morioka M . Prognostic value of right ventricular global longitudinal strain in transthyretin amyloid cardiomyopathy. J Cardiol. 2022; 80(1):56-63. DOI: 10.1016/j.jjcc.2022.02.010. View

15.

Phelan D, Collier P, Thavendiranathan P, Popovic Z, Hanna M, Plana J . Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis. Heart. 2012; 98(19):1442-8. DOI: 10.1136/heartjnl-2012-302353. View

16.

Garcia-Pavia P, Kristen A, Drachman B, Carlsson M, Amass L, Angeli F . Survival in a Real-World Cohort of Patients With Transthyretin Amyloid Cardiomyopathy Treated With Tafamidis: An Analysis From the Transthyretin Amyloidosis Outcomes Survey (THAOS). J Card Fail. 2024; 31(3):525-533. DOI: 10.1016/j.cardfail.2024.06.003. View

17.

Rausch K, Scalia G, Sato K, Edwards N, Lam A, Platts D . Left atrial strain imaging differentiates cardiac amyloidosis and hypertensive heart disease. Int J Cardiovasc Imaging. 2020; 37(1):81-90. DOI: 10.1007/s10554-020-01948-9. View

18.

Nochioka K, Quarta C, Claggett B, Roca G, Rapezzi C, Falk R . Left atrial structure and function in cardiac amyloidosis. Eur Heart J Cardiovasc Imaging. 2017; 18(10):1128-1137. DOI: 10.1093/ehjci/jex097. View

19.

Arnberg E, Eldhagen P, Lofbacka V, Venkateshvaran A, Pilebro B, Lindqvist P . RWT/SaVR-A Simple and Highly Accurate Measure Screening for Transthyretin Cardiac Amyloidosis. J Clin Med. 2022; 11(14). PMC: 9320450. DOI: 10.3390/jcm11144120. View

20.

Quarta C, Solomon S, Uraizee I, Kruger J, Longhi S, Ferlito M . Left ventricular structure and function in transthyretin-related versus light-chain cardiac amyloidosis. Circulation. 2014; 129(18):1840-9. DOI: 10.1161/CIRCULATIONAHA.113.006242. View