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De Carli G, Mandoli GE, Salvatici C, Biagioni G, Marallo C, Turchini F, Ghionzoli N, Melani A, Pastore MC, Gozzetti A, D'Ascenzi F, Cavigli L, Giacomin E, Cameli M, Focardi M. Speckle tracking echocardiography in plasma cell disorders: The role of advanced imaging in the early diagnosis of AL systemic cardiac amyloidosis. Int J Cardiol 2024; 398:131599. [PMID: 37979786 DOI: 10.1016/j.ijcard.2023.131599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/26/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Amyloid light-chain amyloidosis is a rare condition characterized by the abnormal production of immunoglobulin light chain that misshape and form amyloid fibrils. Over time, these amyloid deposits can accumulate slowly, causing dysfunction in organs and tissues. Early identification is crucial to ensure optimal treatment. We aim to identify a better marker of cardiac amyloidosis, using advanced echocardiography, to improve diagnosis and the timing of available treatments. MATERIALS AND METHODS 108 consecutive hematological patients (32, 30% female and 76, 70% male) with a plasma cell disorder referred to our Cardiological center underwent ECG, first and second-level echocardiography (Speckle Tracking) and complete biochemical profile. The best predictors of ALCA (AUC ≥ 0.8) were included in a further analysis stratified by AL score. RESULTS At ROC analysis, the best bio-humoral predictors for the diagnosis of ALCA were Nt-pro-BNP (AUC: 0.97; p < 0.01) and Hs-Tn (AUC: 0.87; p < 0.01). Regarding echocardiography, the best diagnostic predictors were left atrial stiffness (LAS) (AUC: 0.83; p < 0.01) for the left atrium; free wall thickness for the right ventricle (AUC: 0.82; <0.01); left ventricular global longitudinal strain (LVGLS) (AUC: 0.92; p < 0.01) and LVMi (AUC 0.80; p < 0.001) for the left ventricle; and AL-score (AUC 0.83 p < 0.01). In patients with AL-SCORE < 1, LAS (AUC 0.86 vs AUC 0.79), LVGLS (AUC 0.92 vs AUC 0.86) and LV mass (AUC 0.91 vs AUC 0.72) had better diagnostic accuracy than patients with higher AL-score (AL SCORE ≥ 1). CONCLUSION Multi-parametric imaging approach with LVGLS and LAS may be helpful for detecting early cardiac involvement in AL amyloidosis.
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Affiliation(s)
- G De Carli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - G E Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - C Salvatici
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - G Biagioni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - C Marallo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - F Turchini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - N Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - A Melani
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M C Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - A Gozzetti
- Department of Hematology, Siena University, Siena, Italy
| | - F D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - L Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - E Giacomin
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Iijima T, Sawa N, Wake A, Kono K, Kinowaki K, Ubara Y, Ohashi K. Linear discriminant analysis on electrocardiogram achieved classification of cardiac involvement status in amyloid light-chain amyloidosis. J Cardiol 2023; 82:349-355. [PMID: 37343933 DOI: 10.1016/j.jjcc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVES Cardiac amyloidosis (CA) is the most crucial determinant of amyloid light-chain (AL) amyloidosis patients' prognosis. We attempted cardiac involvement prediction by 12‑lead electrocardiograph (ECG) and echocardiography (UCG) in AL amyloidosis patients. MATERIALS AND METHODS Fifty patients with histologically confirmed AL amyloidosis underwent gadolinium-enhanced magnetic resonance imaging (Gd-MRI), and CA was assessed using late gadolinium enhancement. ECG and UCG parameters were measured on admission. Fisher's linear discriminant analysis was used to create a model for predicting CA using the ECG and UCG parameters. RESULTS Prediction by five ECG parameters [QTc(B), QRS-T-angle, III-QRS, aVF-QRS, and V3-R] showed the best performance. Average sensitivity and specificity in the modeling sets, utilizing a linear discriminator based on these five variables, were 99.2 % and 96.8 % and in validation sets, 94.2 % and 90.3 %, respectively. In addition, we tested this model on an additional 26-patient cohort and survival analysis using the Kaplan-Meier method, and significant differences between CA positively predicted and negatively predicted patients were observed. CONCLUSION Here, we suggest the application of a condensed classical multivariate statistical technique for the diagnosis of CA. It can be used as a guide to invasive endomyocardial biopsy for those in whom Gd-MRI is contraindicated and as a guide for repeat Gd-MRI in follow-up of AL amyloidosis.
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Affiliation(s)
- Takashi Iijima
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Japan.
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Wake
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan; Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan; Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Kei Kono
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | | | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan; Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Li Z, Yan C, Hu GX, Zhao R, Jin H, Yun H, Wei Z, Pan CZ, Shu XH, Zeng MS. Layer-specific strain in patients with cardiac amyloidosis using tissue tracking MR. FRONTIERS IN RADIOLOGY 2023; 3:1115527. [PMID: 37601532 PMCID: PMC10435886 DOI: 10.3389/fradi.2023.1115527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/04/2023] [Indexed: 08/22/2023]
Abstract
Background Cardiac infiltration is the major predictor of poor prognosis in patients with systemic amyloidosis, thus it becomes of great importance to evaluate cardiac involvement. Purpose We aimed to evaluate left ventricular myocardial deformation alteration in patients with cardiac amyloidosis (CA) using layer-specific tissue tracking MR. Material and Methods Thirty-nine patients with CA were enrolled. Thirty-nine normal controls were also recruited. Layer-specific tissue tracking analysis was done based on cine MR images. Results Compared with the control group, a significant reduction in LV whole layer strain values (GLS, GCS, and GRS) and layer-specific strain values was found in patients with CA (all P < 0.01). In addition, GRS and GLS, as well as subendocardial and subepicardial GLS, GRS, and GCS, were all diminished in patients with CA and reduced LVEF, when compared to those with preserved or mid-range LVEF (all P < 0.05). GCS showed the largest AUC (0.9952, P = 0.0001) with a sensitivity of 93.1% and specificity of 90% to predict reduced LVEF (<40%). Moreover, GCS was the only independent predictor of LV systolic dysfunction (Odds Ratio: 3.30, 95% CI:1.341-8.12, and P = 0.009). Conclusion Layer-specific tissue tracking MR could be a useful method to assess left ventricular myocardial deformation in patients with CA.
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Affiliation(s)
- Zheng Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Cheng Yan
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Xiang Hu
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rui Zhao
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
| | - Hang Jin
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hong Yun
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zheng Wei
- Department of Hematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cui-Zhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xian-Hong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Cardiovascular Disease, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Meng-Su Zeng
- Shanghai Institute of Medical Imaging, Shanghai, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Guidelines for Echocardiographic Diagnosis of Cardiomyopathy: Recommendations from Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Anwar AM, tenCate FJ. Echocardiographic evaluation of hypertrophic cardiomyopathy: A review of up-to-date knowledge and practical tips. Echocardiography 2021; 38:1795-1808. [PMID: 34555207 DOI: 10.1111/echo.15200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/24/2021] [Accepted: 08/23/2021] [Indexed: 11/27/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most frequent cardiac disease with genetic substrate, affecting about .2%-.5% of the population. The proper diagnosis is important for optimal management and follow-up. Echocardiography plays an essential role in the assessment of patients with HCM including diagnosis, screening, management formulation, prognosis, and follow up. It also helps to differentiate HCM from other diseases. The advancement of software and probe technology added many echo modalities and techniques that helped in refining the diagnostic and assessing the prognosis of patients with HCM. In this review, we briefly summarize how to integrate the different echocardiographic modalities to obtain comprehensive assessment supported by an updated knowledge of the latest guidelines and recently published articles. Many practical tips and tricks are included in this review to improve the diagnostic accuracy of echocardiography and minimize errors during interpretation.
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Affiliation(s)
- Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.,Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Jurcuţ R, Onciul S, Adam R, Stan C, Coriu D, Rapezzi C, Popescu BA. Multimodality imaging in cardiac amyloidosis: a primer for cardiologists. Eur Heart J Cardiovasc Imaging 2021; 21:833-844. [PMID: 32393965 DOI: 10.1093/ehjci/jeaa063] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/26/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022] Open
Abstract
Amyloidosis is a systemic infiltrative disease, in which unstable proteins misfold, form aggregates and amyloid fibrils which can deposit in various organs: heart, kidneys, liver, gastrointestinal tract, nervous system structures, lungs, or soft tissue. Cardiac amyloidosis (CA) diagnosis requires awareness, high level of clinical suspicion and expertise in integrating clinical, electrocardiographic, and multimodality imaging data. The overall scenario is complex and no single test emerges over the others, but different techniques are useful at various stages of the diagnostic workup. After a clinical suspicion of CA is raised by various non-imaging red-flags, eligible patients should undergo complete echocardiography and multiparametric cardiovascular magnetic resonance imaging. Even though the clinical suspicion of CA is confirmed by cardiac imaging, the accurate differentiation between the two most frequent and treatable amyloid types, i.e. light chain (AL) and transthyretin (ATTR) requires further work-up including phosphate scintigraphy. This article reviews the latest and essential data on multimodality imaging of patients with suspected or confirmed CA in a useful and practical manner for the general and imaging cardiologists.
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Affiliation(s)
- Ruxandra Jurcuţ
- Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022322 Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
| | - Sebastian Onciul
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,Department of Cardiology, Floreasca Emergency Hospital, Calea Floreasca 8, Bucharest 014461, Romania
| | - Robert Adam
- Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022322 Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
| | - Claudiu Stan
- Department of Nuclear Medicine and Ultrasonography, Fundeni Clinical Institute, Sos. Fundeni 258, Bucharest 022322, Romania
| | - Daniel Coriu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.,Department of Haematology, Fundeni Clinical Hospital, Sos. Fundeni 258, Bucharest 022322, Romania
| | - Claudio Rapezzi
- University Cardiological Center, University of Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Bogdan A Popescu
- Department of Cardiology, Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, 022322 Bucharest, Romania.,University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania
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Sascău R, Anghel L, Clement A, Bostan M, Radu R, Stătescu C. The Importance of Multimodality Imaging in the Diagnosis and Management of Patients with Infiltrative Cardiomyopathies: An Update. Diagnostics (Basel) 2021; 11:diagnostics11020256. [PMID: 33562254 PMCID: PMC7915769 DOI: 10.3390/diagnostics11020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022] Open
Abstract
Infiltrative cardiomyopathies (ICMs) comprise a broad spectrum of inherited and acquired conditions (mainly amyloidosis, sarcoidosis, and hemochromatosis), where the progressive buildup of abnormal substances within the myocardium results in left ventricular hypertrophy and manifests as restrictive physiology. Noninvasive multimodality imaging has gradually eliminated endomyocardial biopsy from the diagnostic workup of infiltrative cardiac deposition diseases. However, even with modern imaging techniques’ widespread availability, these pathologies persist in being largely under- or misdiagnosed. Considering the advent of novel, revolutionary pharmacotherapies for cardiac amyloidosis, the archetypal example of ICM, a standardized diagnostic approach is warranted. Therefore, this review aims to emphasize the importance of contemporary cardiac imaging in identifying specific ICM and improving outcomes via the prompt initiation of a targeted treatment.
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Affiliation(s)
- Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
| | - Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Alexandra Clement
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Mădălina Bostan
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Rodica Radu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
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Izumiya Y, Hayashi H, Ishikawa H, Shibata A, Yoshiyama M. How to Identify Transthyretin Cardiac Amyloidosis at an Early Stage. Intern Med 2021; 60:1-7. [PMID: 32713926 PMCID: PMC7835474 DOI: 10.2169/internalmedicine.5505-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cardiac involvement of systemic amyloidosis is preferentially observed in patients with amyloid light chain amyloidosis or transthyretin amyloidosis (ATTR). Owing to the development of diagnostic modalities and changes in recognition by physicians, transthyretin cardiac amyloidosis (ATTR-CA) is now understood to be a more common cause of heart failure than previously thought. Recent progress in disease-modifying therapeutic interventions, such as transthyretin stabilizers, has resulted in ATTR-CA changing from an incurable disease to a curable disease. These interventions are particularly effective in patients with mild symptoms of heart failure, thus indicating that early detection and a precise diagnosis are important for improving the prognosis. In this review article, we summarize the recent reports of early screening of ATTR-CA and describe some important points regarding the making of a precise diagnosis, especially focusing on histological evaluations.
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Affiliation(s)
- Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Hiroya Hayashi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Hirotoshi Ishikawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Atsushi Shibata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan
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Abstract
PURPOSE OF REVIEW The review's main focus centers on the genetics of hereditary cardiac amyloidosis, highlighting the opportunities and challenges posed by the widespread availability of genetic screening and diagnostic cardiac imaging. RECENT FINDINGS Advancements in cardiac imaging, heightened awareness of the ATTR amyloidosis diagnosis, and greater access to genetic testing have all led to an increased appreciation of the prevalence of ATTR cardiac amyloidosis. Elucidation of the TTR molecular structure and effect of mutations on TTR function have allowed for novel TTR therapy development leading to clinical implementation of transthyretin stabilizers and transthyretin gene silencers. The transthyretin amyloidoses are a diverse group of protein misfolding disorders with cardiac and peripheral/autonomic nervous system manifestations due to protein deposition. Genetic screening allows for the early identification of asymptomatic TTR mutation carriers. With the advent of TTR-specific therapeutics, clinical guidance is necessary for the management of individuals with mutations in the TTR gene without evidence of disease.
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Prominent basal and middle strain longitudinal involvement in newly-diagnosed and never treated hypertensive patients without clear-cut hypertrophy. Int J Cardiol 2020; 304:179-184. [DOI: 10.1016/j.ijcard.2020.01.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/18/2019] [Accepted: 01/15/2020] [Indexed: 01/20/2023]
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Arenas IA, Podesta CA, Issa O, Lin J, Brenes JC. Myocardial longitudinal strain, fitness, and heart failure risk factors in young adults. Echocardiography 2020; 37:404-411. [PMID: 32077529 DOI: 10.1111/echo.14613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS To investigate the relationship between fitness, heart failure (HF) risk factors (age, blood pressure, and obesity), and global/regional myocardial longitudinal strain in young adults undergoing stress testing. METHODS Individuals 25-55 years old without any significant medical history, not taking medications, and with a normal maximal stress echocardiogram were eligible. Global and regional longitudinal strain (LS) was evaluated by 2D speckle tracking echocardiography. RESULTS One hundred and seventy patients were included, of which 60% were males. The mean age was 43 years old, 49% had optimal blood pressure, and 30% were obese. On average, patients achieved 10.5 (3) METS, and the global LS was -19.9 (3.1) %. Reduced fitness was associated with decreased global longitudinal strain (GLS). Those in the top GLS quartile walked on average 1 minute and 21 seconds longer compared with the lowest quartile (P < .001). The effect of fitness on LS was preferential to the mid and apex, such that there was an apex-to-base gradient. Obesity was also independently associated with reduced GLS. However, the reduction in LS in obese individuals was more prominent at the base and mid-walls with relative sparing of the apex. Similar to fitness, aging was also associated with an increase in the apex-to-base gradient of LS. Furthermore, diastolic filling parameters correlated distinctively with regional LS. CONCLUSIONS In young adults without cardiovascular disease, low fitness and obesity are independently associated with reduced left ventricular longitudinal strain. There is a differential effect of HF risk factors on regional longitudinal function.
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Affiliation(s)
- Ivan A Arenas
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Carlos A Podesta
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Omar Issa
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Jeffrey Lin
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Juan C Brenes
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
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Pradel S, Brun S, Victor G, Pascal P, Fournier P, Ribes D, Lavie-Badie Y, Galinier M, Carrié D, Berry I, Lairez O. Pattern of myocardial 99mTc-HMDP uptake and impact on myocardial function in patients with transthyretin cardiac amyloidosis. J Nucl Cardiol 2020; 27:96-105. [PMID: 29881913 DOI: 10.1007/s12350-018-1316-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/16/2018] [Indexed: 01/15/2023]
Abstract
AIMS The purpose of the study was to describe the pattern of 99mTc-labeled phosphate agents myocardial uptake by scintigraphy and explore its impact on left ventricular (LV) functions in transthyretin cardiac amyloidosis (TTR-CA). METHODS Fifty patients with TTR-CA underwent 99mTc- hydroxymethylene-diphosphonate (99mTc-HMDP) scintigraphy and echocardiography with measure of LV thickness, longitudinal strain (LS), systolic and diastolic functions. Cardiac retention by scintigraphy was assessed by visual scoring and the heart/whole body (H/WB) ratio was calculated by dividing counts in the heart by counts in late whole-body images. RESULTS The mean population age was 79 ± 10 years. Mean H/WB ratio was 12 ± 7. Myocardial 99mTc-HMDP uptake on segments 5, 6, 7, 8, 11, 12, 13, 14, 16, and 17 was correlated with H/WB ratio. Mean LVEF and global LS were 51 ± 10% and - 10 ± 3%, respectively. H/WB ratio was correlated with global LS (R = 0.408, P = .003), Ea (R = - 0.566, P < .001) and mean left ventricular wall thickness (R = 0.476, P < .001) but not with LVEF (R = - 0.109, P = .453). Segmental myocardial uptake was slightly correlated with segmental LS (R = 0.152, P < .001). H/WB ratio was not correlated with NT-proBNP levels (R = 0.219, P = .148) neither E/Ea ratio (R = 0.204, P = .184). CONCLUSION These findings show the relationship between bone tracer myocardial uptake and LV functions in patients with TTR cardiac amyloidosis.
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Affiliation(s)
- Sarah Pradel
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Stéphanie Brun
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Gérard Victor
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Pierre Pascal
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
| | - Pauline Fournier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - David Ribes
- Department of Nephrology and Organ Transplantation, Rangueil University Hospital, Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Isabelle Berry
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital, Toulouse, France.
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France.
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.
- Medical School of Rangueil, University Paul Sabatier, Toulouse, France.
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13
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Echocardiographic tissue imaging evaluation of myocardial characteristics and function in cardiomyopathies. Heart Fail Rev 2020; 26:813-828. [PMID: 31950337 DOI: 10.1007/s10741-020-09918-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Current echocardiography techniques have allowed more precise assessment of cardiac structure and function of the several types of cardiomyopathies. Parameters derived from echocardiographic tissue imaging (ETI)-tissue Doppler, strain, strain rate, and others-are extensively used to provide a framework in the evaluation and management of cardiomyopathies. Generally, myocardial function assessed by ETI is depressed in all types of cardiomyopathies, non-ischemic dilated cardiomyopathy (DCM) in particular. In hypertrophic cardiomyopathy (HCM), ETI is useful to identify subclinical disease in family members of HCM, to differentiate HCM from other conditions causing cardiac hypertrophy and to predict cardiac events. ETI also for HCM allows addressing the mechanism behind left ventricular outflow tract obstruction and its improvement after therapeutic options. ETI provides cardiac amyloidosis with unique and specific findings such as "apical sparing." Nevertheless, ETI does not seem to provide as much information amenable to histological findings as recently emerging techniques of cardiac magnetic resonance imaging. This review introduces usefulness of ETI and some other ultrasound techniques for detecting clinical and subclinical characteristics of cardiomyopathies, focusing on DCM, HCM, and cardiac amyloidosis.
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14
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Boldrini M, Cappelli F, Chacko L, Restrepo-Cordoba MA, Lopez-Sainz A, Giannoni A, Aimo A, Baggiano A, Martinez-Naharro A, Whelan C, Quarta C, Passino C, Castiglione V, Chubuchnyi V, Spini V, Taddei C, Vergaro G, Petrie A, Ruiz-Guerrero L, Moñivas V, Mingo-Santos S, Mirelis JG, Dominguez F, Gonzalez-Lopez E, Perlini S, Pontone G, Gillmore J, Hawkins PN, Garcia-Pavia P, Emdin M, Fontana M. Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis. JACC Cardiovasc Imaging 2019; 13:909-920. [PMID: 31864973 DOI: 10.1016/j.jcmg.2019.10.011] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration. BACKGROUND Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool. METHODS We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance. RESULTS A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e' wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical-to-base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90). CONCLUSIONS Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
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Affiliation(s)
- Michele Boldrini
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Emergency Department, Internal Medicine Department, Amyloidosis Research and Treatment Center, Istituto di Ricerca a Carattere Clinico e Scientifico Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Maria Alejandra Restrepo-Cordoba
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Angela Lopez-Sainz
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Carol Whelan
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Cristina Quarta
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Claudio Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | | | - Giuseppe Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Aviva Petrie
- Eastman Dental Institute, University College London, Grays Inn Road, London, United Kingdom
| | - Luis Ruiz-Guerrero
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Vanessa Moñivas
- University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | | | - Jesus G Mirelis
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Esther Gonzalez-Lopez
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Stefano Perlini
- Emergency Department, Internal Medicine Department, Amyloidosis Research and Treatment Center, Istituto di Ricerca a Carattere Clinico e Scientifico Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Julian Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain; University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Michele Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom.
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15
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Esposito R, Galderisi M, Santoro C, Imbriaco M, Riccio E, Maria Pellegrino A, Sorrentino R, Lembo M, Citro R, Angela Losi M, Spinelli L, Trimarco B, Pisani A. Prominent longitudinal strain reduction of left ventricular basal segments in treatment-naïve Anderson-Fabry disease patients. Eur Heart J Cardiovasc Imaging 2019; 20:438-445. [PMID: 30085001 DOI: 10.1093/ehjci/jey108] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 06/20/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS Little is known about regional longitudinal strain (LS) distribution in early stages of Anderson-Fabry disease (AFD) cardiomyopathy. We investigated regional left ventricular (LV) patterns of LS strain and base-to-apex behaviour of LS in treatment-naïve AFD patients. METHODS AND RESULTS Twenty-three consecutive AFD patients at diagnosis and 23 healthy controls without cardiovascular risk factors and matched for age and sex to the patients, underwent a comprehensive evaluation of target organs. An echo-Doppler exam, including determination of regional and global LS strain (GLS) was obtained. The average LS of 6 basal (BLS), 6 middle (MLS), and 5 apical (ALS) segments and relative regional strain ratio [ALS/(BLS + MLS)] were also calculated. Ejection fraction and diastolic indices did not differ between the two groups. LV mass index was greater in AFD (P < 0.01). GLS (P = 0.006), BLS (P < 0.0001), and MLS (P = 0.003), but not ALS, were lower in AFD patients and relative regional strain ratio was higher in AFD (P < 0.01) than in controls. These analyses were confirmed separately in the two genders and even after excluding patients with wall hypertrophy. By subdividing AFD patients according to lysoGB3 levels, 9 patients with lysoGB3 ≥ 1.8 ng/L had lower ALS compared to 11 patients with lysoGB3 < 1.8 ng/L (P < 0.01). CONCLUSION In naïve AFD patients, we observed an early reduction of LV LS, involving mainly LV basal myocardial segments. Nevertheless, the association found between the higher lysoGB3 levels and the lower apical cap LS demonstrates that apical segments LS, despite still normal, is not spared at diagnosis.
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Affiliation(s)
- Roberta Esposito
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Massimo Imbriaco
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Eleonora Riccio
- Department of Public Medicine, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | | | - Regina Sorrentino
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Rodolfo Citro
- Division of Cardiology, San Giovanni e Ruggi D'Aragona Hospital, Via San Leonardo, 1, Salerno, Italy
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Letizia Spinelli
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University Federico II, Via Sergio Pansini, 5, Naples, Italy
| | - Antonio Pisani
- Department of Public Medicine, University Federico II, Via Sergio Pansini, 5, Naples, Italy
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16
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Manolis AS, Manolis AA, Manolis TA, Melita H. Cardiac amyloidosis: An underdiagnosed/underappreciated disease. Eur J Intern Med 2019; 67:1-13. [PMID: 31375251 DOI: 10.1016/j.ejim.2019.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
Cardiac amyloidosis or amyloid cardiomyopathy (ACM), commonly resulting from extracellular deposition of amyloid fibrils consisted of misfolded immunoglobulin light chain (AL) or transthyretin (TTR) protein, is an underestimated cause of heart failure and cardiac arrhythmias. Among the three types of cardiac amyloidosis (wild-type or familial TTR and light-chain), the wild-type (Wt) TTR-related amyloidosis (ATTR) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF), and amyloidosis should be considered in the differential diagnosis of this heart failure group of patients. Recent advances in the diagnosis and drug treatment of ACM have ushered in a new era in early disease detection and better management of these patients. Certain clues in cardiac and extracardiac manifestations of ACM may heighten clinical suspicion and guide further confirmatory testing. Newer noninvasive imaging methods (strain echocardiography, cardiac magnetic resonance and bone scintigraphy) may obviate the need for endomyocardial biopsy in ATTR patients, while newer targeted therapies may alter the adverse prognosis in these patients. Early recognition of ACM is crucial in halting the disease process before irreversible organ damage occurs. Chemotherapy and stem-cell transplantation combined with immunomodulatory therapy may also favorably affect the course and prognosis of light chain ACM. Finally, in select patients with end-stage disease, heart transplantation may render results comparable to non-ACM patients. All these issues are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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17
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Galeeva ZM, Galyavich AS, Baleeva LV, Galimzyanova LA, Rafikov AY, Gizatullina NF, Mustafina DA. [Not Available]. KARDIOLOGIIA 2019; 59:93-96. [PMID: 30710995 DOI: 10.18087/cardio.2019.1.10221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
In this article we present brief overview of the subject of amyloidosis and involvement of the cardiovascular system, the criteria for diagnosis, principles of treatment, and the clinical case of cardiac amyloidosis.
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18
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Ten Years of 2D Longitudinal Strain for Early Myocardial Dysfunction Detection: A Clinical Overview. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8979407. [PMID: 30627581 PMCID: PMC6304576 DOI: 10.1155/2018/8979407] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 12/30/2022]
Abstract
In recent years, the role of left ventricular ejection fraction (EF) as the gold standard parameter for the evaluation of systolic function has been questioned, and many efforts have been concentrated in the clinical validation of new noninvasive tools for the study of myocardial contractility. Improvement in the accuracy of speckle-tracking echocardiography has resulted in a large amount of research showing the ability of two-dimensional strain to overcome EF limitations in the majority of primary and secondary heart diseases. Currently, global longitudinal strain (GLS) is considered the most accurate and sensitive parameter for the assessment of early left ventricular dysfunction. This review summarizes the advantages that this measurement can provide in several clinical settings. Moreover, the important cautions that should be considered in making the choice to use GLS also are addressed. Finally, a special focus on bull's-eye polar maps for the assessment of regional changes of longitudinal function and the usefulness of these maps in the differential diagnosis of several diseases is provided.
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19
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Vitarelli A, Lai S, Petrucci MT, Gaudio C, Capotosto L, Mangieri E, Ricci S, Germanò G, De Sio S, Truscelli G, Vozella F, Pergolini MS, Giordano M. Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy. Int J Cardiol 2018; 271:371-377. [DOI: 10.1016/j.ijcard.2018.03.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/24/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
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20
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Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G, Donal E, Sade LE, Ernande L, Garbi M, Grapsa J, Hagendorff A, Kamp O, Magne J, Santoro C, Stefanidis A, Lancellotti P, Popescu B, Habib G. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2018; 18:1301-1310. [PMID: 29045589 DOI: 10.1093/ehjci/jex244] [Citation(s) in RCA: 395] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/11/2017] [Indexed: 12/28/2022] Open
Abstract
Aims This European Association Cardiovascular Imaging (EACVI) Expert Consensus document aims at defining the main quantitative information on cardiac structure and function that needs to be included in standard echocardiographic report following recent ASE/EACVI chamber quantification, diastolic function, and heart valve disease recommendations. The document focuses on general reporting and specific pathological conditions such as heart failure, coronary artery and valvular heart disease, cardiomyopathies, and systemic diseases. Methods and results Demographic data (age, body surface area, blood pressure, and heart rhythm and rate), type (vendor and model) of ultrasound system used and image quality need to be reported. In addition, measurements should be normalized for body size. Reference normal values, derived by ASE/EACVI recommendations, shall always be reported to differentiate normal from pathological conditions. This Expert Consensus document suggests avoiding the surveillance of specific variable using different ultrasound techniques (e.g. in echo labs with high expertise in left ventricular ejection fraction by 3D and not by 2D echocardiography). The report should be also tailored in relation with different cardiac pathologies, quality of images, and needs of the caregivers. Conclusion The conclusion should be concise reflecting the status of left ventricular structure and function, the presence of left atrial and/or aortic dilation, right ventricular dysfunction, and pulmonary hypertension, leading to an objective communication with the patient health caregiver. Variation over time should be considered carefully, taking always into account the consistency of the parameters used for comparison.
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Affiliation(s)
- Maurizio Galderisi
- Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy
| | - Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten)-Universitair ziekenhuis Brussel; and ICMI (In Vivo Cellular and Molecular Imaging) laboratory, Brussels, Belgium
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Nuno Cardim
- Echocardiography Laboratory, Hospital da Luz, Lisbon, Portugal
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden 2300RC, The Netherlands
| | - Giovanni Di Salvo
- Pediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Erwan Donal
- Cardiologie, LTSI-INSERM U 1099, CHU Rennes, Université Rennes 1, Rennes, France
| | | | - Laura Ernande
- Department of Physiology, INSERM U955, Université Paris-Est Creteil, Henri Mondor Hospital, DHU-ATVB, AP-HP, Créteil, France
| | - Madalina Garbi
- King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS UK
| | - Julia Grapsa
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Andreas Hagendorff
- Department of Cardiology-Angiology, Echokardiographie-Labore des Universitätsklinikums AöR, University of Leipzig, Leipzig, Germany
| | - Otto Kamp
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042 France
| | - Ciro Santoro
- Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Naples, Italy
| | - Alexandros Stefanidis
- 1st Department of Cardiology, General Hospital of Nikea, 3 P. Mela str., 184 54, Athens, Greece
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Bogdan Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Gilbert Habib
- Aix- Aix-Marseille Univ, URMITE, Aix Marseille Université-UM63, CNRS 7278, IRD 198, INSERM 1095.,Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille 13005, France
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21
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Habib G, Bucciarelli-Ducci C, Caforio ALP, Cardim N, Charron P, Cosyns B, Dehaene A, Derumeaux G, Donal E, Dweck MR, Edvardsen T, Erba PA, Ernande L, Gaemperli O, Galderisi M, Grapsa J, Jacquier A, Klingel K, Lancellotti P, Neglia D, Pepe A, Perrone-Filardi P, Petersen SE, Plein S, Popescu BA, Reant P, Sade LE, Salaun E, Slart RHJA, Tribouilloy C, Zamorano J. Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography. Eur Heart J Cardiovasc Imaging 2018; 18:1090-1121. [PMID: 28510718 DOI: 10.1093/ehjci/jex034] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 12/11/2022] Open
Abstract
Restrictive cardiomyopathies (RCMs) are a diverse group of myocardial diseases with a wide range of aetiologies, including familial, genetic and acquired diseases and ranging from very rare to relatively frequent cardiac disorders. In all these diseases, imaging techniques play a central role. Advanced imaging techniques provide important novel data on the diagnostic and prognostic assessment of RCMs. This EACVI consensus document provides comprehensive information for the appropriateness of all non-invasive imaging techniques for the diagnosis, prognostic evaluation, and management of patients with RCM.
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Affiliation(s)
- Gilbert Habib
- Aix- Aix-Marseille Univ, URMITE, Aix Marseille Université-UM63, CNRS 7278, IRD 198, INSERM 1095.,Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, 13005 Marseille, France
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, National Institute of Health Research (NIHR) Bristol Cardiovascular Biomedical Research Unit (BRU), University of Bristol, Bristol, UK
| | - Alida L P Caforio
- Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padova, Italy
| | - Nuno Cardim
- Multimodality Cardiac Imaging Department, Sports Cardiology and Cardiomyopathies Centre-Hospital da Luz; Lisbon, Portugal
| | - Philippe Charron
- Université Versailles Saint Quentin, INSERM U1018, Hôpital Ambroise Paré, Boulogne-Billancourt, France.,Centre de référence pour les maladies cardiaques héréditaires, APHP, ICAN, Hôpital de la Pitié Salpêtrière, Paris, France
| | | | - Aurélie Dehaene
- Department of Radiology and Cardiovascular Imaging, APHM, Hôpitaux de la Timone, Pôle d'imagerie Médicale, 13005 Marseille, France
| | - Genevieve Derumeaux
- Department of Physiology, INSERM U955, Université Paris-Est Creteil, Henri Mondor Hospital, DHU-ATVB, AP-HP, Créteil, France
| | - Erwan Donal
- Cardiologie-CHU Rennes & CIC-IT 1414 & LTSI INSERM 1099 - Université Rennes-1
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | - Laura Ernande
- Department of Physiology, INSERM U955, Université Paris-Est Creteil, Henri Mondor Hospital, DHU-ATVB, AP-HP, Créteil, France
| | - Oliver Gaemperli
- University Heart Center Zurich, Interventional Cardiology and Cardiac Imaging 19, Zurich
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Julia Grapsa
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Alexis Jacquier
- Department of Radiology and Cardiovascular Imaging, APHM, Hôpitaux de la Timone, Pôle d'imagerie Médicale, Aix-Marseille Université, CNRS, CRMBM UMR 7339, 13385 Marseille, France
| | - Karin Klingel
- Department of Molecular Pathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Patrizio Lancellotti
- Departments of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Danilo Neglia
- Cardiovascular Department, Fondazione Toscana G. Monasterio, CNR Institute of Clinical Physiology, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R.-Regione Toscana Pisa, Italy
| | | | - Steffen E Petersen
- Department of Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, London, UK
| | - Sven Plein
- Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories, University of Leeds, UK
| | - Bogdan A Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | | | | | - Erwan Salaun
- Cardiology Department, La Timone Hospital, Marseille France
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, PO Box 217, 7500 AEEnschede, The Netherlands
| | - Christophe Tribouilloy
- Department of Cardiology, University Hospital Amiens, Amiens, France and INSERM U-1088, Jules Verne University of Picardie, Amiens, France
| | - Jose Zamorano
- University Hospital Ramon y Cajal Carretera de Colmenar Km 9,100, 28034 Madrid, Spain
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Vergé MP, Cochet H, Reynaud A, Morlon L, Peyrou J, Vincent C, Rooryck C, Ritter P, Lafitte S, Réant P. Characterization of hypertrophic cardiomyopathy according to global, regional, and multi-layer longitudinal strain analysis, and prediction of sudden cardiac death. Int J Cardiovasc Imaging 2018; 34:1091-1098. [PMID: 29488042 DOI: 10.1007/s10554-018-1323-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/22/2018] [Indexed: 01/24/2023]
Abstract
To evaluate the severity of hypertrophic cardiomyopathy (HCM) according to global, regional, and multi-layer longitudinal strain (LS) analysis using speckle-tracking echocardiography. From February 2007 to November 2014, we prospectively evaluated 375 consecutive HCM patients referred to our specialized cardiomyopathy center. Demographics, clinical, and rest and exercise echocardiographic parameters were collected according to a completely standardized protocol. Global, regional, and multilayer strain analyses were performed. Correlations between LS and other characteristics were evaluated, and we assessed their prognostic value to predict sudden cardiac death (SCD) or appropriate implantable cardioverter defibrillator (ICD) shocks during follow-up, using Cox proportional hazards analyses. We finally included 217 patients (50.1 ± 15.6 years, 67% male) but only 179 (82%) had LS analysis of sufficient quality. An inverse relation was observed between the mean basal left ventricular (LV) LS and diastolic parameters [E/Ea (r = - 0.30) and left atrium indexed volume (r = - 0.23)], as well as between the resting LV outflow-tract maximal gradient (r = - 0.26) or during peak exercise (r = - 0.20). Mean LS in the LV hypertrophic area was particularly related with maximal wall thickness (r = - 0.47) and transmural global LS with the degree of myocardial fibrosis in cardiac magnetic resonance (r = - 0.32). During a median follow-up of 2.8 ± 1.5 years, mean transmural LS in the hypertrophic area was predictor of SCD and appropriate ICD shock (10 events/179 patients, hazard ratio = 0.83 [95% CI 0.72-0.95], p = 0.01). Basal LS and hypertrophic area LS are valuable parameters to evaluate HCM severity. Mean hypertrophic area LS particularly seems predictive of SCD occurrence and appropriate ICD shocks.
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Affiliation(s)
| | - Hubert Cochet
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Amélie Reynaud
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Lucas Morlon
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Jérôme Peyrou
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Cécile Vincent
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France
| | - Caroline Rooryck
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Philippe Ritter
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Stéphane Lafitte
- Bordeaux University Hospital, 33000, Bordeaux, France.,University of Bordeaux, 33000, Bordeaux, France.,IHU Lyric, 33600, Pessac, France
| | - Patricia Réant
- Bordeaux University Hospital, 33000, Bordeaux, France. .,University of Bordeaux, 33000, Bordeaux, France. .,IHU Lyric, 33600, Pessac, France. .,Hopital Cardiologique Haut-Leveque, Avenue de Magellan, 33604, Pessac, France.
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23
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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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24
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Borgia F, Pezzullo E, Schiano Lomoriello V, Sorrentino R, Lo Iudice F, Cocozza S, Della Casa R, Parenti G, Strisciuglio P, Trimarco B, Galderisi M. Myocardial deformation in pediatric patients with mucopolysaccharidoses: A two-dimensional speckle tracking echocardiography study. Echocardiography 2017; 34:240-249. [DOI: 10.1111/echo.13444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Francesco Borgia
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Enrica Pezzullo
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | | | - Regina Sorrentino
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Francesco Lo Iudice
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Sara Cocozza
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Roberto Della Casa
- Department of Translational Medical Sciences; Federico II University Hospital; Naples Italy
| | - Giancarlo Parenti
- Department of Translational Medical Sciences; Federico II University Hospital; Naples Italy
| | - Pietro Strisciuglio
- Department of Translational Medical Sciences; Federico II University Hospital; Naples Italy
| | - Bruno Trimarco
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
| | - Maurizio Galderisi
- Department Advanced Biomedical Sciences; Federico II University Hospital; Naples Italy
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25
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Nardozza M, Chiodi E, Mele D. Left Ventricle Relative Apical Sparing in Cardiac Amyloidosis. J Cardiovasc Echogr 2017; 27:141-142. [PMID: 29142812 PMCID: PMC5672686 DOI: 10.4103/jcecho.jcecho_22_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Amyloidosis is a disease characterized by the extracellular deposition of the protein amyloid. It is a multiorgan disease, and cardiac involvement is not uncommon, generally in the form of a restrictive cardiomyopathy. Typical aspects of cardiac amyloidosis have been described at echocardiography and magnetic resonance imaging (MRI). In particular, the relative apical sparing at two-dimensional speckle-tracking echocardiography has been reported to be specific for cardiac amyloidosis. In our case, we report for the first time that this echocardiographic sign is related to lack of hyperenhancement at late gadolinium enhancement imaging in cardiac MRI.
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Affiliation(s)
- Marianna Nardozza
- Non Invasive Cardiology Unit, Emergency Department, University Hospital of Ferrara, Ferrara, Italy
| | - Elisabetta Chiodi
- Radiology Unit, Radiology and Laboratory Medicine Department, University Hospital of Ferrara, Ferrara, Italy
| | - Donato Mele
- Non Invasive Cardiology Unit, Emergency Department, University Hospital of Ferrara, Ferrara, Italy
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