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Wu Y, Wang X, Gào X, Xu L, Wang B, Cai Z. Prognostic factors in Chinese patients with immunoglobulin light chain amyloidosis: a scoping review and meta-analysis. Ann Med 2024; 56:2386635. [PMID: 39129426 PMCID: PMC11321117 DOI: 10.1080/07853890.2024.2386635] [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: 09/28/2023] [Revised: 03/07/2024] [Accepted: 03/15/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVE This scoping review and meta-analysis aimed to map the evidence regarding prognostic factors in Chinese patients with immunoglobulin light chain (AL) amyloidosis and to identify current research gaps. METHODS We searched EMBASE, PubMed, and CNKI databases from their inception to 15 September 2021. All studies investigated the association between any prognostic factor and target outcomes, including overall survival (OS), progression-free survival (PFS), and end-stage renal disease (ESRD) in Chinese patients with AL amyloidosis. RESULTS This scoping review included 52 studies, of which 44 with 6,432 patients contributed to the multivariate prognostic analysis. Multivariate analysis identified a total of 106 factors that correlated with OS, 16 factors with PFS, and 18 factors with ESRD. Five prognostic factors were significantly associated with PFS, and 11 prognostic factors were significantly associated with ESRD. Meta-analysis was only available for prognostic factors without heterogeneous cutoff values, for which hazard ratios (HRs) and their 95% confidence intervals (CIs) were reported. Meta-analysis showed that bone marrow plasma cells (BMCs) (HR: 1.96, 95% CI: 1.21-3.19, p < 0.05) and interventricular septal thickness (IVST) (HR: 1.23, 95% CI: 1.10-1.38, p < 0.05) were independently associated with OS. CONCLUSION The significant prognostic factors associated with OS, PFS, and ESRD in Chinese patients with AL amyloidosis were related to plasma cell tumor load, biological characteristics, cardiac involvement, renal involvement, population characteristics, and treatment. Further studies should explore additional prognostic factors in patients with AL amyloidosis to develop prognostic models.
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Affiliation(s)
- Yu Wu
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Wang
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Xīn Gào
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Lingjie Xu
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Bin Wang
- Xi’an Janssen Pharmaceutical Ltd, Beijing, Chaoyang District, China
| | - Zhen Cai
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Hu M, Song Y, Yang C, Wang J, Zhu W, Kan A, Yang P, Dai J, Yu H, Gong L. The value of myocardial contraction fraction and long-axis strain to predict late gadolinium enhancement in multiple myeloma patients with secondary cardiac amyloidosis. Sci Rep 2024; 14:16832. [PMID: 39039146 PMCID: PMC11263677 DOI: 10.1038/s41598-024-67544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024] Open
Abstract
The aim of this study is to assess the effectiveness of conventional and two additional functional markers derived from standard cardiac magnetic resonance (CMR) images in detecting the occurrence of late gadolinium enhancement (LGE) in patients with secondary cardiac amyloidosis (CA) related to multiple myeloma (MM). This study retrospectively included 32 patients with preserved ejection fraction (EF) who had MM-CA diagnosed consecutively. Conventional left ventricular (LV) function markers and two additional functional markers, namely myocardial contraction fraction (MCF) and LV long-axis strain (LAS), were obtained using commercial cardiac post-processing software. Logistic regression analyses and receiver operating characteristic (ROC) analysis were performed to evaluate the predictive performances. (1) There were no notable distinctions in clinical features between the LGE+ and LGE- groups, with the exception of a reduced systolic blood pressure in the former (105.60 ± 18.85 mmHg vs. 124.50 ± 20.95 mmHg, P = 0.022). (2) Patients with MM-CA presented with intractable heart failure with preserved ejection fraction (HFpEF). The LVEF in the LGE+ group exhibited a greater reduction (54.27%, IQR 51.59-58.39%) in comparison to the LGE- group (P < 0.05). And MM-CA patients with LGE+ had significantly higher LVMI (90.15 ± 23.69 g/m2), lower MCF (47.39%, IQR 34.28-54.90%), and the LV LAS were more severely damaged (- 9.94 ± 3.42%) than patients with LGE- (all P values < 0.05). (3) The study found that MCF exhibited a significant independent association with LGE, as indicated by an odds ratio of 0.89 (P < 0.05). The cut-off value for MCF was determined to be 64.25% with a 95% confidence interval ranging from 0.758 to 0.983. The sensitivity and specificity of this association were calculated to be 95% and 83%, respectively. MCF is a simple reproducible predict marker of LGE in MM-CA patients. It is a potentially CMR-based method that promise to reduce scan times and costs, and boost the accessibility of CMR.
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Affiliation(s)
- Mengyao Hu
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Yipei Song
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Chunhua Yang
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Jiazhao Wang
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Wei Zhu
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Ao Kan
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Pei Yang
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Jiankun Dai
- Clinical and Technical Support, GE Healthcare, Beijing, People's Republic of China
| | - Honghui Yu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, No.17, Yongwai Zheng Street, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China.
| | - Lianggeng Gong
- Department of Radiology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, No.1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China.
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Xu K, Xu R, Xu HY, Xie LJ, Yang ZG, Fu H, Bai W, Zhang L, Zhou XY, Guo YK. Free-Breathing Compressed Sensing Cine Cardiac MRI for Assessment of Left Ventricular Strain by Feature Tracking in Children. J Magn Reson Imaging 2024; 59:1832-1840. [PMID: 37681476 DOI: 10.1002/jmri.29003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Cardiac MRI feature-tracking (FT) with breath-holding (BH) cine balanced steady state free precession (bSSFP) imaging is well established. It is unclear whether FT-strain measurements can be reliably derived from free-breathing (FB) compressed sensing (CS) bSSFP imaging. PURPOSE To compare left ventricular (LV) strain analysis and image quality of an FB CS bSSFP cine sequence with that of a conventional BH bSSFP sequence in children. STUDY TYPE Prospective. SUBJECTS 40 children able to perform BHs (cohort 1 [12.1 ± 2.2 years]) and 17 children unable to perform BHs (cohort 2 [5.2 ± 1.8 years]). FIELD STRENGTH/SEQUENCE 3T, bSSFP sequence with and without CS. ASSESSMENT Acquisition times and image quality were assessed. LV myocardial deformation parameters were compared between BH cine and FB CS cine studies in cohort 1. Strain indices and image quality of FB CS cine studies were also assessed in cohort 2. Intraobserver and interobserver variability of strain parameters was determined. STATISTICAL TESTS Paired t-test, Wilcoxon signed-rank test, intraclass correlation coefficient (ICC), and Bland-Altman analysis. A P-value <0.05 was considered statistically significant. RESULTS In cohort 1, the mean acquisition time of the FB CS cine study was significantly lower than for conventional BH cine study (15.6 s vs. 209.4 s). No significant difference were found in global circumferential strain rate (P = 0.089), global longitudinal strain rate (P = 0.366) and EuroCMR image quality scores (P = 0.128) between BH and FB sequences in cohort 1. The overall image quality score of FB CS cine in cohort 2 was 3.5 ± 0.5 with acquisition time of 14.7 ± 2.1 s. Interobserver and intraobserver variabilities were good to excellent (ICC = 0.810 to 0.943). DATA CONCLUSION FB CS cine imaging may be a promising alternative technique for strain assessment in pediatric patients with poor BH ability. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Ke Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Rong Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Hua-Yan Xu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lin-Jun Xie
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Fu
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wei Bai
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lu Zhang
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiao-Yue Zhou
- Siemens Healthineers Digital Technology (Shanghai) Co., Ltd., Shanghai, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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Datar Y, Clerc OF, Cuddy SAM, Kim S, Taylor A, Neri JC, Benz DC, Bianchi G, Yee AJ, Sanchorawala V, Ruberg FL, Landau H, Liao R, Kijewski MF, Jerosch-Herold M, Kwong RY, Di Carli MF, Falk RH, Dorbala S. Quantification of right ventricular amyloid burden with 18F-florbetapir positron emission tomography/computed tomography and its association with right ventricular dysfunction and outcomes in light-chain amyloidosis. Eur Heart J Cardiovasc Imaging 2024; 25:687-697. [PMID: 38193678 PMCID: PMC11057921 DOI: 10.1093/ehjci/jead350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 01/10/2024] Open
Abstract
AIMS In systemic light-chain (AL) amyloidosis, quantification of right ventricular (RV) amyloid burden has been limited and the pathogenesis of RV dysfunction is poorly understood. Using 18F-florbetapir positron emission tomography/computed tomography (PET/CT), we aimed to quantify RV amyloid; correlate RV amyloid with RV structure and function; determine the independent contributions of RV, left ventricular (LV), and lung amyloid to RV function; and associate RV amyloid with major adverse cardiac events (MACE: death, heart failure hospitalization, cardiac transplantation). METHODS AND RESULTS We prospectively enrolled 106 participants with AL amyloidosis (median age 62 years, 55% males) who underwent 18F-florbetapir PET/CT, magnetic resonance imaging, and echocardiography. 18F-florbetapir PET/CT identified RV amyloid in 63% of those with and 40% of those without cardiac involvement by conventional criteria. RV amyloid burden correlated with RV ejection fraction (EF), RV free wall longitudinal strain (FWLS), RV wall thickness, RV mass index, N-terminal pro-brain natriuretic peptide, troponin T, LV amyloid, and lung amyloid (each P < 0.001). In multivariable analysis, RV amyloid burden, but not LV or lung amyloid burden, predicted RV dysfunction (EF P = 0.014; FWLS P < 0.001). During a median follow-up of 28 months, RV amyloid burden predicted MACE (P < 0.001). CONCLUSION This study shows for the first time that 18F-florbetapir PET/CT identifies early RV amyloid in systemic AL amyloidosis prior to alterations in RV structure and function. Increasing RV amyloid on 18F-florbetapir PET/CT is associated with worse RV structure and function, predicts RV dysfunction, and predicts MACE. These results imply a central role for RV amyloid in the pathogenesis of RV dysfunction.
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Affiliation(s)
- Yesh Datar
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Olivier F Clerc
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Sarah A M Cuddy
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Sirwoo Kim
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Alexandra Taylor
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Jocelyn Canseco Neri
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Dominik C Benz
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Giada Bianchi
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Andrew J Yee
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Vaishali Sanchorawala
- Section of Hematology, Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Frederick L Ruberg
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Heather Landau
- Division of Medical Oncology, Memorial Sloan Kettering Medical Center, New York, NY, USA
| | - Ronglih Liao
- Amyloidosis Program, Stanford University, Stanford, CA, USA
| | - Marie Foley Kijewski
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Michael Jerosch-Herold
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Raymond Y Kwong
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
- CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
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5
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Hu M, Shen Y, Yu H, Song Y, Zheng T, Hong D, Gong L. Prognostic value of cardiac magnetic resonance imaging feature tracking technology in patients with light chain amyloidosis. Clin Radiol 2024; 79:e239-e246. [PMID: 37953095 DOI: 10.1016/j.crad.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/27/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023]
Abstract
AIM To undertake a meta-analysis of the prognostic value of cardiac magnetic resonance imaging feature tracking (CMR-FT) in patients with light-chain cardiac amyloidosis (LCA). MATERIALS AND METHODS A systematic search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. All analyses were conducted using RevMan 5.3 software. RESULTS Eight studies were included with 663 patients. For the left ventricle, the results showed that CMR-FT was statistically significant in predicting death, with less impaired global circumferential (GCS), radial (GRS) and longitudinal (GLS) strain in survivors of LCA (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.09-1.25; 0.95, 0.93-0.96; 1.12, 1.05-1.20, all p<0.001). For ejection fraction (EF) and mass index, surviving patients had higher EFs and mass index (OR 0.96, 95% CI 0.96-0.97; 1.01, 1.01-1.02). For the right ventricle, the results showed that CMR-FT was statistically significant in predicting death, with less impaired GLS and GRS in survivors of LCA (OR 1.11, 95% CI 1.08-1.15; 0.93, 0.90-0.96, all p<0.001). Surviving patients had higher EFs (OR 0.97, 95% CI 0.96-0.98, p<0.001). Upon removing the studies one by one, there was no significant change in the results of the study. Both analyses showed no apparent publication deviation on funnel plots. CONCLUSION Parameters derived from CMR-FT technology are promising new predictors for LCA, and are easily available and reliable. Patients with poor myocardial deformability are at highest risk of death.
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Affiliation(s)
- M Hu
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, No. 1 Min-de Road, Donghu District, Nanchang, 33000, Jiangxi Province, People's Republic of China
| | - Y Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - H Yu
- Department of Radiology, Jiangxi Province Medical Imaging Research Institute, The First Affiliated Hospital of Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Y Song
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, No. 1 Min-de Road, Donghu District, Nanchang, 33000, Jiangxi Province, People's Republic of China
| | - T Zheng
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, No. 1 Min-de Road, Donghu District, Nanchang, 33000, Jiangxi Province, People's Republic of China
| | - D Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwai Zheng Street, Donghu District, Nanchang 330006, Jiangxi Province, People's Republic of China.
| | - L Gong
- Medical Imaging Center, The Second Affiliated Hospital of Nanchang University, No. 1 Min-de Road, Donghu District, Nanchang, 33000, Jiangxi Province, People's Republic of China.
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Tana M, Tana C, Panarese A, Mantini C, Ricci F, Porreca E. Clinical and Cardiovascular Magnetic Resonance Imaging Features of Cardiac Amyloidosis. Rev Cardiovasc Med 2023; 24:291. [PMID: 39077571 PMCID: PMC11273132 DOI: 10.31083/j.rcm2410291] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 07/31/2024] Open
Abstract
Amyloidosis is a systemic disease characterized by the accumulation of insoluble aggregates in various organs, leading to parenchymal damage. When these amyloid fibrils are deposited in the extracellular matrix of the cardiac structures, the condition is referred to as cardiac amyloidosis (CA). The extent of organ involvement determines the degree of cardiac impairment, which can significantly impact prognosis. The two most implicated proteins in CA are transthyretin and misfolded monoclonal immunoglobulin light chains. These proteins give rise to two distinct clinical forms of CA: transthyretin amyloidosis (ATTR-CA) and light-chain amyloidosis (AL-CA). ATTR-CA is further classified into two subtypes: ATTRm-CA, which occurs at a younger age and is caused by hereditary misfolded mutated proteins, and ATTRwt-CA, which is an acquired wild-type form more commonly observed in older adults, referred to as senile amyloidosis. While AL-CA was considered the most prevalent form for many years, recent autopsy studies have revealed an increase in cases of ATTRwt-CA. This narrative review aims to describe the clinical and imaging features of CA, with a particular focus on cardiac complications and mortality associated with the AL form. Early identification and differentiation of CA from other disorders are crucial, given the higher risk and severity of cardiac involvement in AL-CA. Furthermore, emphasis is placed on the potential utility of cardiovascular magnetic resonance imaging in detecting early cases of CA.
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Affiliation(s)
- Marco Tana
- Internal Medicine and Cardiovascular Ultrasound Unit, Medical Department, SS. Annunziata Hospital, 66100 Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Claudio Tana
- Geriatrics Clinic, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Alessandro Panarese
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Ettore Porreca
- Internal Medicine and Cardiovascular Ultrasound Unit, Medical Department, SS. Annunziata Hospital, 66100 Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
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7
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Boretto P, Patel NH, Patel K, Rana M, Saglietto A, Soni M, Ahmad M, Sin Ying Ho J, De Filippo O, Providencia RA, Hyett Bray JJ, D’Ascenzo F. Prognosis prediction in cardiac amyloidosis by cardiac magnetic resonance imaging: a systematic review with meta-analysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead092. [PMID: 37840586 PMCID: PMC10575621 DOI: 10.1093/ehjopen/oead092] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
Cardiac involvement is the foremost determinant of the clinical progression of amyloidosis. The diagnostic role of cardiac magnetic resonance (CMR) imaging in cardiac amyloidosis has been established, but the prognostic role of various right and left CMR tissue characterization and functional parameters, including global longitudinal strain (GLS), late gadolinium enhancement (LGE), and parametric mapping, is yet to be delineated. We searched EMBASE, PubMed, and MEDLINE for studies analysing the prognostic use of CMR imaging in patients with light chain amyloidosis or transthyretin amyloidosis cardiac amyloidosis. The primary endpoint was all-cause mortality. A random effects model was used to calculate a pooled odds ratio using inverse-variance weighting. Nineteen studies with 2199 patients [66% males, median age 59.7 years, interquartile range (IQR) 58-67] were included. Median follow-up was 24 months (IQR 20-32), during which 40.8% of patients died. Both tissue characterization left heart parameters such as elevated extracellular volume [hazard ratio (HR) 3.95, 95% confidence interval (CI) 3.01-5.17], extension of left ventricular (LV) LGE (HR 2.69, 95% CI 2.07-3.49) elevated native T1 (HR 2.19, 95% CI 1.12-4.28), and functional parameters such as reduced LV GLS (HR 1.91, 95% CI 1.52-2.41) and reduced LV ejection fraction (EF; HR 1.20, 95% CI 1.17-1.23) were associated with increased all-cause mortality. Unlike the presence of right ventricular (RV) LGE (HR 3.40, 95% CI 0.51-22.54), parameters such as RV GLS (HR 2.08, 95% CI 1.6-2.69), RVEF (HR 1.13, 95% CI 1.05-1.22), and tricuspid annular systolic excursion (TAPSE) (HR 1.11, 95% CI 1.02-1.21) were also associated with mortality. In this large meta-analysis of patients with cardiac amyloidosis, CMR parameters assessing RV and LV function and tissue characterization were associated with an increased risk of mortality.
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Affiliation(s)
- Paolo Boretto
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Neal Hitesh Patel
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Keval Patel
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Mannat Rana
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Andrea Saglietto
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Manas Soni
- Research Department of Medical Education, UCL Medical School,
74 Huntley St, WC1E 6DE London, UK
| | - Mahmood Ahmad
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS
Foundation Trust, 10 Pond St, NW3 2PS London,
UK
| | - Jamie Sin Ying Ho
- Department of Cardiology, Royal Free Hospital, Royal Free London NHS
Foundation Trust, 10 Pond St, NW3 2PS London,
UK
| | - Ovidio De Filippo
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
| | - Rui Andre Providencia
- Institute of Health Informatics Research, University College
London, 222 Euston Road, NW1 2DA London, UK
| | - Jonathan James Hyett Bray
- Institute of Health Informatics Research, University College
London, 222 Euston Road, NW1 2DA London, UK
- Institute of Life Sciences-2, Swansea Bay University Health Board and
Swansea University Medical School, Swansea University, 4
Mumbles Rd, Sketty, SA3 5AU Swansea, UK
| | - Fabrizio D’Ascenzo
- Department of Cardiovascular and Thoracic, Città della Salute e della
Scienza Hospital, University of Turin, Corso Bramante, 88,
10126 Turin, Italy
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8
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Földeák D, Kormányos Á, Nemes A. Prognostic role of three-dimensional speckle-tracking echocardiography-derived left ventricular global longitudinal strain in cardiac amyloidosis: Insights from the MAGYAR-Path Study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 36840337 DOI: 10.1002/jcu.23445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Systemic amyloidosis is an uncommon disorder in which amyloid fibrils deposit extracellularly. Three-dimensional speckle-tracking echocardiography (3DSTE) is a novel method able to assess left ventricular (LV) global longitudinal strain (GLS). Our aim was to evaluate the prognostic impact of 3DSTE-derived LV-GLS in patients with cardiac amyloidosis (CA). MATERIALS AND METHODS A total of 35 patients suffering from light-chain (AL) CA or transthyretin (TTR) CA were selected, but 7 patients had to be excluded due to insufficient image quality or were lost for follow-up. With AL-CA 23 cases, while for TTR-CA 5 patients were diagnosed. Complete two-dimensional Doppler and 3DSTE were performed in all subjects. RESULTS The median follow-up was 201 days (ranging from 36 to 632 days) during which cardiovascular event was detected in 17 CA patients, including 8 cardiac deaths. Six patients were diagnosed with acute heart failure, two patients needed invasive interventions (percutaneous coronary intervention with stent-implantation, implantable cardioverter defibrillator implantation) and in one patient new higher grade atrioventricular block was registered. Using ROC analysis, 3DSTE-derived LV-GLS ≥11.8% (absolute value) was found to be a significant predictor for cardiovascular event-free survival (sensitivity 65%, specificity 64%, area under the curve 0.71, p = .05). Lower LV ejection fraction was confirmed in patients with LV-GLS <11.8% as compared to cases with LV-GLS ≥11.8%. In case of a cardiovascular event, LV-GLS was lower as compared to that of subjects with no events. Multivariable regression analysis confirmed that LV-GLS and LV end-diastolic diameter were independent predictors of cardiovascular survival. CONCLUSION 3DSTE-derived LV-GLS is an independent predictor for future cardiovascular events in CA patients.
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Affiliation(s)
- Dóra Földeák
- Division of Haematology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Árpád Kormányos
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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9
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The Clinical Characteristics of Immunoglobulin Light Chain Amyloidosis in the Chinese Population: A Systematic Scoping Review. HEMATO 2022. [DOI: 10.3390/hemato4010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Immunoglobulin light chain (AL) amyloidosis is the most common type of systemic amyloidosis in China and is associated with increased morbidity and a poor prognosis. However, the clinical characteristics of Chinese patients with AL amyloidosis have not been systematically investigated. This scoping review aimed to summarize the available literature regarding the clinical characteristics of patients with AL amyloidosis and identify potential knowledge gaps. We searched three electronic databases from inception to 7 February 2021. PICOS (Patient, Intervention, Comparison, Outcome and Study) design structure was used to formulate the data extraction. All statistical calculations and analyses were performed with R (version 3.6.0). Sixty-seven articles with 5022 patients were included. Results suggest Chinese patients were younger (57 years) at the time of diagnosis when compared with other patient populations and were predominantly male (61.2%). The time interval from the onset of symptoms to diagnosis was between 6 and 12 months. It was found that 41.1% of Chinese patients with AL amyloidosis were diagnosed with an advanced stage III disease when diagnosed, and 20.2% had a concurrent disease. The most involved organs were the kidneys (84.3%) and the heart (62.5%). In conclusion, our study shows some similarities and differences with other studies on the clinical characteristics of Chinese patients with AL amyloidosis, including the age at diagnosis, Mayo stage, and organ involvement. However, a nationwide epidemiological investigation is still needed to provide a comprehensive overview of this patient population in China.
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Bo K, Zhou Z, Sun Z, Gao Y, Zhang H, Wang H, Liu T, Xu L. Prognostic Value of Cardiac Magnetic Resonance in Assessing Right Ventricular Strain in Cardiovascular Disease: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2022; 23:406. [PMID: 39076664 PMCID: PMC11270452 DOI: 10.31083/j.rcm2312406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 10/11/2023] Open
Abstract
Objective To evaluate the prognostic value of cardiac magnetic resonance (CMR) imaging in assessing right ventricular strain via meta-analysis of current literature. Background Right ventricular strain recorded with CMR serves as a novel indicator to quantify myocardial deformation. Although several studies have reported the predictive value of right ventricular strain determined using CMR, their validity is limited by small sample size and low event number. Methods Embase, Medline and Web of Science were searched for studies assessing the prognostic value of myocardial strain. The primary endpoint was a composite of all-cause mortality, cardiovascular death, aborted sudden cardiac death, heart transplantation and heart failure admissions. Results A total of 14 studies met the selection criteria and were included in the analysis (n = 3239 adults). The random-effects model showed the association of parameters of right ventricular strain with major adverse cardiac events. Absolute value of right ventricular global longitudinal strain was negatively correlated with right ventricular ejection fraction (hazard ratio: 1.07, 95% confidence interval: 1.05-1.08; p = 0.013). Despite the small number of studies, right ventricular radial strain, right ventricular circumferential strain and right ventricular long-axis strain displayed potential prognostic value. Conclusions Right ventricular strain measured with CMR is an effective prognostic indicator for cardiovascular disease.
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Affiliation(s)
- Kairui Bo
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, 6845 Perth, Western Australia, Australia
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Tong Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
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11
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Pu H, Cui B, Liu J, He W, Zhou X, Lin H, Peng L. Characterization and clinical significance of biventricular mechanics in patients with systemic lupus erythematosus by 3T cardiovascular magnetic resonance tissue tracking. Quant Imaging Med Surg 2022; 12:1079-1095. [PMID: 35111606 PMCID: PMC8739123 DOI: 10.21037/qims-21-520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/31/2021] [Indexed: 10/11/2023]
Abstract
BACKGROUND Detecting impaired left ventricle (LV) or right ventricle (RV) mechanics could aid in fully understanding the process of cardiac involvement in patients with systemic lupus erythematosus (SLE). This study aimed to evaluate biventricular strain parameters derived from cardiac magnetic resonance (CMR) tissue tracking in SLE patients and their association with other clinical variables. METHODS A group of 47 SLE patients and 27 healthy controls were enrolled and underwent CMR examination, including cine and late gadolinium enhancement (LGE) imaging. Aside from RV strain parameters in the radial direction, biventricular global peak strain and peak systolic/diastolic global strain rate in radial, circumferential, and longitudinal directions were assessed for each participant. Multivariate linear regression analysis was used to analyze the factors related to the biventricular strain parameters. Receiver operating characteristic (ROC) analysis was used to identify RV dysfunction. RESULTS Compared with the controls, part of the biventricular strain parameters in the SLE subgroup with preserved ejection fraction (EF) were impaired, which was more significant in the SLE subgroup with reduced EF (all P<0.05). The SLE patients with RV dysfunction (15/47) included patients with LV dysfunction (8/47). The RVEF was associated with impaired LV global peak strain and peak diastolic strain rate in the SLE patients (absolute value of β=0.406-0.715, all P<0.05). The LV LGE in SLE patients (12/47) was associated with LV global longitudinal peak strain and peak diastolic global longitudinal strain rate (β=0.378 and -0.342; all P<0.05). There were independent correlations between pulmonary arterial hypertension and RV global longitudinal peak strain, anti-ribonucleoprotein (RNP) antibody and RV global circumferential peak strain, and pericardial effusion and RV peak diastolic global circumferential strain rate, respectively (β=0.319, 0.359, and -0.285, respectively; all P<0.05). The LV global longitudinal peak strain had greater diagnostic accuracy for RV dysfunction RV dysfunction [area under curve (AUC): 0.933, cut-off value: -13.38%). CONCLUSIONS Biventricular strain parameters derived from CMR are sensitive markers of subclinical ventricular function impairment before EF reduction at an early stage of SLE. Biventricular strain analysis could be considered for inclusion in early cardiac functional assessment in SLE patients, particularly LV global longitudinal peak strain, which might assist in therapeutic decision-making and disease monitoring.
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Affiliation(s)
- Huaxia Pu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Beibei Cui
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Hui Lin
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
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12
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Abstract
PURPOSE OF REVIEW The rapid search for suitable tricuspid transcatheter devices has ignited renewed enthusiasm in accurate characterization of tricuspid valve disease. Cardiovascular magnetic resonance (CMR), traditionally used as the gold standard in assessment for right ventricular size and function, has recently seen its use expanded to assess both the structure and function of the tricuspid apparatus. This review will highlight the role of CMR in tricuspid valve disease and compare it with other commonly used imaging modalities. RECENT FINDINGS Dynamic anatomical assessment of the tricuspid apparatus, in combination with accurate leaflet identification, is possible with CMR. Tricuspid regurgitation volume and fraction are derived through an indirect volumetric method, and therefore, able to overcome many traditional hurdles involved with valve regurgitation quantitation. Adverse right heart prognostic factors in tricuspid valve disease, such as right heart volumes, function, and tissue characterization, are optimally assessed using CMR. SUMMARY Cardiovascular magnetic resonance is a powerful modality that should be harnessed in order to obtain a multifaceted assessment of tricuspid valve structure, function, and the effects of valve disease on right heart remodeling.
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Tadic M, Kersten J, Nita N, Schneider L, Buckert D, Gonska B, Scharnbeck D, Dahme T, Imhof A, Belyavskiy E, Cuspidi C, Rottbauer W. The Prognostic Importance of Right Ventricular Longitudinal Strain in Patients with Cardiomyopathies, Connective Tissue Diseases, Coronary Artery Disease, and Congenital Heart Diseases. Diagnostics (Basel) 2021; 11:diagnostics11060954. [PMID: 34073460 PMCID: PMC8228710 DOI: 10.3390/diagnostics11060954] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Right ventricular (RV) systolic function represents an important independent predictor of adverse outcomes in many cardiovascular (CV) diseases. However, conventional parameters of RV systolic function (tricuspid annular plane excursion (TAPSE), RV myocardial performance index (MPI), and fractional area change (FAC)) are not always able to detect subtle changes in RV function. New evidence indicates a significantly higher predictive value of RV longitudinal strain (LS) over conventional parameters. RVLS showed higher sensitivity and specificity in the detection of RV dysfunction in the absence of RV dilatation, apparent wall motion abnormalities, and reduced global RV systolic function. Additionally, RVLS represents a significant and independent predictor of adverse outcomes in patients with dilated cardiomyopathy (CMP), hypertrophic CMP, arrhythmogenic RV CMP, and amyloidosis, but also in patients with connective tissue diseases and patients with coronary artery disease. Due to its availability, echocardiography remains the main imaging tool for RVLS assessment, but cardiac magnetic resonance (CMR) also represents an important additional imaging tool in RVLG assessment. The findings from the large studies support the routine evaluation of RVLS in the majority of CV patients, but this has still not been adopted in daily clinical practice. This clinical review aims to summarize the significance and predictive value of RVLS in patients with different types of cardiomyopathies, tissue connective diseases, and coronary artery disease.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
- Correspondence: ; Tel.: +49-17632360011
| | - Johannes Kersten
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Nicoleta Nita
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Leonhard Schneider
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Dominik Buckert
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Birgid Gonska
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Dominik Scharnbeck
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Tilman Dahme
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Armin Imhof
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Evgeny Belyavskiy
- Department of Cardiology, Charité—Universitätsmedizin Berlin (Campus Virchow-Klinikum), 13353 Berlin, Germany;
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy;
| | - Wolfgang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
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14
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Cavigli L, Focardi M, Cameli M, Mandoli GE, Mondillo S, D'Ascenzi F. The right ventricle in “Left-sided” cardiomyopathies: The dark side of the moon. Trends Cardiovasc Med 2020; 31:476-484. [DOI: 10.1016/j.tcm.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
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