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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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Molnár AÁ, Sánta A, Merkely B. Echocardiography Imaging of the Right Ventricle: Focus on Three-Dimensional Echocardiography. Diagnostics (Basel) 2023; 13:2470. [PMID: 37568832 PMCID: PMC10416971 DOI: 10.3390/diagnostics13152470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Right ventricular function strongly predicts cardiac death and adverse cardiac events in patients with cardiac diseases. However, the accurate right ventricular assessment by two-dimensional echocardiography is limited due to its complex anatomy, shape, and load dependence. Advances in cardiac imaging and three-dimensional echocardiography provided more reliable information on right ventricular volumes and function without geometrical assumptions. Furthermore, the pathophysiology of right ventricular dysfunction and tricuspid regurgitation is frequently connected. Three-dimensional echocardiography allows a more in-depth structural and functional evaluation of the tricuspid valve. Understanding the anatomy and pathophysiology of the right side of the heart may help in diagnosing and managing the disease by using reliable imaging tools. The present review describes the challenging echocardiographic assessment of the right ventricle and tricuspid valve apparatus in clinical practice with a focus on three-dimensional echocardiography.
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Affiliation(s)
- Andrea Ágnes Molnár
- Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary; (A.S.); (B.M.)
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Usuku H, Yamamoto E, Sueta D, Noguchi M, Fujisaki T, Egashira K, Oike F, Fujisue K, Hanatani S, Arima Y, Takashio S, Kawano Y, Oda S, Kawano H, Matsushita K, Ueda M, Matsui H, Matsuoka M, Tsujita K. Prognostic value of right ventricular global longitudinal strain in patients with immunoglobulin light-chain cardiac amyloidosis. Eur Heart J Open 2023; 3:oead048. [PMID: 37214543 PMCID: PMC10196102 DOI: 10.1093/ehjopen/oead048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023]
Abstract
Aims Left ventricular (LV) global longitudinal strain (GLS) (LV-GLS) is a strong and independent predictor of outcomes in patients with immunoglobulin light-chain (AL) cardiac amyloidosis. This study was performed to investigate whether right ventricular (RV) GLS (RV-GLS) provides prognostic information in patients with AL amyloidosis. Methods and results Among 74 patients who were diagnosed with AL cardiac amyloidosis at Kumamoto University Hospital from December 2005 to December 2022, 65 patients who had enough information for two-dimensional speckle tracking imaging and did not receive chemotherapy before the diagnosis of cardiac amyloidosis were retrospectively analysed. During a median follow-up of 359 days, 29 deaths occurred. In two-dimensional echocardiographic findings, LV-GLS, left atrium reservoir strain (LASr), and RV-GLS were significantly lower in the all-cause death group than in the survival group (LV-GLS: 8.9 ± 4.2 vs. 11.7 ± 3.9, P < 0.01; LASr: 9.06 ± 7.28 vs. 14.09 ± 8.32, P < 0.05; RV-GLS: 12.0 ± 5.1 vs. 16.8 ± 4.0, P < 0.01). Multivariable Cox proportional hazard analysis showed RV-GLS was significantly and independently associated with all-cause death in patients with AL cardiac amyloidosis (hazard ratio 0.85; 95% confidence interval, 0.77-0.94; P < 0.01). Receiver operating characteristic analysis showed that the area under the curve of RV-GLS for all-cause death was 0.774 and that the best cut-off value of RV-GLS was 14.5% (sensitivity, 75%; specificity, 72%). In the Kaplan-Meier analysis, patients with AL cardiac amyloidosis who had low RV-GLS (<14.5%) had a significantly higher probability of all-cause death (P < 0.01). Conclusion RV-GLS has prognostic value in patients with AL cardiac amyloidosis and provides greater prognostic power than LV-GLS and LASr.
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Affiliation(s)
- Hiroki Usuku
- Department of Laboratory Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | | | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Momoko Noguchi
- Department of Laboratory Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tomohiro Fujisaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Koichi Egashira
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Fumi Oike
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yawara Kawano
- Department of Hematology, Rheumatology, and Infectious Diseases, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Division of Advanced Cardiovascular Therapeutics, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Mitsuharu Ueda
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hirotaka Matsui
- Department of Molecular Laboratory Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masao Matsuoka
- Department of Hematology, Rheumatology, and Infectious Diseases, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
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Abstract
Amyloid deposits are defined by their tinctorial properties. Under the light microscope amyloid deposits are eosinophilic and amorphous when stained with hematoxylin and eosin. With Congo red staining the deposits are positive and under polarized light will exhibit green birefringence. Sixty years later electron microscopy demonstrated that all deposits were fibrillar. All amyloid deposits are protein derived. The clinical characteristics will be driven by the nature of the protein subunit. In cardiology, the 2 most common subunits accounting for well more than 90% of cardiac amyloidosis are either immunoglobulin light chain, amyloid light-chain (AL) amyloidosis, or transthyretin; transthyretin (TTR) amyloidosis. Although 70% of patients with systemic amyloidosis have cardiac involvement the diagnosis is made by cardiologists only 20% of the time, suggesting significant gaps in knowledge in how to establish a workflow to arrive at a diagnosis in everyday practice.
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Affiliation(s)
- Morie A Gertz
- Department of Medicine, Mayo Clinic Rochester, 200 Southwest First Street, W10, Rochester, MN 55905, USA.
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Ismailov RM, Lerut J, Aceña Á, Khasanova ZD. Enhancing knowledge and awareness of transthyretin cardiac amyloidosis and shared decision-making among cardiology team members in Colorado, USA via an online educational initiative. Hosp Pract (1995) 2021; 50:37-41. [PMID: 34879213 DOI: 10.1080/21548331.2021.2016334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Our project aimed to increase knowledge of noninvasive diagnostic modalities (including bone radiotracer scintigraphy), raise suspicion of transthyretin cardiac amyloidosis (ATTR-CA), and improve cardiology team member's awareness and knowledge of shared decision-making (SDM), as well as the quality of SDM communication between cardiology team members and patients. METHODS An online educational module and survey was developed and cardiology team members in Colorado, USA, were invited to participate. This online educational module included various important topics related to ATTR-CA (e.g., the cause of ATTR-CA, endomyocardial biopsy, and noninvasive methods to diagnose ATTR-CA) and SDM (e.g., benefits of SDM, the role of SDM in the diagnosis of ATTR-CA, implementation of SDM in cardiology practice, and the 3-talk model). RESULTS There were 34 survey respondents, over one-third of whom were cardiologists. Most respondents agreed on the importance of diagnosing ATTR-CA at an early stage, and about three-quarters of the survey takers agreed that bone scintigraphy can reliably diagnose ATTR-CA without the need for endomyocardial biopsy. Concern over increased time commitment was the leading barrier to the implementation of SDM in respondents' clinical practice. The majority of respondents identified the correct answer regarding ATTR-CA and SDM after reading the online educational module. This improvement in scores after exposure to the online educational module was statistically significant. CONCLUSION Baseline knowledge and awareness of various issues related to ATTR-CA was relatively low among cardiology team members. Participants' knowledge was enhanced through our effective online educational program. Prospective educational projects focused on various methods of detecting ATTR-CA as well as other amyloid conditions in diverse clinical settings will remain important.
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Affiliation(s)
- Rovshan M Ismailov
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation, Denver, CO, USA
| | - Jan Lerut
- Institute for Experimental and Clinical Research (IREC), Université Catholique Louvain (UCL, Brussels, Belgium
| | - Álvaro Aceña
- Cardiology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Zaytuna D Khasanova
- Complex Mechanisms of Disease, Aging and Trauma (CMDAT) Research Foundation, Denver, CO, USA
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Liu S, Wang Y, Li J, Li G, Kong F, Mu L, Jia D, Li Y, Yang J, Ma C. Incremental Value of Three-dimensional Speckle-tracking Echocardiography for Evaluating Left Ventricular Systolic Function in Patients with Coronary Slow Flow. Curr Probl Cardiol 2021;:100928. [PMID: 34353632 DOI: 10.1016/j.cpcardiol.2021.100928] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
The purpose was to evaluate left ventricular (LV) systolic function in patients with coronary slow flow (CSF), and compared the incremental values of 3-dimensional (3D) speckle-tracking echocardiography (STE). Seventy-three patients with CSF and 60 control subjects were enrolled. CSF was diagnosed during coronary angiography. Two-dimensional (2D) and 3D global strain were measured using STE. Sex, mitral E, 2D GLS, and all 3D strain parameters were independent predictors of CSF. Combination of sex, mitral E, and 3D GTS had the highest area under the curve (AUC) for identifying CSF (AUC, 0.81; P < 0.001). Integrated discrimination index (IDI) improved adding 3D GTS to the combined sex and mitral E model (IDI = 0.12, P = 0.01) or 2D GLS model (IDI = 0.14, P < 0.001). LV systolic function was impaired in CSF patients. 3D GTS had an independent and incremental value for predicting CSF compared with 2D echocardiography.
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Lei C, Zhu X, Hsi DH, Wang J, Zuo L, Ta S, Yang Q, Xu L, Zhao X, Wang Y, Sun S, Liu L. Predictors of cardiac involvement and survival in patients with primary systemic light-chain amyloidosis: roles of the clinical, chemical, and 3-D speckle tracking echocardiography parameters. BMC Cardiovasc Disord 2021; 21:43. [PMID: 33478398 PMCID: PMC7819214 DOI: 10.1186/s12872-021-01856-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background Light-chain (AL) amyloidosis is the most common type of systemic amyloidosis with poor prognosis. Currently, the predictors of cardiac involvement and prognostic staging systems are primarily based on conventional echocardiography and serological biomarkers. We used three-dimensional speckle tracking echocardiography (STE-3D) measurements of strain, hypothesizing that it could detect cardiac involvement and aid in prediction of mortality. Methods We retrospectively analysed 74 consecutive patients with biopsy-proven AL amyloidosis. Among them, 42 showed possible cardiac involvement and 32 without cardiac involvement. LV global longitudinal strain (GLS), global radial strain, global circumferential strain and global area strain (GAS) measurements were obtained. Results The GLS and GAS were considered significant predictors of cardiac involvement. The cut-off values discriminating cardiac involvement were 16.10% for GLS, 32.95% for GAS. During the median follow-up of 12.5 months (interquartile range 4–25 months), 20 (27%) patients died. For the Cox proportional model survival analysis, heart rate, cardiac troponin T, NT-proBNP levels, E/e’, GLS, and GAS were univariate predictors of death. Multivariate Cox model showed that GLS ≤ 14.78% and cardiac troponin T ≥ 0.049 mg/l levels were independent predictors of survival. Conclusions STE-3D measurements of LV myocardial mechanics could detect cardiac involvement in patients with AL amyloidosis; GLS and cardiac biomarkers can provided prognostic information for mortality prediction.
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Affiliation(s)
- Changhui Lei
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - Xiaoli Zhu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - David H Hsi
- Department of Cardiology, Heart and Vascular Institute, Stamford Hospital, Stamford, CT, USA
| | - Jing Wang
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - Lei Zuo
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - Shengjun Ta
- Department of Ultrasound, Yan'an Hospital, Yan'an, Shannxi, China
| | - Qianli Yang
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - Lei Xu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - Xueli Zhao
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China
| | - Yan Wang
- Department of Nephrology, XiJing Hospital, Xi'an, Shannxi, China
| | - Shiren Sun
- Department of Nephrology, XiJing Hospital, Xi'an, Shannxi, China.
| | - Liwen Liu
- Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Xi'an, China.
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Fine NM, White JA, Jimenez-Zepeda V, Howlett JG. Determinants and Prognostic Significance of Serial Right Heart Function Changes in Patients With Cardiac Amyloidosis. Can J Cardiol 2020; 36:432-440. [DOI: 10.1016/j.cjca.2020.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
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Truong VT, Phan HT, Pham KN, Duong HN, Ngo TN, Palmer C, Nguyen TT, Truong BH, Vo MA, Tretter JT, Nagueh SF, Chung ES, Mazur W. Normal Ranges of Left Ventricular Strain by Three-Dimensional Speckle-Tracking Echocardiography in Adults: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2019; 32:1586-1597.e5. [DOI: 10.1016/j.echo.2019.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/16/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022]
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Saha SK, Kiotsekoglou A, Gopal AS, Lindqvist P. Biatrial and right ventricular deformation imaging: Implications of the recent EACVI consensus document in the clinics and beyond. Echocardiography 2019; 36:1910-1918. [DOI: 10.1111/echo.14498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/13/2019] [Accepted: 09/17/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Samir K. Saha
- Department of Clinical Physiology Umeå University Hospital Umeå Sweden
| | | | - Aasha S Gopal
- Department of cardiac imaging Saint Francis Hospital Roslyn NY USA
| | - Per Lindqvist
- Department of Clinical Physiology Umeå University Hospital Umeå Sweden
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12
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Abstract
RATIONALE Cardiac transthyretin amyloidosis is a progressive and fatal cardiomyopathy for which several promising therapies are in development. The diagnosis is frequently delayed or missed because of the limited specificity of clinical manifestations, routine electrocardiogram, echocardiography and the traditional requirement for endomyocardial biopsy confirmation. PATIENT CONCERNS A 68-year-old female had suffered from lumbago for 5 years with progressive weakness, numbness in both lower limb. DIAGNOSIS The patient's clinical signs were not specific, but cardiac amyloidosis was suspected based on relative left ventricular apical sparing of longitudinal strain on echocardiography and continuous elevated serum levels of cardiac biomarkers (ultrasensitive cardiac troponin I and NT-proBNP). She was finally diagnosed hereditary transthyretin-related cardiac amylodosis by specific findings of cardiovascular magnetic resonance imaging (CMR), -technetium pyrophosphate (Tc-PYP) scintigraphy and genetic testing. INTERVENTIONS The patient received medications including diuretics, beta-blockers and angiotensin-converting enzyme inhibitors at the time of hospitalization. Ultimately, however, she refused further treatments and requested discharge from our hospital. OUTCOMES A series of noninvasive technique enables the diagnosis of hereditary transthyretin-related cardiac amyloidosis. LESSONS While endomyocardial biopsy is not able to performed, this case demonstrates that a combination of noninvasive techniques, especially CMR, nuclear imaging, and genetic testing, may help us to make a correct diagnosis of hereditary transthyretin-related cardiac amyloidosis.
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Affiliation(s)
- Jin Qin
- Division of Cardiology, Department of Internal Medicine
| | | | | | | | - Hong Wang
- Genetic Diagnostic Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Rui Li
- Division of Cardiology, Department of Internal Medicine
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine
| | - Jiangtao Yan
- Division of Cardiology, Department of Internal Medicine
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13
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Abstract
PURPOSE OF REVIEW To summarize literature on the application of myocardial strain in patients with heart failure published since 2018. RECENT FINDINGS Left ventricular (LV) and right ventricular strain provides important prognostic information in patients with acute and chronic heart failure and new insights in disease mechanisms in amyloidosis. The addition of left atrial strain to current societal diastolic dysfunction criteria may improve detection of clinically relevant diastolic dysfunction. The recently developed method for noninvasive estimation of myocardial work incorporates loading conditions into the evaluation of LV performance that may be important for selection of patients for cardiac resynchronization therapy. SUMMARY Evidence linking myocardial strain to adverse outcomes in heart failure is steadily being developed. Although GLS seems to be ready for clinical use, further validation and standardization of RV, LA strain and myocardial work is needed.
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Amsallem M, Witteles R, Haddad F. Reply: Increasingly Recognized Role of Right Ventricle Assessment in Cardiac Amyloidosis. JACC Heart Fail 2019; 7:279-280. [PMID: 30819389 DOI: 10.1016/j.jchf.2018.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
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Koyama J, Minamisawa M, Sekijima Y, Kuwahara K, Katsuyama T, Maruyama K. Role of echocardiography in assessing cardiac amyloidoses: a systematic review. J Echocardiogr 2019; 17:64-75. [PMID: 30741395 DOI: 10.1007/s12574-019-00420-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/21/2022]
Abstract
Cardiac amyloidosis is a manifestation of one of several systemic amyloidoses, and is characterized by increased left-ventricular (LV) wall thickness and normal or decreased LV cavity size. Congestive heart failure in cardiac amyloidosis is characterized by a predominant diastolic LV dysfunction, and systolic dysfunction occurs only in late-stage disease. Echocardiography is a noninvasive, reproducible method for assessing cardiac morphology and function in cardiac amyloidosis, and some echocardiographic indices are prognostic for amyloidoses. This review describes the advances in echocardiography and its role in the diagnosis and management of cardiac amyloidoses. Our review suggests that LV longitudinal function and the cyclic variation of myocardial integrated backscatter may be the best predictors of adverse outcomes. In the future, new echocardiographic techniques, such as fully automated echocardiogram interpretation, should provide further useful information for assessing cardiac function and prognosis in cardiac amyloidosis patients.
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16
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Binder C, Duca F, Stelzer PD, Nitsche C, Rettl R, Aschauer S, Kammerlander AA, Binder T, Agis H, Kain R, Hengstenberg C, Mascherbauer J, Bonderman D. Mechanisms of heart failure in transthyretin vs. light chain amyloidosis. Eur Heart J Cardiovasc Imaging 2019; 20:512-524. [DOI: 10.1093/ehjci/jey225] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Philipp Dominik Stelzer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Stefan Aschauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Andreas A Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Thomas Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Hermine Agis
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Renate Kain
- Clinical Institute of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria
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Vitarelli A, Petrucci MT, Lai S, Gaudio C, Capotosto L, Mangieri E, Ricci S, De Sio S, Truscelli G, Vozella F, Pergolini MS. Dataset on the use of 3D speckle tracking echocardiography in light-chain amyloidosis. Data Brief 2018; 18:1239-1246. [PMID: 29900299 PMCID: PMC5996947 DOI: 10.1016/j.dib.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022] Open
Abstract
The dataset presented in this article is related to the research article entitled "Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy" (Vitarelli et al., 2018) [1], which examined the potential utility of left ventricular (LV) and right ventricular (RV) deformation and rotational parameters derived from three-dimensional speckle-tracking echocardiography (3DSTE) to diagnose cardiac amyloidosis(CA) and differentiate this disease from other forms of myocardial hypertrophy. The combined assessment of LV basal longitudinal strain, LV basal rotation and RV basal longitudinal strain had a high discriminative power for detecting CA. The data of this study provides more understanding on the value of LV 3DSTE deformation parameters as well as RV parameters in this particular cardiomyopathy.
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Affiliation(s)
- Antonio Vitarelli
- Depts of Cardiology, Hematology and Medicine, Sapienza University, Rome, Italy
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