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Fecha
2019-05-08
Derechos de acceso
info:eu-repo/semantics/openAccess
Título de la revista
ISSN de la revista
Título del volumen
Editorial
Elsevier
Citas
Resumen
Background
Cardiac amyloidosis (CA) causes restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic light-chain CA (ALCA) and transthyretin-derived CA (either wild type transthyretin amyloidosis [TTRwt] or mutant transthyretin amyloidosis [TTRm]). Left ventricular (LV) apical sparing has been extensively studied using speckle-tracking echocardiography for diagnosis, but the right ventricular (RV) deformation pattern has not been described. The aims of this study were to characterize RV involvement in patients with CA and to identify parameters that may help in the differential diagnosis between ALCA and transthyretin-derived CA subtypes.
Methods
Seventy-eight patients with CA (47 with ALCA, 20 with TTRwt, and 11 with TTRm) and 24 healthy control subjects were included. Global longitudinal strain (GLS) was analyzed in 16 LV and six RV segments. LV and RV apical ratios (ARs) were obtained. GLS was expressed as an absolute value.
Results
LV GLS and free-wall RV longitudinal strain were impaired in all patients (LV GLS: 11.9 ± 2.9% in ALCA, 12.5 ± 3.8% in TTRwt, 14.9 ± 2.7% in TTRm, and 21.9 ± 2.6% in control subjects [P < .01]; free-wall RV longitudinal strain: 13.1 ± 6.8%, 14.9 ± 4.5%, 17.2 ± 3.4%, and 22.1 ± 3.1%, respectively [P < .01]). LV and RV ARs were higher in ALCA compared with both TTRwt, TTRm, and control subjects (LV AR: 1.1 ± 0.2, 0.8 ± 0.2, 0.9 ± 0.1, and 0.7 ± 0.1, respectively [P < .001]; RV AR: 1.1 ± 0.2, 0.6 ± 0.2, 0.6 ± 0.1, and 0.6 ± 0.1, respectively [P < .001]). Cutoff values of LV AR > 0.96 and RV AR > 0.8 showed high accuracy to differentiate between ALCA and transthyretin-derived CA.
Conclusions
RV dysfunction is common in patients with CA. Analysis of RV strain showed an apical sparing pattern, as previously described in the left ventricle, with a higher AR as a specific finding in patients with ALCA. RV AR may be a parameter that can differentiate the subtypes of amyloidosis on the basis of speckle-tracking echocardiographic analysis.
Descripción
The registered version of this article, first published in Journal of the American Society of Echocardiography, is available online at the publisher's website: Elsevier, https://doi.org/10.1016/j.echo.2019.03.005
La versión registrada de este artículo, publicado por primera vez en Journal of the American Society of Echocardiography, está disponible en línea en el sitio web del editor: Elsevier, https://doi.org/10.1016/j.echo.2019.03.005
La versión registrada de este artículo, publicado por primera vez en Journal of the American Society of Echocardiography, está disponible en línea en el sitio web del editor: Elsevier, https://doi.org/10.1016/j.echo.2019.03.005
Categorías UNESCO
Palabras clave
amyloidosis, right ventricle, speckle-tracking, longitudinal strain, apical ratio
Citación
Moñivas Palomero, V., Durante-Lopez, A., Torres Sanabria, M., Segovia Cubero, J., González-Mirelis, J., Vázquez López-Ibor, J., Navarro Rico, S. M., Krsnik, I., Domínguez, F., Martínez Mingo, A., Hernández-Pérez, F. J., et al. (2019). Role of right ventricular strain measured by two-dimensional speckle-tracking echocardiography in the differential diagnosis of cardiac amyloidosis. Journal of the American Society of Echocardiography, 32(7), 845–853.e1. https://doi.org/10.1016/j.echo.2019.03.005
Centro
Facultad de Psicología
Departamento
Metodología de las Ciencias del Comportamiento