PROGNOSTIC VALUE OF LEFT ATRIAL STRAIN IS HIGHEST AMONG FOUR CHAMBER STRAIN IMAGING IN LIGHT CHAIN CARDIAC AMYLOIDOSIS

Introduction: Light chain cardiac amyloidosis (AL) has a variable but usually poor prognosis. Left ventricular (LV) function measures including LV strain imaging for global longitudinal strain (GLS) have shown clinically prognostic value in AL. However, the utility of novel left atrial (LA) strain imaging and its associations with LV disease remains unclear. Hypothesis: LA strain is of additive prognostic value to GLS in AL. Methods: We included 99 consecutive patients with AL. Cardiac amyloidosis either confirmed by endocardial biopsy (25%) or by non-cardiac tissue biopsy and imaging data supportive of cardiac amyloidosis. Peak LA reservoir strain was calculated as an average of peak longitudinal strain from apical 2- and 4-chamber views. GLS and apical sparing ratio were assessed using the 3 standard apical views. All-cause mortality was tracked over a median of 5 years. Results: Echocardiographic GLS and peak longitudinal LA strain were feasible in 96 (97%) and 86 (87%) of patients, respectively. There were 48 AL patients who died during follow-up. Patients with low GLS (GLS < median; 10.3% absolute values) had worse prognosis than patients with high GLS group (p<0.001). Although peak longitudinal LA strain was correlated with GLS (R=0.65 p<0.001), peak longitudinal LA strain had additive prognostic value. AL patients with low GLS and low Peak LA strain (<13.4%) had a 8.3-fold increase in mortality risk in comparison to patients with high GLS (95% confidence interval: 3.84-18.03; p<0.001). Multivariable analysis showed peak longitudinal LA strain was significantly and independently associated with survival after adjusting for clinical and echocardiographic covariates (p<0.01). Conclusions: Peak longitudinal LA strain was additive to LV GLS in predicting prognosis in patients with biopsy confirmed AL amyloidosis. LA strain imaging has potential clinical utility in patients with AL cardiac amyloidosis.

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LEFT ATRIAL AND VENTRICULAR STRAIN IMAGING ADDS PROGNOSTIC VALUE TO BIOMARKER STAGING MODELS IN LIGHT CHAIN CARDIAC AMYLOIDOSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)04640-4 ◽

2021 ◽

Vol 77 (18) ◽

pp. 3286

Author(s):

Peter Huntjens ◽

Kathleen Zhang ◽

Yuko Soyama ◽

Daniel Lenihan ◽

John Gorcsan

Keyword(s):

Light Chain ◽

Left Atrial ◽

Prognostic Value ◽

Cardiac Amyloidosis ◽

Strain Imaging

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Left atrial strain imaging differentiates cardiac amyloidosis and hypertensive heart disease

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-020-01948-9 ◽

2020 ◽

Author(s):

Karen Rausch ◽

Gregory M. Scalia ◽

Kei Sato ◽

Natalie Edwards ◽

Alfred King-yin Lam ◽

...

Keyword(s):

Heart Disease ◽

Left Atrial ◽

Cardiac Amyloidosis ◽

Hypertensive Heart Disease ◽

Strain Imaging ◽

Left Atrial Strain ◽

Atrial Strain

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Prognostic value of left atrial strain in patients with moderate asymptomatic mitral regurgitation

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-019-01598-6 ◽

2019 ◽

Vol 35 (9) ◽

pp. 1597-1604 ◽

Cited By ~ 6

Author(s):

Matteo Cameli ◽

Maria Concetta Pastore ◽

Francesca Maria Righini ◽

Giulia Elena Mandoli ◽

Flavio D’Ascenzi ◽

...

Keyword(s):

Mitral Regurgitation ◽

Left Atrial ◽

Prognostic Value ◽

Left Atrial Strain ◽

Atrial Strain

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Abstract 16571: An Appraisal on Prognostic Value of Left Atrial Strain in Exercise Echocardiography

Circulation ◽

10.1161/circ.142.suppl_3.16571 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Zi Ye ◽

William Miranda ◽

Garvan Kane ◽

Robert B McCully ◽

Jae K Oh

Keyword(s):

Heart Failure ◽

Diastolic Function ◽

Left Atrial ◽

Prognostic Value ◽

Filling Pressure ◽

Exercise Echocardiography ◽

Heart Failure Hospitalization ◽

Left Atrial Strain ◽

Echocardiographic Parameters ◽

Atrial Strain

Introduction: Diastolic dysfunction impairs exercise capacity and has prognostic value in exercise echocardiography. We aimed to assess whether left atrial strain (LAS), which is reduced with worsening in diastolic function, is associated with all-cause death or heart failure hospitalization in patients undergoing treadmill echocardiography. Methods: We performed 2D-speckle tracking analysis of LAS in 1636 consecutive patients (mean age 64±13 and 59% men) who underwent treadmill echocardiography between 1/2013 and 1/2014. We used the 2016 ASE recommendation to define diastolic function and elevated LV filling pressure. Results: Of 1636 study subjects, 95% had LV ejection fraction ≥ 50%. Diastolic function was normal in 44% of patients and abnormal in the remaining (23% grade I, 9% grade II, 1% grade III, and 23% indeterminate). During a mean follow-up of 5.5±1.8 years, 210 patients (12.8%) experienced the composite outcome (157 death and 88 heart failure hospitalization). Lower LASreseroivr, LASbooster and LA emptying fraction (LAEF) were all associated with increased risk for the adverse outcome independent of age, sex, clinical and echocardiographic parameters, and after further adjustment for diastolic function (abnormal vs. normal) (all p≤0.001). The association of LASbooster with the outcome attenuated in a model with LASreservoir or LAEF (both p>0.1). Adding LASreservoir to clinical and echocardiographic parameters provided incremental prognostic value (continuous net reclassification improvement=0.09, p=0.04), but not LAEF or LASbooster. Patients with LASreservoir <34.2% (lowest tertile) had more than doubled risk for death or heart failure hospitalization than those with LASreservoir ≥34.2% after multivariable adjustment in the entire cohort (adjusted hazard ratio 2.2, 95%CI: 1.53 - 3.23), as well as in those with normal stress test (n=1217, adjusted HR, 3.53, 95%CI: 2.29 - 5.53) or those without elevated resting LV filling pressure (n=1466, adjusted HR: 2.08, 95%CI: 1.46 - 2.96). Conclusions: LASreservoir provides independent prognostic information in patients undergoing exercise echocardiography.

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