Author + information
- Received February 10, 2015
- Revision received April 23, 2015
- Accepted May 14, 2015
- Published online February 1, 2016.
- Julien Ternacle, MDa,b,c,d,e,f,
- Diane Bodez, MDa,b,c,d,e,f,
- Aziz Guellich, PhDa,b,c,d,e,f,
- Etienne Audureau, MD, PhDb,c,g,
- Stephane Rappeneau, PhDa,b,c,d,e,f,
- Pascal Lim, MD, PhDa,b,c,e,f,
- Costin Radu, MDa,b,e,f,g,
- Soulef Guendouz, MDa,b,c,d,e,f,
- Jean-Paul Couetil, MDb,e,h,
- Nicole Benhaiem, MDi,
- Luc Hittinger, MD, PhDa,b,c,d,e,f,
- Jean-Luc Dubois-Randé, MD, PhDa,b,c,d,e,f,
- Violaine Plante-Bordeneuve, MD, PhDa,b,f,j,
- Dania Mohty, MD, PhDk,
- Jean-François Deux, MD, PhDa,b,c,f,l and
- Thibaud Damy, MD, PhDa,b,c,d,e,f,∗ ()
- aUPEC, Créteil, France
- bMondor Amyloidosis Network, Créteil, France
- cDepartment of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
- dINSERM U955, GRC Amyloid Research Institute, Créteil, France
- eDHU ATVB, Créteil, France
- fINSERM Clinical Investigation Center 006, Créteil, France
- gDepartment of Public Health, AP-HP, Henri-Mondor Teaching Hospital and Clinical Epidemiology and Aging EA 4393, Créteil, France
- hDepartment of Cardiovascular Surgery, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
- iDepartment of Pathology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
- jDepartment of Neurology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
- kDepartment of Cardiology, Dupuytren Hospital, CHU Limoges, Pôle Cœur-Poumon-Rein, Limoges, France
- lDepartment of Radiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
- ↵∗Reprint requests and correspondence:
Prof. Thibaud Damy, Department of Cardiology, Henri Mondor University Hospital, 51 Av de Lattre de Tassigny, Créteil 94100, France.
Objectives The aim of this study was to compare left ventricular longitudinal strain (LS) evaluated by 2-dimensional echocardiography with cardiac magnetic resonance (CMR) in cardiac amyloidosis (CA), establish correlations between histological and imaging findings, and assess the prognostic usefulness of LS measurement and CMR.
Background CA is a condition with a poor prognosis due chiefly to 3 forms of amyloidosis: light-chain amyloidosis (AL), hereditary transthyretin (M-TTR), and wild-type transthyretin (WT-TTR). Two-dimensional echocardiography measurement of LS has been reported to detect early left ventricular systolic dysfunction. The pathophysiological underpinnings, regional distribution, and prognostic significance of LS in CA are unclear.
Methods All patients underwent echocardiography, and 53 underwent CMR. The native hearts of the 3 patients who received heart transplants were subjected to histological examination. For each of the 17 left ventricular segments in the American Heart Association model, we evaluated LS, late gadolinium enhancement (LGE) by CMR, and cardiac amyloid deposition. Univariate and multivariate analyses were performed at 6 months to identify variables associated with major adverse cardiac events (MACE).
Results We studied 79 patients with CA; 26 had AL, 36 M-TTR, and 17 WT-TTR. Mean LS was −10 ± 4%. Both LS and amyloid deposits showed a basal-to-apical gradient. The mean LS and number of segments with LGE were similar across the 3 CA types. LS correlated with LGE and amyloid burden (r = 0.72). LGE was seen in the 6 basal segments in all WT-TTR patients. During the median follow-up of 11 months (range 4 to 17 months), 36 (46%) patients experienced MACE. Independent predictors of MACE were apical LS (cutoff, −14.5%), N-terminal pro–B-type natriuretic peptide (cutoff, 4,000 ng/l), and New York Heart Association functional class III to IV heart failure.
Conclusions Basal-to-apical LS abnormalities are similar across CA types and reflect the amyloid burden. Apical LS independently predicts MACE.
The study was funded by Henri-Mondor Teaching Hospital. Prof. Damy has received grants and consultant fees from Pfizer and consultant fees from Alnylam. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 10, 2015.
- Revision received April 23, 2015.
- Accepted May 14, 2015.
- American College of Cardiology Foundation