Comparison of right ventricular longitudinal strain imaging, tricuspid annular plane systolic excursion, and cardiac biomarkers for early diagnosis of cardiac involvement and risk stratification in primary systematic (AL) amyloidosis: A 5-year cohort study

Diego Bellavia, Patricia Pellikka, Angela Dispenzieri, Christopher G. Scott, Ghormallah B. Al-Zahrani, Martha Grogan, Francesco Pitrolo, Jae Kuen Oh, Fletcher A Jr. Miller

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Abstract

Aims To determine the role of assessing right ventricular (RV) function, using standard echocardiography and Doppler myocardial imaging (DMI), in the early diagnosis of cardiac amyloidosis and in the prediction of mortality. Methods and results Patients with primary systemic (AL) amyloidosis seen at our institution from 1 February 2004 through 31 October 2005 (N = 249) were categorized by left ventricular thickness and É velocity and compared with 38 age- and sexmatched controls. Standard echocardiographic and DMI examination were used to measure echocardiographic parameters of RV function: systolic tissue velocity, strain rate, and strain were determined for basal and middle RV free wall segments. Patients were followed up for the endpoint of mortality. RV tricuspid annular plane systolic excursion (TAPSE) and all DMI measurements were lower in patients with AL amyloidosis and normal echocardiography results (AL-normal-echo group) than controls. A bivariate model including strain of the basal segment of the RV free wall and TAPSE was the best for distinguishing AL-normal-echo patients from controls. Male sex [hazard ratio (HR), 2.2; P = 0.005], brain natriuretic peptide levels (HR 1.4; P = 0.003), troponin T levels (HR 1.6; P = 0.01), pleural effusion (HR 3.6; P < 0.001), E/A ratio (HR 1.3; P = 0.006), RV systolic pressure (HR 1.02; P = 0.01), and RV strain rate of the middle segment (HR 1.3; P = 0.02) were independent predictors of death. Conclusion DMI measures of the RV can identify early impairment of cardiac function or stratify risk of death in patients with AL amyloidosis. Further studies with longer follow-up are warranted to confirm these results.

Original languageEnglish (US)
Pages (from-to)680-689
Number of pages10
JournalEuropean Heart Journal Cardiovascular Imaging
Volume13
Issue number8
DOIs
StatePublished - Aug 2012

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Early Diagnosis
Amyloidosis
Cohort Studies
Biomarkers
Right Ventricular Function
Troponin T
Mortality
Doppler Echocardiography
Brain Natriuretic Peptide
Sex Ratio
Ventricular Pressure
Pleural Effusion
Echocardiography
Meretoja syndrome
Blood Pressure
Control Groups

Keywords

  • AL amyloidosis
  • Cardiac biomarkers
  • Right ventricular function
  • Standard echocardiography
  • Strain rate imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{678164e6d85c47dd81f5ad81b20f8004,
title = "Comparison of right ventricular longitudinal strain imaging, tricuspid annular plane systolic excursion, and cardiac biomarkers for early diagnosis of cardiac involvement and risk stratification in primary systematic (AL) amyloidosis: A 5-year cohort study",
abstract = "Aims To determine the role of assessing right ventricular (RV) function, using standard echocardiography and Doppler myocardial imaging (DMI), in the early diagnosis of cardiac amyloidosis and in the prediction of mortality. Methods and results Patients with primary systemic (AL) amyloidosis seen at our institution from 1 February 2004 through 31 October 2005 (N = 249) were categorized by left ventricular thickness and {\'E} velocity and compared with 38 age- and sexmatched controls. Standard echocardiographic and DMI examination were used to measure echocardiographic parameters of RV function: systolic tissue velocity, strain rate, and strain were determined for basal and middle RV free wall segments. Patients were followed up for the endpoint of mortality. RV tricuspid annular plane systolic excursion (TAPSE) and all DMI measurements were lower in patients with AL amyloidosis and normal echocardiography results (AL-normal-echo group) than controls. A bivariate model including strain of the basal segment of the RV free wall and TAPSE was the best for distinguishing AL-normal-echo patients from controls. Male sex [hazard ratio (HR), 2.2; P = 0.005], brain natriuretic peptide levels (HR 1.4; P = 0.003), troponin T levels (HR 1.6; P = 0.01), pleural effusion (HR 3.6; P < 0.001), E/A ratio (HR 1.3; P = 0.006), RV systolic pressure (HR 1.02; P = 0.01), and RV strain rate of the middle segment (HR 1.3; P = 0.02) were independent predictors of death. Conclusion DMI measures of the RV can identify early impairment of cardiac function or stratify risk of death in patients with AL amyloidosis. Further studies with longer follow-up are warranted to confirm these results.",
keywords = "AL amyloidosis, Cardiac biomarkers, Right ventricular function, Standard echocardiography, Strain rate imaging",
author = "Diego Bellavia and Patricia Pellikka and Angela Dispenzieri and Scott, {Christopher G.} and Al-Zahrani, {Ghormallah B.} and Martha Grogan and Francesco Pitrolo and Oh, {Jae Kuen} and Miller, {Fletcher A Jr.}",
year = "2012",
month = "8",
doi = "10.1093/ehjci/jes009",
language = "English (US)",
volume = "13",
pages = "680--689",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
number = "8",

}

TY - JOUR

T1 - Comparison of right ventricular longitudinal strain imaging, tricuspid annular plane systolic excursion, and cardiac biomarkers for early diagnosis of cardiac involvement and risk stratification in primary systematic (AL) amyloidosis

T2 - A 5-year cohort study

AU - Bellavia, Diego

AU - Pellikka, Patricia

AU - Dispenzieri, Angela

AU - Scott, Christopher G.

AU - Al-Zahrani, Ghormallah B.

AU - Grogan, Martha

AU - Pitrolo, Francesco

AU - Oh, Jae Kuen

AU - Miller, Fletcher A Jr.

PY - 2012/8

Y1 - 2012/8

N2 - Aims To determine the role of assessing right ventricular (RV) function, using standard echocardiography and Doppler myocardial imaging (DMI), in the early diagnosis of cardiac amyloidosis and in the prediction of mortality. Methods and results Patients with primary systemic (AL) amyloidosis seen at our institution from 1 February 2004 through 31 October 2005 (N = 249) were categorized by left ventricular thickness and É velocity and compared with 38 age- and sexmatched controls. Standard echocardiographic and DMI examination were used to measure echocardiographic parameters of RV function: systolic tissue velocity, strain rate, and strain were determined for basal and middle RV free wall segments. Patients were followed up for the endpoint of mortality. RV tricuspid annular plane systolic excursion (TAPSE) and all DMI measurements were lower in patients with AL amyloidosis and normal echocardiography results (AL-normal-echo group) than controls. A bivariate model including strain of the basal segment of the RV free wall and TAPSE was the best for distinguishing AL-normal-echo patients from controls. Male sex [hazard ratio (HR), 2.2; P = 0.005], brain natriuretic peptide levels (HR 1.4; P = 0.003), troponin T levels (HR 1.6; P = 0.01), pleural effusion (HR 3.6; P < 0.001), E/A ratio (HR 1.3; P = 0.006), RV systolic pressure (HR 1.02; P = 0.01), and RV strain rate of the middle segment (HR 1.3; P = 0.02) were independent predictors of death. Conclusion DMI measures of the RV can identify early impairment of cardiac function or stratify risk of death in patients with AL amyloidosis. Further studies with longer follow-up are warranted to confirm these results.

AB - Aims To determine the role of assessing right ventricular (RV) function, using standard echocardiography and Doppler myocardial imaging (DMI), in the early diagnosis of cardiac amyloidosis and in the prediction of mortality. Methods and results Patients with primary systemic (AL) amyloidosis seen at our institution from 1 February 2004 through 31 October 2005 (N = 249) were categorized by left ventricular thickness and É velocity and compared with 38 age- and sexmatched controls. Standard echocardiographic and DMI examination were used to measure echocardiographic parameters of RV function: systolic tissue velocity, strain rate, and strain were determined for basal and middle RV free wall segments. Patients were followed up for the endpoint of mortality. RV tricuspid annular plane systolic excursion (TAPSE) and all DMI measurements were lower in patients with AL amyloidosis and normal echocardiography results (AL-normal-echo group) than controls. A bivariate model including strain of the basal segment of the RV free wall and TAPSE was the best for distinguishing AL-normal-echo patients from controls. Male sex [hazard ratio (HR), 2.2; P = 0.005], brain natriuretic peptide levels (HR 1.4; P = 0.003), troponin T levels (HR 1.6; P = 0.01), pleural effusion (HR 3.6; P < 0.001), E/A ratio (HR 1.3; P = 0.006), RV systolic pressure (HR 1.02; P = 0.01), and RV strain rate of the middle segment (HR 1.3; P = 0.02) were independent predictors of death. Conclusion DMI measures of the RV can identify early impairment of cardiac function or stratify risk of death in patients with AL amyloidosis. Further studies with longer follow-up are warranted to confirm these results.

KW - AL amyloidosis

KW - Cardiac biomarkers

KW - Right ventricular function

KW - Standard echocardiography

KW - Strain rate imaging

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U2 - 10.1093/ehjci/jes009

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