Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis
Abstract Aims To clarify the usefulness of left atrial (LA) function and left ventricular (LV) function obtained by two‐dimensional (2D) speckle tracking echocardiography to diagnose concomitant transthyretin amyloid cardiomyopathy (ATTR‐CM) in patients with aortic stenosis (AS). Methods and results...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-06-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13909 |
| _version_ | 1818477770278174720 |
|---|---|
| author | Fumi Oike Hiroki Usuku Eiichiro Yamamoto Kyohei Marume Seiji Takashio Masanobu Ishii Noriaki Tabata Koichiro Fujisue Kenshi Yamanaga Daisuke Sueta Shinsuke Hanatani Yuichiro Arima Satoshi Araki Seitaro Oda Hiroaki Kawano Hirofumi Soejima Kenichi Matsushita Mitsuharu Ueda Toshihiro Fukui Kenichi Tsujita |
| author_facet | Fumi Oike Hiroki Usuku Eiichiro Yamamoto Kyohei Marume Seiji Takashio Masanobu Ishii Noriaki Tabata Koichiro Fujisue Kenshi Yamanaga Daisuke Sueta Shinsuke Hanatani Yuichiro Arima Satoshi Araki Seitaro Oda Hiroaki Kawano Hirofumi Soejima Kenichi Matsushita Mitsuharu Ueda Toshihiro Fukui Kenichi Tsujita |
| author_sort | Fumi Oike |
| collection | DOAJ |
| description | Abstract Aims To clarify the usefulness of left atrial (LA) function and left ventricular (LV) function obtained by two‐dimensional (2D) speckle tracking echocardiography to diagnose concomitant transthyretin amyloid cardiomyopathy (ATTR‐CM) in patients with aortic stenosis (AS). Methods and results We analysed 72 consecutive patients with moderate to severe AS who underwent 99mTc‐pyrophosphate (PYP) scintigraphy at Kumamoto University Hospital from January 2012 to September 2020. We divided these 72 patients into 2 groups based on their 99mTc‐PYP scintigraphy positivity or negativity. Among 72 patients, 16 patients (22%) were positive, and 56 patients (78%) were negative for 99mTc‐PYP scintigraphy. In clinical baseline characteristics, natural logarithm troponin T was significantly higher in the 99mTc‐PYP scintigraphy‐positive than scintigraphy‐negative group (−2.9 ± 0.5 vs. −3.5 ± 0.8 ng/mL, P < 0.05). In conventional echocardiography, the severity of AS was not significantly different between these two groups. In 2D speckle tracking echocardiography, the relative apical longitudinal strain (LS) index (RapLSI) [apical LS/ (basal LS + mid LS)] was significantly higher (1.09 ± 0.49 vs. 0.78 ± 0.23, P < 0.05) and the peak longitudinal strain rate (LSR) in LA was significantly lower in the 99mTc‐PYP scintigraphy‐positive than scintigraphy‐negative group (0.36 ± 0.14 vs. 0.55 ± 0.20 s−1, P < 0.05). Multivariable logistic analysis revealed the peak LSR in LA and RapLSI were significantly associated with 99mTc‐PYP scintigraphy positivity. Receiver operating characteristic analysis showed that the area under the curve (AUC) of the peak LSR in LA for 99mTc‐PYP scintigraphy positivity was 0.79 and that the best cut‐off value of the peak LSR in LA was 0.47 s−1 (sensitivity: 78.6% and specificity: 72.3%). The AUC of RapLSI for 99mTc‐PYP scintigraphy positivity was 0.69, and the cut‐off value of RapLSI was decided as 1.00 (sensitivity: 43.8% and specificity: 87.5%) according to the previous report. The 99mTc‐PYP scintigraphy positivity in patients with RapLSI ≥ 1.0 and the peak LSR in LA ≤ 0.47 s−1 was 83.3% (5/6), and the 99mTc‐PYP scintigraphy negativity in patients with RapLSI < 1.0 and the peak LSR in LA > 0.47 s−1 was 96.6% (28/29). Conclusions Left atrial and LV strain analysis were significantly associated with 99mTc‐PYP scintigraphy positivity in ATTR‐CM patients with moderate to severe AS. The combination of the peak LSR in LA and RapLSI might be a useful predictor of the presence of ATTR‐CM in patients with moderate to severe AS. |
| first_indexed | 2024-12-10T09:41:09Z |
| format | Article |
| id | doaj.art-507d6fc02796492cb5f9e21ea5f0e69a |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-10T09:41:09Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-507d6fc02796492cb5f9e21ea5f0e69a2022-12-22T01:54:00ZengWileyESC Heart Failure2055-58222022-06-01931976198610.1002/ehf2.13909Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosisFumi Oike0Hiroki Usuku1Eiichiro Yamamoto2Kyohei Marume3Seiji Takashio4Masanobu Ishii5Noriaki Tabata6Koichiro Fujisue7Kenshi Yamanaga8Daisuke Sueta9Shinsuke Hanatani10Yuichiro Arima11Satoshi Araki12Seitaro Oda13Hiroaki Kawano14Hirofumi Soejima15Kenichi Matsushita16Mitsuharu Ueda17Toshihiro Fukui18Kenichi Tsujita19Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Diagnostic Radiology, Faculty of Life Sciences Kumamoto University Kumamoto JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanDepartment of Neurology, Graduate School of Medical Sciences Kumamoto University Kumamoto JapanDepartment of Cardiovascular Surgery, Graduate School of Medical Sciences Kumamoto University Kumamoto JapanDepartment of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences Kumamoto University 1‐1‐1 Honjo, Chuo‐ku Kumamoto 860‐8556 JapanAbstract Aims To clarify the usefulness of left atrial (LA) function and left ventricular (LV) function obtained by two‐dimensional (2D) speckle tracking echocardiography to diagnose concomitant transthyretin amyloid cardiomyopathy (ATTR‐CM) in patients with aortic stenosis (AS). Methods and results We analysed 72 consecutive patients with moderate to severe AS who underwent 99mTc‐pyrophosphate (PYP) scintigraphy at Kumamoto University Hospital from January 2012 to September 2020. We divided these 72 patients into 2 groups based on their 99mTc‐PYP scintigraphy positivity or negativity. Among 72 patients, 16 patients (22%) were positive, and 56 patients (78%) were negative for 99mTc‐PYP scintigraphy. In clinical baseline characteristics, natural logarithm troponin T was significantly higher in the 99mTc‐PYP scintigraphy‐positive than scintigraphy‐negative group (−2.9 ± 0.5 vs. −3.5 ± 0.8 ng/mL, P < 0.05). In conventional echocardiography, the severity of AS was not significantly different between these two groups. In 2D speckle tracking echocardiography, the relative apical longitudinal strain (LS) index (RapLSI) [apical LS/ (basal LS + mid LS)] was significantly higher (1.09 ± 0.49 vs. 0.78 ± 0.23, P < 0.05) and the peak longitudinal strain rate (LSR) in LA was significantly lower in the 99mTc‐PYP scintigraphy‐positive than scintigraphy‐negative group (0.36 ± 0.14 vs. 0.55 ± 0.20 s−1, P < 0.05). Multivariable logistic analysis revealed the peak LSR in LA and RapLSI were significantly associated with 99mTc‐PYP scintigraphy positivity. Receiver operating characteristic analysis showed that the area under the curve (AUC) of the peak LSR in LA for 99mTc‐PYP scintigraphy positivity was 0.79 and that the best cut‐off value of the peak LSR in LA was 0.47 s−1 (sensitivity: 78.6% and specificity: 72.3%). The AUC of RapLSI for 99mTc‐PYP scintigraphy positivity was 0.69, and the cut‐off value of RapLSI was decided as 1.00 (sensitivity: 43.8% and specificity: 87.5%) according to the previous report. The 99mTc‐PYP scintigraphy positivity in patients with RapLSI ≥ 1.0 and the peak LSR in LA ≤ 0.47 s−1 was 83.3% (5/6), and the 99mTc‐PYP scintigraphy negativity in patients with RapLSI < 1.0 and the peak LSR in LA > 0.47 s−1 was 96.6% (28/29). Conclusions Left atrial and LV strain analysis were significantly associated with 99mTc‐PYP scintigraphy positivity in ATTR‐CM patients with moderate to severe AS. The combination of the peak LSR in LA and RapLSI might be a useful predictor of the presence of ATTR‐CM in patients with moderate to severe AS.https://doi.org/10.1002/ehf2.13909Transthyretin amyloid cardiomyopathyAortic stenosisTwo‐dimensional speckle tracking echocardiographyLeft atrial functionThe peak longitudinal strain rateRelative apical longitudinal strain index |
| spellingShingle | Fumi Oike Hiroki Usuku Eiichiro Yamamoto Kyohei Marume Seiji Takashio Masanobu Ishii Noriaki Tabata Koichiro Fujisue Kenshi Yamanaga Daisuke Sueta Shinsuke Hanatani Yuichiro Arima Satoshi Araki Seitaro Oda Hiroaki Kawano Hirofumi Soejima Kenichi Matsushita Mitsuharu Ueda Toshihiro Fukui Kenichi Tsujita Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis ESC Heart Failure Transthyretin amyloid cardiomyopathy Aortic stenosis Two‐dimensional speckle tracking echocardiography Left atrial function The peak longitudinal strain rate Relative apical longitudinal strain index |
| title | Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis |
| title_full | Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis |
| title_fullStr | Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis |
| title_full_unstemmed | Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis |
| title_short | Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis |
| title_sort | utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis |
| topic | Transthyretin amyloid cardiomyopathy Aortic stenosis Two‐dimensional speckle tracking echocardiography Left atrial function The peak longitudinal strain rate Relative apical longitudinal strain index |
| url | https://doi.org/10.1002/ehf2.13909 |
| work_keys_str_mv | AT fumioike utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT hirokiusuku utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT eiichiroyamamoto utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT kyoheimarume utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT seijitakashio utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT masanobuishii utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT noriakitabata utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT koichirofujisue utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT kenshiyamanaga utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT daisukesueta utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT shinsukehanatani utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT yuichiroarima utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT satoshiaraki utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT seitarooda utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT hiroakikawano utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT hirofumisoejima utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT kenichimatsushita utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT mitsuharuueda utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT toshihirofukui utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis AT kenichitsujita utilityofleftatrialandventricularstrainfordiagnosisoftransthyretinamyloidcardiomyopathyinaorticstenosis |