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Diagnostic and prognostic value of the left atrial myopathy evaluation in cardiac amyloidosis using echocardiography.
Ferkh, Aaisha; Geenty, Paul; Stefani, Luke; Emerson, Peter; Pham, Jennifer; Byth, Karen; Boyd, Anita C; Richards, David; Taylor, Mark S; Kwok, Fiona; Kizana, Eddy; Thomas, Liza.
Afiliación
  • Ferkh A; Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.
  • Geenty P; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
  • Stefani L; Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.
  • Emerson P; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
  • Pham J; Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.
  • Byth K; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
  • Boyd AC; Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.
  • Richards D; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
  • Taylor MS; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia.
  • Kwok F; WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia.
  • Kizana E; Westmead Private Cardiology, Westmead, New South Wales, Australia.
  • Thomas L; Westmead Private Cardiology, Westmead, New South Wales, Australia.
ESC Heart Fail ; 2024 Aug 11.
Article en En | MEDLINE | ID: mdl-39129371
ABSTRACT

BACKGROUND:

Cardiac amyloidosis (CA) is an under-recognized cause of heart failure. Left atrial (LA) myopathy contributes to a worse prognosis in heart failure and is a feature of transthyretin (ATTR) and light-chain (AL) CA. LA mechanical dispersion (LA-MD) is a novel marker of intra-atrial dyssynchrony implicated in LA myopathy and the future development of atrial fibrillation (AF).

AIMS:

This study aimed to determine the characteristics and prognostic value of LA myopathy in ATTR and AL cardiomyopathy through a comprehensive LA echocardiographic evaluation.

METHODS:

ATTR (n = 86) and AL (n = 86) CA patients were compared with hypertensive heart disease (HHT) patients (n = 58). Transthoracic echocardiographic measurements including LA strain and LA-MD were obtained with patient follow-up for mortality.

RESULTS:

ATTR and AL patients had a median follow-up of 66 months, with 26 mortality events. Left ventricular (LV) mass, diastolic function (average-e' and E/e'), LV global longitudinal strain, and LA volume and function (LA function index and strain) were more impaired in ATTR versus AL; these echocardiographic parameters were more impaired in both amyloid groups compared to HHT patients (P < 0.05). LA-MD was increased in ATTR versus AL [median 72.2 (inter-quartile range 55-88.9) vs. 54 (43.5-64.2), respectively, P < 0.001]. Multivariable logistic regression adjusted for age, presence of AF, LV mass, global and basal strain, and E/e' demonstrated that LA-MD was an independent determinant of ATTR CA (P = 0.014). On multivariable analysis, LA reservoir strain was independently associated with the presence of heart failure in the CA group (P < 0.001). LA minimum volume (cut-off ≥18 mL/m2) was a determinant of mortality in AL CA [Cox proportional hazard ratio (HR) 1.042 (1.003-1.082), P = 0.034 and Kaplan-Meier analysis, P = 0.016].

CONCLUSION:

Characterizing LA myopathy has significant diagnostic and prognostic utility in CA. ATTR patients have increased atrial dyssynchrony, which may have implications for AF development. LA reservoir strain was associated with heart failure in CA, whilst LA minimum volume was a predictor of mortality in AL CA.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: ESC Heart Fail Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: ESC Heart Fail Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Reino Unido