Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis
journal contribution
posted on 2023-05-18, 00:30authored byPhelan, D, Collier, P, Thavendiranathan, P, Popovic, ZB, Hanna, M, Plana, JC, Thomas MarwickThomas Marwick, Thomas, JD
Background The diagnosis of cardiac amyloidosis (CA) is challenging owing to vague symptomatology and non-specific echocardiographic findings. Objective To describe regional patterns in longitudinal strain (LS) using two-dimensional speckle-tracking echocardiography in CA and to test the hypothesis that regional differences would help differentiate CA from other causes of increased left ventricular (LV) wall thickness. Methods and results 55 consecutive patients with CA were compared with 30 control patients with LV hypertrophy (n=15 with hypertrophic cardiomyopathy, n=15 with aortic stenosis). A relative apical LS of 1.0, defined using the equation (average apical LS/(average basal LS + mid-LS)), was sensitive (93%) and specific (82%) in differentiating CA from controls (area under the curve 0.94). In a logistic regression multivariate analysis, relative apical LS was the only parameter predictive of CA (p=0.004). Conclusions CA is characterised by regional variations in LS from base to apex. A relative ‘apical sparing’ pattern of LS is an easily recognisable, accurate and reproducible method of differentiating CA from other causes of LV hypertrophy.
History
Publication title
Heart
Volume
98
Issue
19
Pagination
1442-1448
ISSN
1355-6037
Department/School
Menzies Institute for Medical Research
Publisher
B M J Publishing Group
Place of publication
British Med Assoc House, Tavistock Square, London, England, Wc1H 9Jr
Rights statement
Copyright 2012 BMJ Publishing Group Ltd & British Cardiovascular Society