In AL-CA patients, hematologic response improved left ventricular arterial coupling significantly (L-VAC from 0.77 to 0.68 m.s-1.%-1, p=0.005) but not right ventricular coupling.
Does hematological response to treatment improve left and right ventricular-arterial coupling in patients with light-chain cardiac amyloidosis?
In patients with light-chain cardiac amyloidosis, hematological response to treatment is associated with significant improvements in left ventricular-arterial coupling and global longitudinal strain, highlighting the utility of advanced echocardiography over standard ejection fraction for monitoring cardiac response.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Treatment for light-chain cardiac amyloidosis (AL-CA) leads to increased survival especially when given in early stages. In patients with hematological response, assessment of cardiac response is based on biochemical markers while ejection fraction is not a reliable marker of cardiac response. Purpose To noninvasively assess left ventricular-arterial coupling (L-VAC) and right ventricular-arterial coupling (R-VAC) in relation to the degree of treatment response in patients with AL-CA. Methods AL-CA patients diagnosed and treated at the Amyloidosis Expertise Center in Alexandra Hospital were included. Treatment response was assessed based on guidelines. All patients in the study underwent transthoracic echocardiography which included both standard echocardiographic imaging and images suitable for 7 speckle tracking analysis allowing for global longitudinal strain (GLS) measurement. Pulse wave velocity (PWV) was also measured. L-VAC was defined as the PWV/GLS ratio and R-VAC as TAPSE/PASP. Results 65 patients (median age 66.7 years, 98% in Mayo stages 2 and 3) from 2021 to 2023 who were treated and survived at least 1 year from diagnosis were included. 82.5% of patients showed some degree of hematological response to treatment. Patients with hematological response had a statistically significant reduction in left ventricular wall thickness without significant improvement in ejection fraction but with significant improvement in GLS (from -13% to -14%, p=0.027). No significant effect of hematologic response on R-VAC was detected in contrast to L-VAC which improved to a statistically significant extent (from 0.77 to 0.68 m.s-1.%-1, p=0.005). Between stages of hematologic response, statistically significant improvement in L-VAC was observed in patients with complete or very good partial response (from 0.78 to 0.71 m.s-1.%-1, p=0.012). Conclusion In patients with AL-CA, the hematologic response to treatment translates into a significant improvement in left ventricular but not right ventricular function markers.
Briasoulis et al. (Sat,) reported a other. In AL-CA patients, hematologic response improved left ventricular arterial coupling significantly (L-VAC from 0.77 to 0.68 m.s-1.%-1, p=0.005) but not right ventricular coupling.