Lower left atrial reservoir strain independently predicted isolated atrial amyloidosis (IAA) with an odds ratio of 0.74 (95% CI 0.64–0.85; p<0.001) in 189 patients.
Does lower left atrial reservoir strain predict isolated atrial amyloidosis in patients undergoing cardiothoracic surgery?
Lower left atrial reservoir strain is an independent echocardiographic predictor of isolated atrial amyloidosis, suggesting its utility in identifying atrial dysfunction driven by amyloid deposition.
Absolute Event Rate: 0% vs 0%
Abstract Background Isolated atrial amyloidosis (IAA) is the most common form of cardiac amyloidosis caused by the deposition of atrial natriuretic peptide (ANP) type amyloid in atrium. Although amyloid deposition has been suggested to be a clinically important pathogenesis for left atrial dysfunction, it is difficult to predict IAA from clinical information and noninvasive studies. Purpose The study aims to comprehensively evaluate the impact of left atrial dysfunction associated with IAA by integrating pathological confirmation of IAA and echocardiographic assessment of left atrial function. Methods 232 consecutive patients who underwent cardiothoracic surgery and underwent their left atrial appendage resection between August 2015 and May 2024 were retrospectively examined. Standard transthoracic echocardiography, including left atrial strain analysis, was performed to evaluate cardiac function. ANP amyloid deposition was evaluated immunohistologically and graded on a four-point scale based on the extent of myocardial interstitial accumulation: 0 = none; 1+ = mild, focal (5%); 2+ = moderate, multifocal (≥5% but 50%); and 3+ = severe, extensive (≥50%); Cases with a grade of 2+ or 3+ were classified as IAA-positive. Results After adjustment for the exclusion criteria, 189 patients were evaluated. The higher the degree of amyloid deposition, the lower the left atrial reservoir strain, indicating impaired left atrial function (p0.001) (Figure 1). 105 (55.5%) patients were classified as IAA-positive. Left atrial reservoir strain was significantly lower in IAA-positive group (p0.001). In a multivariable analysis adjusted for multiple factors affecting left atrial reservoir strain values, lower reservoir strain values were an independent predictor of IAA-positive (odds ratio 0.74 95% confidence interval 0.64–0.85; p0.001) (Figure 2). Conclusions Left atrial reservoir strain decreased in correlation with ANP type amyloid deposition. The lower left atrial reservoir strain was a useful predictor of IAA-positive, independent of left atrial volume, left atrial pressure, and left ventricular ejection fraction, all of which affect left atrial reservoir strain. The possible involvement of IAA as a contributing factor to left atrial dysfunction should also be considered.Amyloid burden and LA strain analysis Multivariable predictors of IAA
Nishino et al. (Sat,) reported a other. Lower left atrial reservoir strain independently predicted isolated atrial amyloidosis (IAA) with an odds ratio of 0.74 (95% CI 0.64–0.85; p<0.001) in 189 patients.