Key result
Longitudinal strains plus Mayo 2012 stage accurately predict MACE in advanced AL-CA with AUC ~0.89.
Why the study?
Patients with advanced light chain cardiac amyloidosis have a poor prognosis, motivating an assessment of the prognostic value of all cardiac chamber longitudinal strains and their combination with the Mayo staging system.
Does the assessment of all cardiac chamber longitudinal strains provide prognostic value for major adverse cardiac events in patients with advanced light chain cardiac amyloidosis?
Cohort (n=140)
Does the assessment of all cardiac chamber longitudinal strains provide prognostic value for major adverse cardiac events in patients with advanced light chain cardiac amyloidosis?
Echocardiographic assessment of all four cardiac chamber longitudinal strains provides significant incremental prognostic value over the Mayo 2012 staging system in patients with advanced light chain cardiac amyloidosis.
Answers are grounded in this paper and cite their sources.
May enhance MACE risk stratification beyond Mayo stage in advanced AL-CA; leaves open need for prospective validation before clinical use.
OBJECTIVE: Patients with advanced light chain cardiac amyloidosis (AL-CA) have a poor prognosis. We aimed to (1) assess the prognostic significance of all cardiac chamber longitudinal strains and (2) to further determine whether the combination of longitudinal strains with the Mayo staging system could provide additional prognostic value. METHODS: Patients classified as Mayo 2012 stage III and IV were included in our study. We documented major adverse cardiac events (MACEs), including hospitalization for heart failure and all-cause mortality. Right ventricular free wall strain (RV-FWS), left ventricular global longitudinal strain (LV-GLS), left atrial longitudinal peak strain (LAPS), and right atrial longitudinal peak strain (RAPS) were assessed using echocardiography. RESULTS: This research enrolled 140 advanced AL-CA patients, with 49.3% at Mayo 2012 stage IV. During follow-up, 84 patients developed MACEs. LV-GLS, RV-FWS, LAPS, and RAPS were independent risk factors for advanced AL-CA patients. Kaplan-Meier curves revealed that cutoff values of all heart-chamber longitudinal strains had significant additional prognostic values for the Mayo 2012 stage. According to multivariate Cox regression, Age, gender, Mayo 2012, LAPS, RAPS, RV-FWS, and LV-GLS were included in the predictive model. The AUCs of the Model were 0.887, 0.907, and 0.883 for 1-, 3-, and 5-year MACEs, respectively. The model was internally validated using 200 bootstrapped resamples, yielding a corrected C-index of 0.810. A nomogram was developed and dynamically accessed via the following link: https://lxhadvancedalliexiantu.shinyapps.io/ALCA/. CONCLUSION: In patients with advanced AL-CA, it is essential to thoroughly evaluate all cardiac chamber longitudinal strains, particularly focusing on LV-GLS, RV-FWS, LAPS, and RAPS.
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Li et al. (2024) conducted a cohort in advanced light chain cardiac amyloidosis (AL-CA) (n=140). Echocardiographic cardiac chamber longitudinal strains was evaluated on Major adverse cardiac events (MACEs), including hospitalization for heart failure and all-cause mortality. A predictive model incorporating cardiac chamber longitudinal strains and Mayo 2012 stage accurately predicted 1-, 3-, and 5-year MACEs in advanced AL-CA, with AUCs of 0.887, 0.907, and 0.883.
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