Key result
Velocity vector imaging demonstrated that AL amyloidosis patients had significantly lower global longitudinal (-13.9% vs -16.7%; P=0.002) and radial strain compared to normal controls.
Why the study?
Does velocity vector imaging (VVI) identify specific alterations in regional myocardial deformation in patients with AL amyloidosis compared to normal controls?
Observational (n=43)
Does velocity vector imaging (VVI) identify specific alterations in regional myocardial deformation in patients with AL amyloidosis compared to normal controls?
Absolute Event Rate: -13.9% vs -16.7%
p-value: p=0.002
Velocity vector imaging demonstrates that AL amyloidosis is characterized by reduced longitudinal and radial strain with relative apical sparing, while circumferential strain is preserved until severe diastolic dysfunction develops.
VVI may aid characterization of myocardial deformation in AL amyloidosis; extends strain observations but leaves open diagnostic and prognostic value.
BACKGROUND: Cardiac amyloidosis results in increased left ventricular (LV) wall thickness and diastolic dysfunction (DD). Strain measurements using velocity vector imaging (VVI) may further characterize myocardial dysfunction. METHODS: A total of 43 AL amyloidosis patients were compared to age-matched normals and hypertensive patients (HT). Subgroup analysis within the amyloid group was performed based on LV wall thickness (≤14 mm, >14 mm) and diastolic dysfunction (DD) (Group 1: normal and impaired relaxation, Group 2: pseudonormal, Group 3: restrictive). LV strain (longitudinal, circumferential, and radial strain (S) and strain rate [Sr]) were measured using velocity vector imaging (VVI). RESULTS: Increased LV wall thickness and DD were observed in the amyloid group. Global longitudinal (-13.9±4.1% vs -16.7±3.8%; P=.002) and radial (27.4±13.4% vs 38.8±15.7%; P<.001) strain were lower in the amyloid group vs normal controls, while circumferential strain was similar. Segmental analysis demonstrated reduced mid- and basal segmental strain with relative sparing of apical segments in the amyloid group. Reduced longitudinal and radial strain, with preserved circumferential strain, were observed in patients with wall thickness >14 mm; however, circumferential strain was also altered when severe DD (restrictive filling) was present. CONCLUSION: Reduction in longitudinal and radial S and Sr was evident using VVI strain analysis in amyloidosis, with segmental heterogeneity in longitudinal S. There was relative preservation of circumferential strain, which was reduced only in patients with severe DD.
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Lo et al. (2016) conducted an observational in AL amyloidosis (n=43). Velocity vector imaging (VVI) vs. Age-matched normal controls and hypertensive patients was evaluated on Global longitudinal strain (p=0.002). Velocity vector imaging demonstrated that AL amyloidosis patients had significantly lower global longitudinal (-13.9% vs -16.7%; P=0.002) and radial strain compared to normal controls.
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