Comparison of right ventricular longitudinal strain imaging, tricuspid annular plane systolic excursion, and cardiac biomarkers for early diagnosis of cardiac involvement and risk stratification in primary systematic (AL) amyloidosis: a 5-year cohort study: reply

We thank Dr Kostenberger for his interest in our work.1 We agree entirely that tricuspid annular plane excursion (TAPSE) and tricuspid annular peak systolic velocity (S') are essential for detailed evaluation of suspected dysfunction of the right ventricle (RV), including patients with cardiac amyloidosis, as detailed in our manuscript. We have previously demonstrated the utility of left ventricular strain imaging as a predictor of survival in primary systemic amyloidosis.2 In the study alluded to by Dr Kostenberger, we demonstrated the utility of TAPSE and RV strain for identifying otherwise inapparent right ventricular dysfunction for these patients. In addition, the RV strain rate was an independent predictor of mortality. As suggested by Dr Kostenberger, we are continuing to follow this population of patients, including the serial assessment of RV function. Dr Kostenberger mentions the work that his group has performed in demonstrating the utility of TAPSE and S' for patients with congenital heart diseases that affect the RV.3,4 Our colleagues at the Mayo Clinic who perform echocardiography for paediatric patients and for adult patients with congenital heart disease now routinely measure TAPSE and RV strain for patients with suspected RV dysfunction. In our adult echocardiography practice, we have also demonstrated the utility of RV peak systolic longitudinal strain for predicting survival in patients with pulmonary arterial hypertension5 and we now routinely measure RV strain, as well as TAPSE and S’ for these patients. On the basis of this experience, we are currently expanding our use of these RV measurements to most patients who present to us with possible RV dysfunction, and in doing so we have found that it is relatively easy to incorporate this more complete assessment of RV function into our daily practice.