What question did this study set out to answer?

To assess the diagnostic value of multi-chamber speckle-tracking echocardiography, particularly left atrial strain, in detecting cardiac amyloidosis and its subtypes.

March 4, 2022European Heart Journal - Cardiovascular ImagingOpen Access

Multi-chamber speckle tracking imaging and diagnostic value of left atrial strain in cardiac amyloidosis

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Why the study?

Cardiac amyloidosis affects all four cardiac chambers, which can be assessed using speckle-tracking echocardiography.

Does left atrial strain measured by speckle-tracking echocardiography improve the diagnosis of cardiac amyloidosis in screened patients?

Key Points

To assess the diagnostic value of multi-chamber speckle-tracking echocardiography, particularly left atrial strain, in detecting cardiac amyloidosis and its subtypes.
Evaluated 423 consecutive patients screened for cardiac amyloidosis over 5 years across two referral centres.
Assessed speckle-tracking echocardiography across all four chambers alongside standard echocardiographic variables and cardiac biomarkers.
Compared diagnostic risk across strain quartiles and evaluated predictive performance beyond standard clinical models and the IWT score.
Cardiac amyloidosis was confirmed in 261 patients (62%), including 144 (34%) with amyloid transthyretin and 117 (28%) with amyloid light-chain.
Patients with peak left atrial longitudinal strain (LA-PALS) <6.65% and/or peak atrial contraction strain (LA-PACS) <3.62% had a 3.60-fold higher risk of cardiac amyloidosis and a 3.68-fold higher risk of amyloid transthyretin beyond standard clinical models.
In patients with unexplained left ventricular hypertrophy, lowest-quartile LA-PALS or LA-PACS conferred an 8.76-fold higher risk of cardiac amyloidosis beyond standard models and a 2.04-fold higher risk of amyloid transthyretin beyond the IWT score.

Structured PICO

Does left atrial strain measured by speckle-tracking echocardiography improve the diagnosis of cardiac amyloidosis in screened patients?

Population

423 consecutive patients screened for cardiac amyloidosis (CA) over 5 years at two referral centres. CA was diagnosed in 261 patients (62%) with either amyloid transthyretin (ATTR; n = 144, 34%) or amyloid light-chain (AL; n = 117, 28%) CA.

Intervention

Speckle-tracking echocardiography (STE) evaluating strain parameters of all four chambers, specifically peak left atrial longitudinal strain (LA-PALS) and LA-peak atrial contraction strain (LA-PACS)

Comparator

Standard echocardiographic variables, cardiac biomarkers, and the validated IWT score

Outcome

Diagnosis of cardiac amyloidosis (CA) or ATTR-CAsurrogate

Left atrial strain parameters (LA-PALS and LA-PACS) are highly informative for diagnosing cardiac amyloidosis and ATTR-CA, providing incremental diagnostic value over standard echocardiographic and biomarker assessments.

Discussion

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Implication

May support incremental LA strain use for CA diagnosis beyond standard measures; hypothesis-generating, requiring prospective validation before practice change.

Cite This Study

Aimo et al. (2022) studied this question.

synapsesocial.com/papers/6a80207a03a7c7d587cac873 https://doi.org/10.1093/ehjci/jeac057

Topics

Atrial fibrillation Persistent AF management Echocardiography Cardiac amyloidosis

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Implication

May support incremental LA strain use for CA diagnosis beyond standard measures; hypothesis-generating, requiring prospective validation before practice change.

Multi-chamber speckle tracking imaging and diagnostic value of left atrial strain in cardiac amyloidosis

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Multi-chamber speckle tracking imaging and diagnostic value of left atrial strain in cardiac amyloidosis

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

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