In patients with cardiac amyloidosis, myocardial work indices predicted all-cause mortality better than LVEF and MCF (GWE AUC 0.689 vs LVEF AUC 0.511), but did not perform better than GLS (AUC 0.631).
Cohort (n=118)
Do myocardial work indices better predict mortality compared to standard echocardiographic parameters in patients with cardiac amyloidosis?
Myocardial work indices correlate well with known prognostic markers and predict mortality better than LVEF and MCF, but do not outperform GLS in patients with cardiac amyloidosis.
Effect estimate: AUC 0.689 for GWE
BACKGROUND: Cardiac amyloidosis (CA) is a life-threatening restrictive cardiomyopathy. Identifying patients with a poor prognosis is essential to ensure appropriate care. The aim of this study was to compare myocardial work (MW) indices with standard echocardiographic parameters in predicting mortality among patients with CA. METHODS: Clinical, biological and transthoracic echocardiographic parameters were retrospectively compared among 118 patients with CA. Global work index (GWI) was calculated as the area of left ventricular pressure-strain loop. Global work efficiency (GWE) was defined as percentage ratio of constructive work to sum of constructive and wasted works. Sixty-one (52%) patients performed a cardiopulmonary exercise. RESULTS: GWI, GWE, global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and myocardial contraction fraction (MCF) were correlated with N-terminal prohormone brain natriuretic peptide (R=-0.518, R=-0.383, R=-0.553, R=-0.382 and R=-0.336, respectively; p<0.001). GWI and GLS were correlated with peak oxygen consumption (R=0.359 and R=0.313, respectively; p<0.05). Twenty-eight (24%) patients died during a median follow-up of 11 (4-19) months. The best cut-off values to predict all-cause mortality for GWI, GWE, GLS, LVEF and MCF were 937 mm Hg/%, 89%, 10%, 52% and 15%, respectively. The area under the receiver operator characteristic curve of GWE, GLS, GWI, LVEF and MCF were 0.689, 0.631, 0.626, 0.511 and 0.504, respectively. CONCLUSION: In CA population, MW indices are well correlated with known prognosis markers and are better than LVEF and MCF in predicting mortality. However, MW does not perform better than GLS.
Roger‐Rollé et al. (2020) conducted a cohort in Cardiac amyloidosis (n=118). Myocardial work indices (GWI, GWE) vs. Standard echocardiographic parameters (GLS, LVEF, MCF) was evaluated on All-cause mortality (AUC 0.689 for GWE). In patients with cardiac amyloidosis, myocardial work indices predicted all-cause mortality better than LVEF and MCF (GWE AUC 0.689 vs LVEF AUC 0.511), but did not perform better than GLS (AUC 0.631).