Background and objective .– Transthoracic echocardiography (TTE) is usually performed for patients with light chains amyloidosis (AL) when cardiac involvement is suspected. The latter is typically characterized by left ventricular (LV) diastolic dysfunction. However, the LV systolic ejection fraction (LVEF) is usually preserved.
Whether, the different components of the LV systolic contraction are altered in AL, is unknown.
The aim of this preliminary study was to assess the main components of the global LV systolic function, (longitudinal, circumferential, radial, area tracking and twist) using a 3D wall motion tracking imaging, a recent technique coupling a 3D volumetric acquisition with a wall motion tracking imaging in a serie of consecutive healthy controls and in patients with AL according to the Mayo Clinic staging.
Methods and results .– Twenty-nine consecutive subjects (six controls and 23 with AL and different degree of cardiac severity) were analysed. Classical 2DTTE parameters were obtained along with the 3D LV parameters: mean age was 66 ± 10 years, 55% were male. Compared to controls and to those with minimal/moderate (stage I/II) cardiac involvement, those with severe cardiac involvement (stage III) had significantly lower 3DLVEF, 3DLV global: longitudinal, circumferential, radial strain and lower area tracking ( Table 1 ) (all P < 0.05). However, the 3D LV rotation and twist function were not different between the three groups. Traditional 2DTTE showed significant differences in diastolic function in stage III AL compared to those in stage I/II and controls; however, it was not able to detect significant differences in LV volumes and LVEF.
| Variables | Controls ( n = 6) | Stage I/II ( n = 10) | Stage III ( n = 13) | P value |
|---|---|---|---|---|
| Age | 62 ± 9 | 65 ± 10 | 70 ± 10 | 0.03 |
| Sex (% male) | 48 | 48 | 67 | 0.25 |
| 2D LV echo parameters | ||||
| LVEDD (mm) | 45 ± 5 | 43 ± 6 | 43 ± 6 | 0.23 |
| LVESD (mm) | 28 ± 5 | 26 ± 5 | 30 ± 4 | 0.005 |
| LVEDV (mL) | 84 ± 24 | 74 ± 23 | 80 ± 25 | 0.2 |
| LVESV (mL) | 34 ± 12 | 31 ± 13 | 36 ± 15 | 0.3 |
| LVEF (%) | 62 ± 7 | 61 ± 7 | 57 ± 9 | 0.1 |
| IVS (mm) | 9 ± 1 | 13 ± 3 | 16 ± 3 | < 0.0001 |
| Lat E/E′ | 6 ± 0.7 | 11 ± 5 | 15 ± 8 | 0.002 |
| E/A | 0.9 ± 0.2 | 1.5 ± 1.5 | 1.9 ± 1.3 | 0.06 |
| Deceleration time | 199 ± 37 | 208 ± 46 | 194 ± 93 | 0.7 |
| Left atrial volume index (mL/m 2 ) | 18 ± 5 | 28 ± 9 | 39 ± 14 | < 0.0001 |
| 3D LV echo parameters | ||||
| LEVF (%) | 47 ± 4 | 49 ± 6 | 35 ± 9 | 0.007 |
| EDV (mL) | 87 ± 13 | 84 ± 23 | 99 ± 23 | 0.3 |
| ESV (mL) | 46 ± 10 | 42 ± 12 | 67 ± 23 | 0.009 |
| Global longitudinal strain (%) | −13 ± 3 | −11 ± 2 | −7.6 ± 2.8 | 0.001 |
| Global circumferential strain (%) | −20 ± 2 | −21 ± 4 | −16 ± 5 | 0.04 |
| Global radial strain (%) | +29 ± 18 | +15 ± 9 | +7 ± 5 | 0.001 |
| Global area tracking (%) | −30 ± 3 | −31 ± 5 | −23 ± 6 | 0.004 |
| 3D twist (%) | 5 ± 3 | 4.5 ± 3 | 3.7 ± 2 | 0.5 |
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