PMID- 38162105 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240103 IS - 2223-3652 (Print) IS - 2223-3660 (Electronic) IS - 2223-3652 (Linking) VI - 13 IP - 6 DP - 2023 Dec 15 TI - Early diagnostic and prognostic value of myocardial strain derived from cardiovascular magnetic resonance in patients with cardiac amyloidosis. PG - 979-993 LID - 10.21037/cdt-23-205 [doi] AB - BACKGROUND: Cardiac amyloidosis (CA) is one of the causes of heart failure with preserved ejection fraction. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and extracellular volume (ECV) fractions is a preferred method to identify CA. However, the requirement of contrast limits its use in renal deficiency patients. Myocardial strain is a promising method without contrast. We sought to assess the early diagnostic and prognostic value of strain. METHODS: This retrospective study enrolled 31 patients with systemic amyloidosis (SA) in Peking University First Hospital from January 2014 to January 2019. The patients were categorized into three groups, including 11 CA patients with left ventricular hypertrophy (CA-LVH group), 9 CA patients without LVH (CA-NLVH group), and 11 patients with extracardiac SA (SA group). Strain analysis was performed with CMR images. A least absolute shrinkage and selection operator (LASSO) was used to generate strain score. The receiver operating characteristic (ROC) curve was used to evaluate the early diagnostic efficacy of strain score and other single strain parameter. The primary endpoint was defined as death from all cause or rehospitalization for heart failure. A Cox proportional hazards model was used to assess the index value on the prognosis. RESULTS: In CA patients, as the left ventricular wall thickens, the global and regional strain decrease significantly. A new strain score (strain score = 0.00893 x mid-septal circumferential peak strain + 0.02285 x apical radial peak strain + 0.1541 x apical circumferential peak strain + 0.33097 x epicardial circumferential average peak strain + 0.42232 x endocardial longitudinal average peak strain) generated using LASSO showed that the area under the ROC curve was 0.909. All the patients with outcome events were in CA groups, four were in CA-LVH group and one in CA-NLVH group. New York Heart Association (NYHA) grade [hazard ratio (HR) =14.29, 95% confidence interval (CI): 2.34-87.34, P<0.01], brain natriuretic peptide (HR =20.05, 95% CI: 2.21-182.36, P=0.008), cardiac injury biomarker (HR =11.59, 95% CI: 1.03-130.36, P=0.047), E/E' (mitral inflow to mitral relaxation velocity ratio) (HR =1.09, 95% CI: 1.00-1.18, P=0.040), end-systolic left ventricular volume (HR =1.04, 95% CI: 1.00-1.18, P=0.039) and LGE volume (HR =1.11, 95% CI: 1.02-1.20, P=0.012) positively correlate with events. Better renal function (HR =0.92, 95% CI: 0.86-0.98, P=0.011) and ejection fraction (HR =0.94, 95% CI: 0.88-0.99, P=0.027) appear to be protective factors. Although with no statistical difference, the strain damage had a tendency to predict poor prognosis, i.e., mid-ventricular circumferential strain with HR of 1.25 (95% CI: 1.0-1.57, P=0.050) and strain score with HR of 1.30 (95% CI: 0.98-1.73, P=0.067). CONCLUSIONS: Myocardial strain decreased in CA patients. The integrated magnetic resonance imaging (MRI) strain score can serve as a useful tool to identify early myocardial involvement in amyloidosis. The strain damage had a tendency to predict poor prognosis. CI - 2023 Cardiovascular Diagnosis and Therapy. All rights reserved. FAU - Hou, Weijie AU - Hou W AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Wang, Zhi AU - Wang Z AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Huang, Jingzhou AU - Huang J AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Fan, Fangfang AU - Fan F AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Yang, Fan AU - Yang F AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Qiu, Lin AU - Qiu L AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Zhao, Kai AU - Zhao K AD - Department of Radiology, Peking University First Hospital, Beijing, China. FAU - Qiu, Jianxing AU - Qiu J AD - Department of Radiology, Peking University First Hospital, Beijing, China. FAU - Yang, Ying AU - Yang Y AD - Department of Cardiology, Peking University First Hospital, Beijing, China. AD - Echocardiography Core Laboratory, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China. FAU - Ma, Wei AU - Ma W AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Gong, Yanjun AU - Gong Y AD - Department of Cardiology, Peking University First Hospital, Beijing, China. FAU - Hong, Tao AU - Hong T AD - Department of Cardiology, Peking University First Hospital, Beijing, China. LA - eng PT - Journal Article DEP - 20231123 PL - China TA - Cardiovasc Diagn Ther JT - Cardiovascular diagnosis and therapy JID - 101601613 PMC - PMC10753247 OTO - NOTNLM OT - Cardiac amyloidosis (CA) OT - cardiac magnetic resonance (CMR) OT - echocardiography OT - heart failure OT - myocardial strain COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-23-205/coif). The authors have no conflicts of interest to declare. EDAT- 2024/01/02 11:44 MHDA- 2024/01/02 11:45 PMCR- 2023/12/15 CRDT- 2024/01/01 04:14 PHST- 2023/05/10 00:00 [received] PHST- 2023/10/13 00:00 [accepted] PHST- 2024/01/02 11:45 [medline] PHST- 2024/01/02 11:44 [pubmed] PHST- 2024/01/01 04:14 [entrez] PHST- 2023/12/15 00:00 [pmc-release] AID - cdt-13-06-979 [pii] AID - 10.21037/cdt-23-205 [doi] PST - ppublish SO - Cardiovasc Diagn Ther. 2023 Dec 15;13(6):979-993. doi: 10.21037/cdt-23-205. Epub 2023 Nov 23.