Right and left ventricular global longitudinal strain demonstrated adequate diagnostic accuracy for identifying ATTR-CA among patients with left ventricular hypertrophy (AUC 0.770 and 0.743, p<0.001).
Observational (n=96)
No
Does right and left ventricular global longitudinal strain accurately differentiate ATTR-CA from other left ventricular hypertrophy phenotypes in patients with suspected cardiac amyloidosis?
Both right and left ventricular global longitudinal strain demonstrate comparable and adequate diagnostic accuracy for differentiating transthyretin cardiac amyloidosis from other causes of left ventricular hypertrophy.
Effect estimate: AUC 0.743 for LV GLS and 0.770 for RV GLS
p-value: p=<0.001
Abstract Introduction Left ventricular hypertrophy (LVH) may result from various cardiomyopathies, complicating the differentiation of transthyretin cardiac amyloidosis (ATTR-CA) from other LVH phenotypes. The overlap in echocardiographic features can hinder timely diagnosis and limit access to targeted therapeutic interventions. Objectives Assess the diagnostic accuracy of right ventricular (RV) and left ventricular (LV) global longitudinal strain (GLS) to discriminate ATTR-CA in patients (pts) evaluated for suspected CA at a Cardiomyopathy Clinic in a regional hospital in Portugal. Methods Retrospective single-center study of 96 adult pts followed from 2018 to 2024. Inclusion criteria: pts aged ≥ 60 years with LV wall thickness ≥ 12mm and at least one cardiac/extracardiac red flag for CA. Baseline clinical data were collected, and speckle tracking echocardiography was used to analyze RV and LV GLS at the time of diagnosis. Pts were classified in the ATTR-CA group (group 1) and the non-ATTR-CA group (group 2) according to the ESC algorithm for the diagnosis of ATTR-CA. Group comparisons were performed. Results 96 pts were included (median age 79 IQR 10 yrs, 77% male). Following the diagnostic workup, 52 pts (54%) were assigned to group 1, and 44 pts (46%) to group 2, which included 19 with hypertrophic cardiomyopathy, 13 with hypertensive heart disease, 3 with valvular heart disease, and 9 with multifactorial heart disease. Group 1 pts were older (81 IQR 8 vs 78 IQR 10 yrs, p=0.006) and more frequently had overweight (58 vs 32%, p=0.011) and chronic kidney disease (62 vs 39%, p=0.025). Regarding heart failure characterization, the majority of pts had a LV ejection fraction 50% (67 vs 84%, p=0.06). Pts with CA had greater interventricular septum thickness (18.5±3.2 vs 15.7±2.8mm, p0.001), lower RV GLS (-11.2±4.1 vs -15.0±4.1%, p0.001) and lower LV GLS (-9.8±2.9 vs -13.4±4.1%, p0.001). LV and RV GLS showed adequate diagnostic accuracy (AUC 0.743 vs0.770, respectively; p0.001), with LV GLS ≥ -11.7 yielding 81% sensitivity and 66% specificity, and RV GLS ≥ -15.5 yielding 92% sensitivity and 48% specificity for identifying ATTR-CA. Multivariate logistic regression identified lower LV and RV GLS as independent predictors of ATTR-CA (table 1B). Conclusions In this population, pts with ATTR-CA had notably lower RV and LV GLS values compared to non-ATTR-CA pts, with both parameters showing comparable diagnostic accuracy for identifying the disease.
Martins et al. (Thu,) conducted a observational in Suspected cardiac amyloidosis (n=96). Right and left ventricular global longitudinal strain (GLS) was evaluated on Diagnostic accuracy to discriminate ATTR-CA (AUC 0.743 for LV GLS and 0.770 for RV GLS, p=<0.001). Right and left ventricular global longitudinal strain demonstrated adequate diagnostic accuracy for identifying ATTR-CA among patients with left ventricular hypertrophy (AUC 0.770 and 0.743, p<0.001).