Anterior Aortic Plane Systolic Excursion: A Novel Indicator of Transplant-Free Survival in Systemic Light-Chain Amyloidosis

Marco M Ochs; Johannes Riffel; Arnt V Kristen; Ute Hegenbart; Stefan Schönland; Stefan E Hardt; Hugo A Katus; Derliz Mereles; Sebastian J Buss

doi:10.1016/j.echo.2016.09.003

Anterior Aortic Plane Systolic Excursion: A Novel Indicator of Transplant-Free Survival in Systemic Light-Chain Amyloidosis

J Am Soc Echocardiogr. 2016 Dec;29(12):1188-1196. doi: 10.1016/j.echo.2016.09.003. Epub 2016 Oct 27.

Authors

Marco M Ochs¹, Johannes Riffel², Arnt V Kristen², Ute Hegenbart³, Stefan Schönland³, Stefan E Hardt², Hugo A Katus², Derliz Mereles², Sebastian J Buss²

Affiliations

¹ Department of Cardiology, University of Heidelberg, Heidelberg, Germany. Electronic address: marco.ochs@med.uni-heidelberg.de.
² Department of Cardiology, University of Heidelberg, Heidelberg, Germany.
³ Department of Hematooncology, University of Heidelberg, Heidelberg, Germany.

PMID: 28042785
DOI: 10.1016/j.echo.2016.09.003

Abstract

Background: Anterior aortic plane systolic excursion (AAPSE) was evaluated in the present pilot study as a novel echocardiographic indicator of transplant-free survival in patients with systemic light-chain amyloidosis.

Methods: Eighty-nine patients with light-chain amyloidosis were included in the post-hoc analysis. A subgroup of 54 patients with biopsy-proven cardiac amyloid infiltration were compared with 41 healthy individuals to evaluate the discriminative ability of echocardiographic findings. AAPSE is defined as the systolic excursion of the anterior aortic margin. To quantify AAPSE, the M-mode cursor was placed on the aortic valve plane in parasternal long-axis view at end-diastole. Index echocardiography had been performed before chemotherapy. Median follow-up duration was 2.4 years. The primary combined end point was heart transplantation or overall death.

Results: Mean AAPSE was 14 ± 2 mm in healthy individuals (mean age=57 ± 10 years; 56% men; BMI=25 ± 4 kg/m²). AAPSE < 11 mm separated patients from age-, gender-, and BMI-matched control subjects with 93% sensitivity and 97% specificity. Median transplant-free survival of patients with AAPSE < 5 mm was 0.7 versus 4.8 years (P = .0001). AAPSE was an independent indicator of transplant-free survival in multivariate Cox regression (echocardiographic model: hazard ratio=0.72 [P = .03]; biomarker model: hazard ratio=0.62 [P = .0001]). Sequential regression analysis suggested incremental power of AAPSE as a marker of transplant-free survival. An ejection fraction-based model with an overall χ² value of 22.8 was improved by the addition of log NT-proBNP (χ² = 32.6, P < .005), troponin-T (χ² = 39.6, P < .01), and AAPSE (χ² = 54.0, P < .0001).

Conclusions: AAPSE is suggested as an indicator of transplant-free survival in patients with systemic light-chain amyloidosis. AAPSE provided significant incremental value to established staging models.

Keywords: AAPSE; Anterior aortic plane systolic excursion; Cardiomyopathy; Echocardiography; Survival; Systemic light-chain amyloidosis.

Publication types

Randomized Controlled Trial

MeSH terms

Aorta / diagnostic imaging*
Cardiomyopathy, Restrictive / diagnostic imaging*
Cardiomyopathy, Restrictive / mortality*
Cardiomyopathy, Restrictive / surgery
Disease-Free Survival
Echocardiography / methods*
Echocardiography / statistics & numerical data
Female
Germany / epidemiology
Heart Transplantation / mortality
Heart Transplantation / statistics & numerical data
Humans
Immunoglobulin Light-chain Amyloidosis / diagnostic imaging*
Immunoglobulin Light-chain Amyloidosis / mortality*
Immunoglobulin Light-chain Amyloidosis / surgery
Male
Middle Aged
Prevalence
Prognosis
Reproducibility of Results
Risk Factors
Sensitivity and Specificity
Survival Rate
Treatment Outcome