Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis

JACC Cardiovasc Imaging. 2020 Apr;13(4):909-920. doi: 10.1016/j.jcmg.2019.10.011. Epub 2019 Dec 18.


Objectives: This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration.

Background: Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool.

Methods: We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance.

Results: A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e' wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical-to-base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90).

Conclusions: Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.

Keywords: cardiac amyloidosis; echocardiography; global longitudinal strain; hypertrophy; wall thickness.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amyloid Neuropathies, Familial / diagnostic imaging*
  • Amyloid Neuropathies, Familial / pathology
  • Amyloid Neuropathies, Familial / physiopathology
  • Biopsy
  • Cardiomyopathy, Hypertrophic / diagnostic imaging*
  • Diagnosis, Differential
  • Echocardiography*
  • Europe
  • Female
  • Humans
  • Immunoglobulin Light-chain Amyloidosis / diagnostic imaging*
  • Immunoglobulin Light-chain Amyloidosis / pathology
  • Immunoglobulin Light-chain Amyloidosis / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Myocardium / pathology
  • Predictive Value of Tests
  • Ventricular Function, Left
  • Ventricular Remodeling

Supplementary concepts

  • Amyloidosis, Hereditary, Transthyretin-Related