Time-dependent change of relative apical longitudinal strain index in patients with wild-type transthyretin amyloid cardiomyopathy

Hiroki Usuku; Eiichiro Yamamoto; Daisuke Sueta; Momoko Noguchi; Tomohiro Fujisaki; Koichi Egashira; Mami Morioka; Takashi Komorita; Fumi Oike; Koichiro Fujisue; Shinsuke Hanatani; Yuichiro Arima; Seiji Takashio; Seitaro Oda; Hiroaki Kawano; Kenichi Matsushita; Mitsuharu Ueda; Hirotaka Matsui; Kenichi Tsujita

doi:10.1016/j.ijcha.2022.101146

Time-dependent change of relative apical longitudinal strain index in patients with wild-type transthyretin amyloid cardiomyopathy

Int J Cardiol Heart Vasc. 2022 Nov 5:43:101146. doi: 10.1016/j.ijcha.2022.101146. eCollection 2022 Dec.

Authors

Hiroki Usuku^{1

2

3}, Eiichiro Yamamoto^{2

3}, Daisuke Sueta^{2

3}, Momoko Noguchi¹, Tomohiro Fujisaki^{2

3}, Koichi Egashira^{2

3}, Mami Morioka^{2

3}, Takashi Komorita^{2

3}, Fumi Oike^{2

3}, Koichiro Fujisue^{2

3}, Shinsuke Hanatani^{2

3}, Yuichiro Arima^{2

3}, Seiji Takashio^{2

3}, Seitaro Oda⁴, Hiroaki Kawano^{2

3}, Kenichi Matsushita^{2

3

5}, Mitsuharu Ueda^{3

6}, Hirotaka Matsui⁷, Kenichi Tsujita^{2

3}

Affiliations

¹ Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
² Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
³ Center of Metabolic Regulation of Healthy Aging, Kumamoto University, Faculty of Life Sciences, Kumamoto, Japan.
⁴ Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
⁵ Division of Advanced Cardiovascular Therapeutics, Kumamoto University Hospital, Kumamoto, Japan.
⁶ Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
⁷ Department of Molecular Laboratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

Abstract

Aim: This study was conducted to investigate the meaning of left ventricular (LV) apical sparing in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).

Methods and results: 165 patients who were diagnosed with ATTRwt-CM at Kumamoto University Hospital from January 2002 to December 2020 and had sufficient data for two-dimensional speckle tracking echocardiography were enrolled. Of these, 86 patients (52 %) had LV apical sparing (relative apical longitudinal strain index (RapLSI) > 1.0). Multivariable logistic regression analysis revealed the following variables were significantly associated with LV apical sparing: interventricular septal thickness in diastole (odds ratio (OR), 1.19; 95 % confidence interval (CI), 1.01-1.41; p < 0.05); E/e' ratio (OR, 1.06; 95 % CI, 1.00-1.11; p < 0.05); and heart-to-contralateral ratio by ^99mTc-labeled pyrophosphate scintigraphy (OR, 3.40; 95 % CI, 1.07-10.83; p < 0.05).Next, we compared RapLSI at the time of diagnosis with that during the follow-up period (396 days (346-458) after diagnosis) in 92 patients. RapLSI increased significantly during the follow-up period compared with RapLSI at diagnosis in the non-LV apical sparing group (0.89 ± 0.32 vs 0.74 ± 0.18, p < 0.01) but not in the LV apical sparing group (1.33 ± 0.53 vs 1.39 ± 0.45, p = 0.46). A total of 12 patients (29 %) in the non-LV apical sparing group developed LV apical sparing and 11 patients (22 %) in LV apical sparing group diminished LV apical sparing during the follow-up period.

Conclusion: Approximately half of ATTRwt-CM patients did not have LV apical sparing at diagnosis. Because RapLSI in ATTRwt-CM significantly changed over time, repeated two-dimensional speckle tracking analysis is important for suspected ATTR-CM patients.

Keywords: Echocardiography; Left ventricular apical sparing; Longitudinal strain; Two-dimensional speckle tracking echocardiography; Wild-type transthyretin amyloid cardiomyopathy.