Background: The relative apical sparing (RELAPS) pattern on echocardiography, commonly linked to cardiac amyloidosis, may also occur in other conditions such as end-stage renal disease (ESRD). This study aimed to assess the prevalence and clinical predictors of RELAPS among ESRD patients undergoing kidney transplant evaluation.
Methods: This retrospective cohort study included adult ESRD patients with interventricular septal thickness > 12 mm and available strain imaging. Patients diagnosed with transthyretin or light-chain amyloidosis were excluded. RELAPS was defined as an average apical-to-(basal+mid) longitudinal strain ratio > 1.0. Clinical and echocardiographic variables were compared between groups, and multivariable logistic regression was used to identify independent predictors.
Results: Of 1389 patients screened, 199 met inclusion criteria, and 50 (25 %) exhibited a RELAPS pattern. Patients with RELAPS were more likely to be dialysis dependent (86 % vs. 55 %, p < 0.001), have elevated E/e' ratios (14.1 vs. 11.2, p = 0.02) and lower global longitudinal strain (GLS) compared to those without RELAPS (13.5 ± 3.3 vs 15.1 ± 2.9 %; p = 0.02). In multivariable analysis, dialysis (OR 3.9; 95 % CI 1.6-9.7) and E/e' (OR 1.07 per unit; 95 % CI 1.03-1.13) were independently associated with RELAPS. No significant differences were observed in age, gender, septal thickness, or biomarker levels.
Conclusions: The RELAPS pattern is relatively common in ESRD patients with increased septal thickness and is independently associated with dialysis dependence and elevated LV filling pressures. These findings imply that RELAPS may reflect advanced myocardial remodeling and hemodynamic burden, suggesting it is not exclusive to cardiac amyloidosis.
Keywords: Cardiac amyloidosis; Echocardiography; End-stage renal disease; Relative apical sparing; Strain imaging.
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