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Alterations in regional myocardial deformation assessed by strain imaging in cardiac amyloidosis
Author(s) -
Lo Queenie,
Haluska Brian,
Chia EeMay,
Lin MingWei,
Richards David,
Marwick Thomas,
Thomas Liza
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13355
Subject(s) - strain (injury) , cardiac amyloidosis , amyloidosis , medicine , radial stress , cardiology , velocity vector , diastole , basal (medicine) , deformation (meteorology) , materials science , blood pressure , composite material , insulin , engineering , aerospace engineering
Background Cardiac amyloidosis results in increased left ventricular ( LV ) wall thickness and diastolic dysfunction ( DD ). Strain measurements using velocity vector imaging ( VVI ) may further characterize myocardial dysfunction. Methods A total of 43 AL amyloidosis patients were compared to age‐matched normals and hypertensive patients ( HT ). Subgroup analysis within the amyloid group was performed based on LV wall thickness (≤14 mm, >14 mm) and diastolic dysfunction ( DD ) (Group 1: normal and impaired relaxation, Group 2: pseudonormal, Group 3: restrictive). LV strain (longitudinal, circumferential, and radial strain (S) and strain rate [Sr]) were measured using velocity vector imaging ( VVI ). Results Increased LV wall thickness and DD were observed in the amyloid group. Global longitudinal (−13.9±4.1% vs −16.7±3.8%; P =.002) and radial (27.4±13.4% vs 38.8±15.7%; P <.001) strain were lower in the amyloid group vs normal controls, while circumferential strain was similar. Segmental analysis demonstrated reduced mid‐ and basal segmental strain with relative sparing of apical segments in the amyloid group. Reduced longitudinal and radial strain, with preserved circumferential strain, were observed in patients with wall thickness >14 mm; however, circumferential strain was also altered when severe DD (restrictive filling) was present. Conclusion Reduction in longitudinal and radial S and Sr was evident using VVI strain analysis in amyloidosis, with segmental heterogeneity in longitudinal S. There was relative preservation of circumferential strain, which was reduced only in patients with severe DD .