engleski

Reduced early diastolic strain rate is related to poor survival in cardiac amyloidosis patients with preserved ejection fraction.

Purpose: Previous studies suggest that diastolic abnormalities, with altered early filling, are the typical findings in cardiac amyloidosis (CA) and are related to outcome. By the use of speckle tracking imaging, regional and global early diastolic strain rate (SRE) can be easily assessed in CA. We sought to determine whether speckle tracking SRE could be used as a predictor for mortality in CA patients with preserved left ventricular ejection fraction (EF). Methods: Conventional echocardiography and speckle tracking imaging was performed in 40 CA patients (22 male, mean age of 65±9 years) and 30 age- matched healthy subjects (18 male, mean age of 61±8 years). Left ventricular EF was greater than 45% (mean 59±7%) in all CA patients. Segmental early diastolic strain rate (SRE) of six segments and global SRE were measured on apical 4-chamber view. Patients were followed for a median of 14 months (interquartile range 5 to 29 months). The primary end point was all-cause mortality. Results: Eighteen (45%) CA patients died during follow-up. SRE was similar in apical and middle segments as well as in the septal basal segment between death and surviving CA patients. Global and lateral basal SRE in the death group was significantly lower than in survivors (Global SRE: 0.75±0.26 vs. 0.95±0.32 S-1, p=0.037 ; basLat SRE: 0.54±0.42 vs. 0.90±0.61 S-1, p=0.04). Global (r=-0.509, p<0.001) and lateral basal SRE (r=-0.403, p=0.004) were negatively correlated with left ventricular mass index in patients with CA. Kaplan-Meier plots demonstrated that reduced global SRE (≤ 0.8 S-1) and lateral basal SRE (≤ 0.5 S-1) were both associated with significantly increased mortality in CA patients (log rank p=0.001). Cox proportional hazard regression showed that reduced global SRE (HR 5.02, p=0.005) and lateral basal SRE (HR 7.01, p=0.002) were independent predictors of poor survival in CA patients after adjusting for age, gender, number of organ involvements and septum thickness, whereas transmitral flow velocity to annular velocity ratio (E/E', HR 1.55, p=0.414), E/SRE (HR 1.61, p=0.322), and deceleration time of early filling (DT, HR 1.79, p=0.237) were not predictors of mortality in CA patients. Conclusions: Global and lateral basal SRE are negatively correlated with left ventricular mass index and independent predictors of survival in CA patients with preserved EF. Global and lateral basal SRE values are superior to other conventional diastolic parameters for predicting death in CA patients with preserved EF.

Amyloidosis; preserved EF; speckle tracking imaging; early filling; diastolic function.

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