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Left atrial strain imaging differentiates cardiac amyloidosis and hypertensive heart disease

Karen Rausch1,2, Gregory M Scalia1,3, Kei Sato1

  • 1Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.

The International Journal of Cardiovascular Imaging
|July 31, 2020
PubMed

Insights

Left atrial strain analysis using echocardiography can help differentiate cardiac amyloidosis (CA) from hypertensive heart disease. Reduced LA strain parameters indicate CA, even with similar left ventricular wall thickness.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Biophysics

Background:

  • Cardiac amyloidosis (CA) diagnosis is challenging, often confused with hypertensive heart disease due to similar left ventricular (LV) wall thickening.
  • Left atrial (LA) function assessment is crucial for understanding cardiac health and disease progression.

Purpose of the Study:

  • To evaluate the utility of LA function and deformation analysis using strain and strain rate (SR) imaging in differentiating CA from hypertensive heart disease.
  • To compare LA strain parameters between CA subtypes (AL and ATTR amyloidosis) and hypertensive patients.

Main Methods:

  • Retrospective review of 44 confirmed CA cases (AL and ATTR subtypes) and 25 hypertensive patients with increased LV wall thickness.
  • 2D-Speckle tracking echocardiography (STE) derived LA strain analysis was performed to assess reservoir, conduit, and contractile function phases.
  • Comparison of LA strain and SR parameters between the CA cohorts and the hypertensive cohort.

Main Results:

  • All LA strain parameters were significantly reduced in the amyloid light chain (AL) cohort compared to the hypertensive (HT) cohort, despite similar LV wall thickness.
  • The amyloid transthyretin (ATTR) cohort showed reduced LA strain similar to the AL cohort, with thicker LV walls and higher atrial fibrillation burden.
  • A reservoir strain cutoff of 20% demonstrated 86.4% sensitivity and 88.6% specificity for detecting CA versus hypertensive heart disease.

Conclusions:

  • LA strain parameters effectively identify LA dysfunction in all types of CA.
  • LA function is significantly impaired in CA compared to hypertensive heart disease, even with comparable LV wall thickness.
  • LA strain imaging offers incremental value in distinguishing CA from hypertensive cardiac changes, aiding clinical diagnosis.

Keywords:
Atrial deformationCardiac amyloidosisHypertensionLeft atrial strain

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