Diagnostic and prognostic value of the left atrial myopathy evaluation in cardiac amyloidosis using echocardiography

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Noninvasive Assessment of Cardiac Abnormalities in Experimental Autoimmune Myocarditis by Magnetic Resonance Microscopy Imaging in the Mouse
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Aaisha Ferkh1,2, Paul Geenty1,2, Luke Stefani1,2

  • 1Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia.

ESC Heart Failure
|August 12, 2024
PubMed

Insights

Cardiac amyloidosis (CA) involves left atrial (LA) myopathy, impacting heart failure prognosis. Increased LA mechanical dispersion (LA-MD) in transthyretin CA (ATTR) suggests greater dyssynchrony, while LA minimum volume predicts mortality in light-chain CA (AL).

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac Electrophysiology

Background:

  • Cardiac amyloidosis (CA) is an underdiagnosed cause of heart failure.
  • Left atrial (LA) myopathy worsens prognosis in heart failure and is characteristic of transthyretin (ATTR) and light-chain (AL) CA.
  • LA mechanical dispersion (LA-MD) indicates intra-atrial dyssynchrony, linked to LA myopathy and atrial fibrillation (AF) risk.

Purpose of the Study:

  • To characterize LA myopathy in ATTR and AL CA using comprehensive echocardiography.
  • To evaluate the prognostic significance of LA abnormalities in CA.
  • To compare LA function and dyssynchrony between ATTR CA, AL CA, and hypertensive heart disease (HHT).

Main Methods:

  • Echocardiographic assessment of LA strain and LA-MD in 86 ATTR CA, 86 AL CA, and 58 HHT patients.
  • Patient follow-up for mortality events.
  • Multivariable regression and Cox proportional hazard models to identify independent predictors of outcomes.

Main Results:

  • ATTR and AL CA patients exhibited more impaired LV and LA function compared to HHT patients.
  • LA-MD was significantly higher in ATTR CA versus AL CA (P < 0.001).
  • LA-MD independently predicted ATTR CA (P=0.014), LA reservoir strain associated with heart failure (P < 0.001), and LA minimum volume predicted mortality in AL CA (P=0.034).

Conclusions:

  • LA myopathy characterization offers diagnostic and prognostic value in CA.
  • ATTR CA is associated with increased atrial dyssynchrony, potentially increasing AF risk.
  • LA reservoir strain and LA minimum volume are key echocardiographic markers for heart failure and mortality prediction in CA.
Abstract

Keywords:
cardiac amyloidosisechocardiographyleft atrial mechanical dispersionleft atrial myopathystrain imaging

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