Comparing Echocardiographic Strain Imaging in Cardiac Amyloid and End-Stage Renal Disease Patients
Taylor Ferris1, Ethan Yohannan2, Kurt Daniel3
1Department of Internal Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
Insights
Apical sparing strain patterns are not specific for diagnosing cardiac amyloidosis (CA) in patients with end-stage renal disease (ESRD). This finding questions the clinical utility of this imaging pattern for CA diagnosis in ESRD populations.
Area of Science:
- Cardiology
- Medical Imaging
- Nephrology
Background:
- Diagnosing cardiac amyloidosis (CA) is challenging due to nonspecific symptoms and echocardiographic findings.
- Apical sparing strain patterns have been proposed as a diagnostic marker for CA.
- The specificity of this pattern in differentiating CA from other conditions like end-stage renal disease (ESRD) is unclear.
Purpose of the Study:
- To compare strain patterns between patients with cardiac amyloidosis (CA) and end-stage renal disease (ESRD).
- To evaluate the diagnostic utility of apical sparing strain patterns in distinguishing CA from ESRD.
Main Methods:
- Compared echocardiographic longitudinal strain (LS) parameters in 25 CA patients (CKD stage ≤3) and 19 ESRD patients (CA negative).
- Calculated relative apical LS using average apical LS divided by the sum of average mid and basal LS.
- Analyzed regional and global LS, echocardiographic, and demographic parameters.
Main Results:
- No significant differences were observed in regional or relative apical strain between CA and ESRD groups.
- A relative apical strain ratio >1 showed 80% sensitivity but only 42% specificity for CA.
- Visual assessment revealed apical sparing strain patterns in all groups.
Conclusions:
- End-stage renal disease (ESRD) exhibits overlapping imaging findings with cardiac amyloidosis (CA).
- Relative apical sparing strain is nonspecific for CA in ESRD patients.
- Clinical diagnosis of CA in ESRD should rely on strong clinical suspicion and other imaging/demographic variables, not solely on apical sparing patterns.
Purpose:
Diagnosing cardiac amyloidosis (CA) is difficult due to nonspecific clinical symptoms and echocardiographic findings. Prior studies have suggested that apical sparing strain patterns may be diagnostically useful. With increasing strain usage, it remains unclear how specific this pattern is to diagnose CA. We analyzed strain patterns between CA and end-stage renal disease (ESRD) patient populations.
Methods:
Patients with ESRD proven negative for CA (n = 19) were compared to CA patients with CKD stage 3 or less (n = 25). The ESRD cohort was stratified based on time on dialysis. Echocardiographic longitudinal strain (LS) parameters were collected, including regional and global LS, echocardiographic, and demographic parameters. Relative apical LS was calculated using the following equation: average apical LS/(average mid LS + average basal LS).
Results:
No significant differences were found regarding regional strain or relative apical strain. Our study showed a sensitivity of 80% and specificity of 42% when using a relative apical strain ratio of >1. All groups demonstrated an apical sparing strain pattern visually on the bulls-eye plot.
Conclusion:
ESRD demonstrates significant overlapping findings across various imaging modalities compared to CA. We demonstrated that relative apical sparing strain is nonspecific for CA among patients with ESRD. Our study calls into question the clinical value of relative apical-sparing stain patterns in identifying CA in an ESRD population and suggests that diagnostic evaluation should be driven by strong clinical suspicion and other imaging and demographic variables.
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