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Strain echocardiography predictors in patients with concomitant cardiac amyloidosis and aortic stenosis: a
Samira Jafarisis1, Shahab Masoumi2, Naser Khezerlouy-Aghdam1
1Cardiovascular Research Center, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz, Eastern Azerbaijan, Iran.
Insights
The "cherry on top" sign, identified through strain predictors, effectively distinguishes cardiac amyloidosis (CA) with aortic stenosis (AS) from isolated AS. This finding aids in accurate diagnosis and improved patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiac Physiology
Background:
- Concomitant cardiac amyloidosis (CA) and aortic stenosis (AS) can be misdiagnosed as isolated AS, complicating treatment and prognosis.
- Accurate differentiation is crucial to prevent complications arising from undiagnosed CA.
Purpose of the Study:
- To evaluate the diagnostic utility of strain predictors in differentiating concomitant CA and AS from isolated AS.
- To assess the prevalence and diagnostic value of the "cherry on top" sign.
Main Methods:
- Forty-two patients with severe AS and suspected CA underwent 99mTc-DPD scintigraphy.
- Speckle-tracking echocardiography and strain analysis were performed, focusing on apical sparing and the "cherry on top" sign.
Main Results:
- The "cherry on top" sign was present in 100% of patients with concomitant CA and AS, showing 100% sensitivity and 67.6% specificity.
- Higher E/E' ratio and RALS, and lower GLS and mean basal LS were observed in patients with concomitant CA.
Conclusions:
- The "cherry on top" sign is a highly sensitive and specific indicator for concomitant CA and AS.
- Strain parameters like GLS, RALS, and E/E' ratio are valuable in distinguishing these conditions.
Background:
Concomitant cardiac amyloidosis (CA) and aortic stenosis (AS) may be mistaken for isolated AS, potentially impacting the treatment strategy and patient's prognosis. Therefore, it is crucial to distinguish between these conditions, as failure to promptly diagnose CA may lead to considerable complications. The aim of this study is to investigate the diagnostic value of strain predictors in patients with concomitant CA and AS compared to isolated AS.
Methods:
Forty-two patients with severe AS suspected of concomitant CA based on a comprehensive clinical evaluation were selected to undergo 99mTc-DPD scintigraphy. Those showing Perugini grade 2 or 3 tracer uptakes without evidence of monoclonal gammopathy were diagnosed with CA and underwent speckle-tracking echocardiography. Furthermore, strain analysis was performed to evaluate myocardial deformation, with a focus on detecting apical sparing and reduction in bull's eye mapping, resulting in the characteristic "cherry on top" sign.
Results:
Eight patients were diagnosed with CA, representing 19.0% of those suspected of concomitant CA and 7.8% of the overall cohort with severe AS. AF arrhythmia was significantly more frequent in these patients compared to those with isolated AS. Echocardiography findings revealed that E/E' ratio and RALS were significantly higher in patients with concomitant CA, while GLS and mean basal LS were significantly lower in this group. The "cherry on top" sign was detected in 19 patients (45.2%), present in 100% of those with concomitant CA and AS, versus 32.4% in isolated AS cases (P = 0.04). This sign demonstrated a sensitivity of 100% and a specificity of 67.6% for predicting concomitant CA and AS.
Conclusions:
In conclusion, the "cherry on top" sign was significantly more prevalent in patients with concomitant CA and AS, compared to those with isolated AS, demonstrating a sensitivity of 100% and a specificity of 67.6% for predicting concomitant CA. Moreover, RALS and E/E' ratios were significantly higher in patients with concomitant CA, whereas GLS and mean basal LS were significantly lower in this group.
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