Triplane Left Atrial Reservoir Strain in Cardiac Amyloidosis: A Comparative Study with Rhythm-Matched Controls

Area of Science:

• Cardiology
• Medical Imaging
• Biophysics

Background:

• Cardiac amyloidosis involves myocardial and atrial infiltration, causing mechanical dysfunction, atrial fibrillation, and thromboembolism.
• Left atrial (LA) strain is a known marker of atrial function, but triplane LA strain data in cardiac amyloidosis are scarce.

Purpose of the Study:

• To evaluate triplane LA reservoir strain in patients with cardiac amyloidosis compared to controls.
• To assess the correlation and agreement between triplane and biplane LA strain measurements.
• To determine the reproducibility of triplane LA strain assessment.

Main Methods:

• Transthoracic echocardiography was performed on 24 cardiac amyloidosis patients and 24 matched controls.
• Triplane and biplane LA reservoir strain were measured using speckle-tracking echocardiography.
• Statistical analyses included two-way ANOVA, Pearson correlation, and Bland-Altman analysis.

Main Results:

• Triplane LA reservoir strain was significantly lower in cardiac amyloidosis patients (6.7 ± 2.7%) versus controls (16.2 ± 8.3%, p < 0.001).
• Amyloidosis patients in sinus rhythm showed impaired LA strain, comparable to controls with atrial fibrillation.
• Strong correlation (r=0.90) and good agreement were found between triplane and biplane LA strain; reproducibility was excellent (ICC > 0.94).

Conclusions:

• Triplane LA reservoir strain is markedly reduced in cardiac amyloidosis, reflecting significant atrial mechanical dysfunction.
• This technique provides comprehensive visualization, high reproducibility, and strong agreement with biplane analysis.
• Triplane LA strain is a valuable complementary tool for characterizing amyloid atriopathy.