Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis

Türkan Seda Tan Kürklü

doi:10.4274/atfm.galenos.2022.00921

Research Article

Sol Atriyal Uzunlamasına Deformasyon Değerinin Kardiyak Amiloidoz Hastalarında Prognoz Üzerine Etkisinin Değerlendirilmesi

Year 2022, Volume: 75 Issue: 1, 42 - 47, 30.06.2022

Türkan Seda Tan Kürklü

Abstract

Amaç: İmmünoglobulin hafif zincir amiloidoz (AL) en sık görülen amiloidozdur. Kardiyak tutulum varlığı kötü sağkalımla ilişkili olup prognostik
sınıflamada biyobelirteçler kullanılmaktadır. Ekokardiyografik parametreler tanıda kullanılmakla birlikte hastalık ciddiyetini belirlemede kabul
gören bir görüntüleme parametresi bulunmamaktadır. Biz çalışmamızda sol atriyal uzunlamasına deformasyon ölçümünün kardiyak AL amiloidoz
hastalarında sağkalımı öngörmedeki yerini araştırmak istedik.

Gereç ve Yöntem: Çalışmamıza kardiyak amiloidoz saptanan 37 hasta dahil edildi. Hastaların klinik ve demografik verilerine ve transtorasik
ekokardiyografi (TTE) görüntülerine arşiv kayıtlarından ulaşıldı. Hastalar sağkalımlarına göre iki gruba ayrıldı.

Bulgular: Çalışmaya dahil edilen hastaların ortalama yaşı 63,9±10,8 yıldı. İki grubun demografik özellikleri ile laboratuvar verileri NT-proBNP değeri
dışında benzer bulundu. NT-proBNP değeri ölüm olan grupta istatistiksel olarak anlamlı derecede artmış saptandı (p=0,02). TTE parametrelerinden
sol atriyal volüm indeksi değeri ölüm olan grupta belirgin olarak artmış (p=0,02), pik atriyal uzunlamasına deformasyon (PALS) değeri ise ölüm olan
grupta belirgin olarak azalmış olarak saptandı (p=0,004). Cox regresyon analizinde PALS’nin NT-proBNP değerinden bağımsız, sağkalımın en önemli
ön gördürücüsü olduğu saptandı [risk oranı (%95 güven aralığı): 0,92 (0,84-0,98); p=0,01].

Sonuç: Çalışmamızda PALS’nin kardiyak AL amiloidoz hastalarında sağkalımla belirgin olarak ilişkili olduğunu saptadık. PALS’nin kardiyak AL
amiloidoz hastalarında prognoza etkisinin daha büyük, prospektif çalışmalarla değerlendirilmesi gerektiğini düşünmekteyiz.

Keywords

Amiloidoz, Amiloid Hafif Zincir, Sol Atriyal Boyuna Gerilme

Ethical Statement

Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Değerlendirme Kurulu’ndan Etik Kurul onayı (karar no: I6-461-21, tarih: 03.08.2021) alınmıştır Hasta Onayı: Retrospektif çalışma. Hakem Değerlendirmesi: Editörler kurulu dışında olan kişiler tarafından değerlendirilmiştir

Supporting Institution

Project Number

Thanks

References

1. Yiğit Kaya S, Özsan GH. AL Amyloidosis. Turkiye Klinikleri J Hematol-Special Topics. 2018;11:140-146.
2. Martinez-Naharro A, Hawkins PN, Fontana M. Cardiac amyloidosis. Clin Med(Lond). 2018;18(Suppl 2):s30-s35.
3. Desport E, Bridoux F, Sirac C, et al. Al amyloidosis. Orphanet J Rare Dis. 2012;7:54.
4. Kyle RA, Linos A, Beard CM, et al. Incidence and natural history of primary systemic amyloidosis in Olmsted County, Minnesota, 1950 through 1989. Blood. 1992;79:1817-1822.
5. Siddiqi OK, Ruberg FL. Cardiac amyloidosis: An update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med. 2018;28:10-21.
6. Kumar S, Dispenzieri A, Katzmann JA, et al. Serum immunoglobulin free light-chain measurement in primary amyloidosis: prognostic value and correlations with clinical features. Blood. 2010;116:5126-5129.
7. Çavuşoğlu Y, Özpelit E, Çelik A, et al. Cardiac amyloidosis: Recent advances in the diagnosis and therapy. Turk Kardiyol Dern Ars. 2019;47(Suppl 2):1-34.
8. Dittrich T, Kimmich C, Hegenbart U, et al. Prognosis and Staging of AL Amyloidosis. Acta Haematol. 2020;143:388-400.
9. Dispenzieri A, Lacy MQ, Katzmann JA, et al. Absolute values of immunoglobulin free light chains are prognostic in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood. 2006;107:3378-3383.
10. Palladini G, Barassi A, Klersy C, et al. The combination of high-sensitivity cardiac troponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis. Blood. 2010;116:3426-3430.
11. Biçer A,Taşcanov MB, Tanrıverdi Z. Günlük pratikte tanıdan tedaviye amiloid kardiyomiyopati. Cukurova Medical Journal. 2020;45:1792-1802.
12. Singh A, Addetia K, Maffessanti F, et al. LA Strain for Categorization of LV Diastolic Dysfunction. JACC Cardiovasc Imaging. 2017;10:735-743.
13. Tan TS, Akbulut IM, Demirtola AI, et al. LA reservoir strain: a sensitive parameter for estimating LV filling pressure in patients with preserved EF. Int J Cardiovasc Imaging. 2021;37:2707-2716.
14. Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591-600.
15. Gertz MA. Immunoglobulin light chain amyloidosis: 2020 update on diagnosis, prognosis, and treatment. Am J Hematol. 2020;95:848-860.
16. Barros-Gomes S, Williams B, Nhola LF, et al. Prognosis of Light Chain Amyloidosis With Preserved LVEF: Added Value of 2D Speckle-Tracking Echocardiography to the Current Prognostic Staging System. JACC Cardiovasc Imaging. 2017;10:398-407.
17. Fontana M, Pica S, Reant P, et al. Prognostic Value of Late Gadolinium Enhancement Cardiovascular Magnetic Resonance in Cardiac Amyloidosis. Circulation. 2015;132:1570-1579.
18. Brecht A, Oertelt-Prigione S, Seeland U, et al. Left Atrial Function in Preclinical Diastolic Dysfunction: Two-Dimensional Speckle-Tracking Echocardiography-Derived Results from the BEFRI Trial. J Am Soc Echocardiogr. 2016;29:750-758.
19. Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Fail Rev. 2016;21:65 76.

Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis

Year 2022, Volume: 75 Issue: 1, 42 - 47, 30.06.2022

Türkan Seda Tan Kürklü

Abstract

Objectives: Immunoglobulin light chain cardiac amyloidosis (AL) is the most common systemic amyloidosis. Cardiac involvement associated with
poor prognosis and biomarkers are used to determine the prognostic stages. Although echocardiographic parameters are used for the diagnosis of
cardiac involvement, they are not established as the markers of disease severity. We sought to investigate whether left atrial longitudinal strain
parameter predicts survival in patients with cardiac AL amyloidosis.

Materials and Methods: Thirty-seven patients with cardiac amyloidosis were included into our study. Clinical and demographic data and
transthoracic echocardiographic views were obtained from medical records. All patients were divided into two groups according to their survival.

Results: The mean age of the study population was 63.9±10.8 years. Demographic characteristics and laboratory parameters except NT-proBNP were
similar between two groups. NT-proBNP value was found as statistically higher in death caused group (p=0.02). In TTE parameters, the left atrial
volume index was higher (p=0.02) however, peak atrial longitudinal strain (PALS) was reduced in death caused group (p=0.004). In Cox proportional
regression method, PALS was found the most important predictor of survival after adjustment for NT-proBNP [hazard ratio (95% confidence
interval): 0.92 (0.84-0.98); p=0.01].

Conclusion: In our study we determined that PALS was highly associated with survival in patients with cardiac AL amyloidosis. We thought that
larger, prospective studies are necessary to evaluate the prognostic impact of PALS in patients with cardiac AL amyloidosis.

Keywords

Amyloidosis, Immunoglobulin Light Chain, Left Atrial Longitudinal Strain

Project Number

References

1. Yiğit Kaya S, Özsan GH. AL Amyloidosis. Turkiye Klinikleri J Hematol-Special Topics. 2018;11:140-146.
2. Martinez-Naharro A, Hawkins PN, Fontana M. Cardiac amyloidosis. Clin Med(Lond). 2018;18(Suppl 2):s30-s35.
3. Desport E, Bridoux F, Sirac C, et al. Al amyloidosis. Orphanet J Rare Dis. 2012;7:54.
4. Kyle RA, Linos A, Beard CM, et al. Incidence and natural history of primary systemic amyloidosis in Olmsted County, Minnesota, 1950 through 1989. Blood. 1992;79:1817-1822.
5. Siddiqi OK, Ruberg FL. Cardiac amyloidosis: An update on pathophysiology, diagnosis, and treatment. Trends Cardiovasc Med. 2018;28:10-21.
6. Kumar S, Dispenzieri A, Katzmann JA, et al. Serum immunoglobulin free light-chain measurement in primary amyloidosis: prognostic value and correlations with clinical features. Blood. 2010;116:5126-5129.
7. Çavuşoğlu Y, Özpelit E, Çelik A, et al. Cardiac amyloidosis: Recent advances in the diagnosis and therapy. Turk Kardiyol Dern Ars. 2019;47(Suppl 2):1-34.
8. Dittrich T, Kimmich C, Hegenbart U, et al. Prognosis and Staging of AL Amyloidosis. Acta Haematol. 2020;143:388-400.
9. Dispenzieri A, Lacy MQ, Katzmann JA, et al. Absolute values of immunoglobulin free light chains are prognostic in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation. Blood. 2006;107:3378-3383.
10. Palladini G, Barassi A, Klersy C, et al. The combination of high-sensitivity cardiac troponin T (hs-cTnT) at presentation and changes in N-terminal natriuretic peptide type B (NT-proBNP) after chemotherapy best predicts survival in AL amyloidosis. Blood. 2010;116:3426-3430.
11. Biçer A,Taşcanov MB, Tanrıverdi Z. Günlük pratikte tanıdan tedaviye amiloid kardiyomiyopati. Cukurova Medical Journal. 2020;45:1792-1802.
12. Singh A, Addetia K, Maffessanti F, et al. LA Strain for Categorization of LV Diastolic Dysfunction. JACC Cardiovasc Imaging. 2017;10:735-743.
13. Tan TS, Akbulut IM, Demirtola AI, et al. LA reservoir strain: a sensitive parameter for estimating LV filling pressure in patients with preserved EF. Int J Cardiovasc Imaging. 2021;37:2707-2716.
14. Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018;19:591-600.
15. Gertz MA. Immunoglobulin light chain amyloidosis: 2020 update on diagnosis, prognosis, and treatment. Am J Hematol. 2020;95:848-860.
16. Barros-Gomes S, Williams B, Nhola LF, et al. Prognosis of Light Chain Amyloidosis With Preserved LVEF: Added Value of 2D Speckle-Tracking Echocardiography to the Current Prognostic Staging System. JACC Cardiovasc Imaging. 2017;10:398-407.
17. Fontana M, Pica S, Reant P, et al. Prognostic Value of Late Gadolinium Enhancement Cardiovascular Magnetic Resonance in Cardiac Amyloidosis. Circulation. 2015;132:1570-1579.
18. Brecht A, Oertelt-Prigione S, Seeland U, et al. Left Atrial Function in Preclinical Diastolic Dysfunction: Two-Dimensional Speckle-Tracking Echocardiography-Derived Results from the BEFRI Trial. J Am Soc Echocardiogr. 2016;29:750-758.
19. Cameli M, Mandoli GE, Loiacono F, et al. Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Fail Rev. 2016;21:65 76.

There are 19 citations in total.

Details

Primary Language	English
Subjects	Cardiology
Journal Section	Articles
Authors	Türkan Seda Tan Kürklü 0000-0002-9349-3371
Project Number	-
Publication Date	June 30, 2022
Published in Issue	Year 2022 Volume: 75 Issue: 1

Cite

APA	Tan Kürklü, T. S. (2022). Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 75(1), 42-47. https://doi.org/10.4274/atfm.galenos.2022.00921
AMA	Tan Kürklü TS. Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası. June 2022;75(1):42-47. doi:10.4274/atfm.galenos.2022.00921
Chicago	Tan Kürklü, Türkan Seda. “Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients With Cardiac Amyloidosis”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75, no. 1 (June 2022): 42-47. https://doi.org/10.4274/atfm.galenos.2022.00921.
EndNote	Tan Kürklü TS (June 1, 2022) Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75 1 42–47.
IEEE	T. S. Tan Kürklü, “Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 1, pp. 42–47, 2022, doi: 10.4274/atfm.galenos.2022.00921.
ISNAD	Tan Kürklü, Türkan Seda. “Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients With Cardiac Amyloidosis”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 75/1 (June 2022), 42-47. https://doi.org/10.4274/atfm.galenos.2022.00921.
JAMA	Tan Kürklü TS. Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75:42–47.
MLA	Tan Kürklü, Türkan Seda. “Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients With Cardiac Amyloidosis”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 75, no. 1, 2022, pp. 42-47, doi:10.4274/atfm.galenos.2022.00921.
Vancouver	Tan Kürklü TS. Evaluation of Prognostic Impact of Left Atrial Longitudinal Strain on Patients with Cardiac Amyloidosis. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2022;75(1):42-7.

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