[Value of assessing left ventricular longitudinal systolic peak strain in differential diagnosis of primary cardiac amyloidosis from hypertrophic cardiomyopathy].
OBJECTIVE
To analyze the endocardial, myocardial, and epicardial longitudinal systolic strain (LSsys) in the left ventricle (LV) segments and walls in patients with cardiac involvement due to primary amyloidosis (AL-CA) and hypertrophic cardiomyopathy (HCM).


METHODS
Twenty patients with biopsy-proven AL-CA, 20 with asymmetric HCM, and 20 age-matched healthy volunteers were analyzed for their clinical characteristics and underwent conventional echocardiography for evaluating LV wall thickness, left atrial and ventricle size, systolic and diastolic function and 2-dimensional velocity vector imaging for evaluating the endocardial, myocardial and epicardial LSsys of the LV segments and walls. AL-CA and HCM patients also underwent cardiac magnetic resonance to evaluate the late gadolinium enhancement (LGE) features.


RESULTS
Compared with the control group, AL-CA and HCM groups, with similar clinical symptoms and physical signs, both showed increased LV wall thickness, left atrial diameter, E/A ratio, septal E/e' ratio and the prevalence of granular sparkling. LV segments and walls endocardial LSsys were significantly lower in AL-CA patients than in HCM patients and the control subjects. The endocardial-epicardial LSsys difference in all the left ventricle walls were significantly smaller in AL-CA group than in the control group, but this difference appeared variable in HCM group. The LGE also presented with different features in AL-CA and HCM: AL-CA group showed subendocardial LGE in almost all the LV walls, but HCM group showed patchy LGE with a regional, multifocal distribution.


CONCLUSIONS
AL-CA is characterized by a significantly reduced endocardial LSsys in the LV segments and an uniform decrease of the endocardial-epicardial LSsys difference in all the LV walls, but the changes in HCM appear variable, and 2-dimensional velocity vector imaging is therefore a useful modality to differentiate AL-CA from HCM.
Department of Cardiology, 2Department of Radiology, 3Institute of Geriatrics, General Hospital of PLA, Beijing 100853, China. E-mail: lucy_victor@sina.com.
Lu
L
Zhang
Ye
Y
Wang
Liuquan
L
Cheng
Jing
J
Wang
Xiao
X
Zhou
Miao
M
Liu
Wei
W
Zhang
Ming
M
Zhang
Bo
B
Zhang
Guang
G
Zhi
D000686:Amyloidosis / Q000175:diagnosis*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003971:Diastole; D004452:Echocardiography; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D013599:Systole