title: Causes and Consequences of Longitudinal LV Dysfunction Assessed by 2D Strain Echocardiography in Cardiac Amyloidosis.
abstract: OBJECTIVE
  The aim of this study was to compare left ventricular longitudinal strain (LS) evaluated by 2-dimensional echocardiography with cardiac magnetic resonance (CMR) in cardiac amyloidosis (CA), establish correlations between histological and imaging findings, and assess the prognostic usefulness of LS measurement and CMR.
  
  
  BACKGROUND
  CA is a condition with a poor prognosis due chiefly to 3 forms of amyloidosis: light-chain amyloidosis (AL), hereditary transthyretin (M-TTR), and wild-type transthyretin (WT-TTR). Two-dimensional echocardiography measurement of LS has been reported to detect early left ventricular systolic dysfunction. The pathophysiological underpinnings, regional distribution, and prognostic significance of LS in CA are unclear.
  
  
  METHODS
  All patients underwent echocardiography, and 53 underwent CMR. The native hearts of the 3 patients who received heart transplants were subjected to histological examination. For each of the 17 left ventricular segments in the American Heart Association model, we evaluated LS, late gadolinium enhancement (LGE) by CMR, and cardiac amyloid deposition. Univariate and multivariate analyses were performed at 6 months to identify variables associated with major adverse cardiac events (MACE).
  
  
  RESULTS
  We studied 79 patients with CA; 26 had AL, 36 M-TTR, and 17 WT-TTR. Mean LS was -10 ± 4%. Both LS and amyloid deposits showed a basal-to-apical gradient. The mean LS and number of segments with LGE were similar across the 3 CA types. LS correlated with LGE and amyloid burden (r = 0.72). LGE was seen in the 6 basal segments in all WT-TTR patients. During the median follow-up of 11 months (range 4 to 17 months), 36 (46%) patients experienced MACE. Independent predictors of MACE were apical LS (cutoff, -14.5%), N-terminal pro-B-type natriuretic peptide (cutoff, 4,000 ng/l), and New York Heart Association functional class III to IV heart failure.
  
  
  CONCLUSIONS
  Basal-to-apical LS abnormalities are similar across CA types and reflect the amyloid burden. Apical LS independently predicts MACE.
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Ternacle
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Bodez
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Aziz
authors.initials: A
authors.lastname: Guellich
authors.affiliation: Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; Department of Public Health, AP-HP, Henri-Mondor Teaching Hospital and Clinical Epidemiology and Aging EA 4393, Créteil, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Audureau
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Rappeneau
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France; Department of Public Health, AP-HP, Henri-Mondor Teaching Hospital and Clinical Epidemiology and Aging EA 4393, Créteil, France.
authors.forename: Costin
authors.initials: C
authors.lastname: Radu
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Soulef
authors.initials: S
authors.lastname: Guendouz
authors.affiliation: Mondor Amyloidosis Network, Créteil, France; DHU ATVB, Créteil, France; Department of Cardiovascular Surgery, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Couetil
authors.affiliation: Department of Pathology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Benhaiem
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Hittinger
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France; Department of Neurology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.
authors.forename: Violaine
authors.initials: V
authors.lastname: Plante-Bordeneuve
authors.affiliation: Department of Cardiology, Dupuytren Hospital, CHU Limoges, Pôle Cœur-Poumon-Rein, Limoges, France.
authors.forename: Dania
authors.initials: D
authors.lastname: Mohty
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France; Department of Radiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Deux
authors.affiliation: UPEC, Créteil, France; Mondor Amyloidosis Network, Créteil, France; Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France; INSERM U955, GRC Amyloid Research Institute, Créteil, France; DHU ATVB, Créteil, France; INSERM Clinical Investigation Center 006, Créteil, France. Electronic address: thibaud.damy@hmn.aphp.fr.
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000150:complications* / Q000175:diagnosis; D001696:Biomechanical Phenomena; D001706:Biopsy; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: amyloid; heart failure; prognosis; speckle tracking