Longitudinal strain of left ventricular basal segments and E/e' ratio differentiate primary cardiac amyloidosis at presentation from hypertensive hypertrophy: an automated function imaging study.
BACKGROUND
Longitudinal strain is an early marker of left ventricular (LV) dysfunction in several cardiac diseases. Our aim was to differentiate cardiac amyloidosis (CA) at diagnosis from hypertensive LV hypertrophy (LVH) by analysis of longitudinal myocardial deformation.


METHODS
Thirty healthy controls (C), 30 newly diagnosed, never treated hypertensives with LVH (H-LVH), and 33 patients with CA at diagnosis underwent echo Doppler including speckle tracking-based automated function imaging (AFI). Averaged peak systolic global longitudinal strain (GLS, 18 segments) and basal, middle, and apical longitudinal strain (BLS, MLS, and ALS, respectively, six segments each) were calculated.


RESULTS
Left ventricular mass index, relative wall thickness, and ejection fraction did not differ between H-LVH and CA. E/e' ratio was higher in CA than in H-LVH (P<.001) and C (P<.0001). GLS was lower in CA than in C (P<.0001), without difference with H-LVH. ALS did not differ among the three groups, MLS was significantly lower in both CA and H-LVH than in C but BLS was lower in CA compared to both H-LVH and C (both P<.0001). In the pooled population, E/e' was independently associated with BLS (β=-0.54, P<.0001). At receiver operating curve analysis, CA was predicted by BLS≤-11.3% (sensitivity=63.3%, specificity=100%) and E/e'≥12.3 (sensitivity=69.7%, specificity=83.3%). The best AUC (=0.819) was obtained by the combination E/e'+BLS.


CONCLUSIONS
Our findings highlight a real difference of E/e' ratio and longitudinal strain of LV basal segments between hypertensive LVH and CA, which could be used to differentiate the two diseases.
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Vincenzo
V
Schiano-Lomoriello
Cardiology Department, University Hospital of Ferrara, Ferrara, Italy. mgalderi@unina.it.
Maurizio
M
Galderisi
Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
Donato
D
Mele
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Roberta
R
Esposito
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Giuseppe
G
Cerciello
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Agostino
A
Buonauro
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Roberta
R
Della Pepa
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Marco
M
Picardi
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Lucio
L
Catalano
Cardiology Department, University Hospital of Ferrara, Ferrara, Italy.
Bruno
B
Trimarco
Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
Fabrizio
F
Pane
D000686:Amyloidosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*
Doppler tissue imaging; cardiac amyloidosis; diastolic function; left ventricular filling pressures; myocardial strain