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Restricted left atrial motion as a result of atrial stiffening in patients with cardiac amyloidosis

Session Poster Session 3

Speaker Haruhiko Higashi

Event : ESC Congress 2019

  • Topic : imaging
  • Sub-topic : Imaging: Myocardial Disease
  • Session type : Poster Session

Authors : H Higashi (Toon,JP), K Inoue (Toon,JP), M Saito (Ozu,JP), M Kinoshita (Toon,JP), J Aono (Toon,JP), S Ikeda (Toon,JP), OS Andersen (Oslo,NO), E Gude (Oslo,NO), H Skulstad (Oslo,NO), EW Remme (Oslo,NO), OA Smiseth (Oslo,NO), O Yamaguchi (Toon,JP)

H Higashi1 , K Inoue1 , M Saito2 , M Kinoshita1 , J Aono1 , S Ikeda1 , OS Andersen3 , E Gude3 , H Skulstad3 , EW Remme3 , OA Smiseth3 , O Yamaguchi1 , 1Ehime University Graduate School of Medicine - Toon - Japan , 2Kitaishikai Hospital - Ozu - Japan , 3Oslo University Hospital - Oslo - Norway ,


Background: Left atrial (LA) involvement of abnormal amyloid fibrils could induce LA dysfunction and stiffening in patients with cardiac amyloidosis (CA). Thus, the assessments of LA function and stiffness might be a potential approach to diagnose CA phenotype among patients with hypertrophied hearts.

Purpose: We sought to determine whether LA reservoir strain with speckle tracking echocardiography could be used a marker of LA stiffness in a derivation cohort. Furthermore, we tested to our hypothesis that LA reservoir strain could differentiate CA patients from hypertrophic cardiomyopathy (HCM) in an independent validation cohort.

Methods: In the derivation cohort, echocardiography was performed simultaneously with measurements of pulmonary capillary wedge pressure (PCWP) in 50 patients with suspected or established heart failure and relatively preserved left ventricular (LV) ejection fraction (56 ± 10%). LA maximum and minimum volume index, and reservoir strain were measured from apical four-chamber view. LA stiffness index was computed as a pressure rise from x-trough to v-wave divided by an increase from minimum to maximum indexed LA volume (Figure A). In an independent validation group, we studied a total of 33 biopsy-proved CA patients and 127 HCM patients (LV ejection fraction: 57 ± 11% vs. 66 ± 10%, P<0.01) in sinus rhythm on the date of comprehensive echocardiographic study. Among them, cardiac magnetic resonance imaging (CMR) could be evaluated in 17 CA patients and 98 HCM patients. Furthermore, right heart catheterization was performed with 12 CA patients and 12 HCM patients in the CMR group.

Results: The derivation cohort study found that there was a significant curvilinear correlation of LA reservoir strain to LA stiffness index (Figure B). In the validation cohort, LA reservoir strain was reduced in patients with CA compared with HCM in all participants (11.6 ± 5.6% vs. 18.5 ± 6.9%, P<0.01), although there was no significant difference of LA maximal volume index between 2 groups (37 ± 16 ml/m2 vs. 37 ± 12 ml/m2, p=0.89). In the CMR group, the late gadolinium enhancement was observed in the LA wall in 16 patients with CA (94.1%) as shown in Figure C. In contrast, the LA enhancement revealed only in 1 patient with HCM (1.0%). Among patients with invasive measures, LA stiffness index [median (interquartile range)] was higher in patients with CA than that in patients with HCM [1.1 (0.4-2.8) vs. 0.2 (0.1-0.6), P=0.01]. 

Conclusions: LA reservoir function was fairly limited in patients with CA compared with HCM. Restricted LA motion might be related to atrial amyloid deposits or fibrosis, which potentially provokes atrial chamber stiffening.

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