Prognostic role of three‐dimensional speckle‐tracking echocardiography‐derived left ventricular global longitudinal strain in cardiac amyloidosis: Insights from the MAGYAR‐Path Study

Abstract

AbstractIntroductionSystemic amyloidosis is an uncommon disorder in which amyloid fibrils deposit extracellularly. Three‐dimensional speckle‐tracking echocardiography (3DSTE) is a novel method able to assess left ventricular (LV) global longitudinal strain (GLS). Our aim was to evaluate the prognostic impact of 3DSTE‐derived LV‐GLS in patients with cardiac amyloidosis (CA).Materials and MethodsA total of 35 patients suffering from light‐chain (AL) CA or transthyretin (TTR) CA were selected, but 7 patients had to be excluded due to insufficient image quality or were lost for follow‐up. With AL‐CA 23 cases, while for TTR‐CA 5 patients were diagnosed. Complete two‐dimensional Doppler and 3DSTE were performed in all subjects.ResultsThe median follow‐up was 201 days (ranging from 36 to 632 days) during which cardiovascular event was detected in 17 CA patients, including 8 cardiac deaths. Six patients were diagnosed with acute heart failure, two patients needed invasive interventions (percutaneous coronary intervention with stent‐implantation, implantable cardioverter defibrillator implantation) and in one patient new higher grade atrioventricular block was registered. Using ROC analysis, 3DSTE‐derived LV‐GLS ≥11.8% (absolute value) was found to be a significant predictor for cardiovascular event‐free survival (sensitivity 65%, specificity 64%, area under the curve 0.71, p = .05). Lower LV ejection fraction was confirmed in patients with LV‐GLS <11.8% as compared to cases with LV‐GLS ≥11.8%. In case of a cardiovascular event, LV‐GLS was lower as compared to that of subjects with no events. Multivariable regression analysis confirmed that LV‐GLS and LV end‐diastolic diameter were independent predictors of cardiovascular survival.Conclusion3DSTE‐derived LV‐GLS is an independent predictor for future cardiovascular events in CA patients.