- •Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is becoming increasingly recognized.
- •Echocardiographic prognostic marker of ATTRwt-CM was not fully clarified.
- •Our study showed that RV-GLS was significant prognostic marker for ATTRwt-CM.
- •RV function is important for the prognosis in patients with ATTRwt-CM.
This study was performed to investigate whether right ventricular global longitudinal strain (RV-GLS) provides prognostic information in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).
Methods and results
Among 129 patients who were diagnosed with ATTRwt-CM at Kumamoto University Hospital from December 2002 to December 2019, 111 patients who had enough information for two-dimensional speckle tracking imaging were retrospectively analyzed. During a median follow-up of 615 days, 26 cardiovascular deaths occurred. Compared with patients in the non-event group, those in the cardiovascular death group were significantly older (81.1 ± 7.4 years vs. 78.2 ± 6.2 years, p = 0.009) and had significantly higher interventricular septal thickness in diastole (16.6 ± 3.1 mm vs. 15.3 ± 2.4 mm, p = 0.048), lower RV-GLS (10.9 ± 2.7% vs. 12.8 ± 3.5%, p = 0.010), and lower right ventricular free wall longitudinal strain (RVFWLS) (13.1 ± 3.3% vs. 15.5 ± 3.8%, p = 0.004). In the univariate Cox proportional hazard analysis, age, left atrial volume index (LAVI), RV-GLS, and RVFWLS were significantly associated with cardiovascular death [age, hazard ratio (HR), 1.10; 95% confidence interval (CI), 1.02–1.19, p = 0.010; LAVI, HR, 1.02; 95% CI, 1.00–1.03, p = 0.009; RV-GLS, HR, 0.86; 95% CI, 0.75–0.97, p = 0.017; RVFWLS, HR 0.89; 95% CI, 0.79–1.00; p = 0.041]. Multivariable Cox proportional hazard analysis showed RV-GLS was significantly and independently associated with cardiovascular death in patients with ATTRwt-CM (HR, 0.86; 95% CI, 0.74–0.99; p = 0.038). Receiver operating characteristic analysis showed that the area under the curve of RV-GLS for cardiovascular death was 0.668 and that the best cut-off value of RV-GLS was 11.59% (sensitivity, 69.2%; specificity, 63.5%). In the Kaplan–Meier analysis, patients with ATTRwt-CM who had low RV-GLS (<11.59%) had a significantly higher probability of total cardiovascular death (p = 0.004) and heart failure-related hospitalization (p = 0.013).
RV-GLS has significant prognostic value in patients with ATTRwt-CM and provides greater prognostic power than conventional echocardiographic findings.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Recent advances in diagnosis and treatment of cardiac amyloidosis.J Cardiol. 2018; 71: 135-143
- Amyloid heart disease.Prog Cardiovasc Dis. 2010; 52: 347-361
- Natural history and therapy of TTR-cardiac amyloidosis: emerging disease-modifying therapies from organ transplantation to stabilizer and silencer drugs.Heart Fail Rev. 2015; 20: 163-178
- Natural history of wild-type transthyretin cardiac amyloidosis and risk stratification using a novel staging system.J Am Coll Cardiol. 2016; 68: 1014-1020
- A new staging system for cardiac transthyretin amyloidosis.Eur Heart J. 2018; 39: 2799-2806
- Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging.J Am Coll Cardiol. 2006; 47: 789-793
- Longitudinal left ventricular function for prediction of survival in systemic light-chain amyloidosis: incremental value compared with clinical and biochemical markers.J Am Coll Cardiol. 2012; 60: 1067-1076
- Right ventricular longitudinal strain measures independently predict chronic heart failure mortality.Echocardiography. 2016; 33: 992-1000
- Diagnosis and management of the cardiac amyloidoses.Circulation. 2005; 112: 2047-2060
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39.e14
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314
- Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance.J Am Soc Echocardiogr. 2017; 30: 303-371
- Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy.N Engl J Med. 2018; 379: 1007-1016
- Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association.Circulation. 2018; 137: e578-e622
- Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure.Circulation. 2008; 117: 1717-1731
Moñivas Palomero V, Durante-Lopez A, Sanabria MT, Cubero JS, González-Mirelis J, Lopez-Ibor JV, et al. Role of right ventricular strain measured by two-dimensional echocardiography in the diagnosis of cardiac amyloidosis. J Am Soc Echocardiogr 2019;32:845–53.e1.
- Prognostic value of right ventricular systolic function in cardiac amyloidosis.Amyloid. 2016; 23: 158-167
- Senile systemic amyloidosis presenting with heart failure: a comparison with light chain-associated amyloidosis.Arch Intern Med. 2005; 165: 1425-1429
- Deformation imaging describes right ventricular function better than longitudinal displacement of the tricuspid ring.Heart. 2010; 96: 281-288
- Right heart dysfunction in heart failure with preserved ejection fraction.Eur Heart J. 2014; 35: 3452-3462
- Evaluation of right ventricular systolic function after mitral valve repair: a two-dimensional Doppler, speckle-tracking, and three-dimensional echocardiographic study.J Am Soc Echocardiogr. 2012; 25: 701-708
- Multicenter study of planar technetium 99m pyrophosphate cardiac imaging: predicting survival for patients with ATTR cardiac amyloidosis.JAMA Cardiol. 2016; 1: 880-889
- Longitudinal but not circumferential deformation reflects global contractile function in the right ventricle with open pericardium.Am J Physiol Heart Circ Physiol. 2006; 290: H2369-H2375
- Incremental prognostic value of right ventricular strain in patients with acute decompensated heart failure.Circ Cardiovasc Imaging. 2018; 11e007249
- Echocardiographic phenotype and prognosis in transthyretin cardiac amyloidosis.Eur Heart J. 2020; 41: 1439-1447
- Intervendor variability of two-dimensional strain using vendor-specific and vendor-independent software.J Am Soc Echocardiogr. 2015; 28: 630-641
Published online: March 10, 2022
Accepted: February 13, 2022
Received in revised form: December 21, 2021
Received: October 14, 2021
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.