Limitations of apical sparing pattern in cardiac amyloidosis: a multicentre echocardiographic study.

Autor:	Cotella J; University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA., Randazzo M; University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA., Maurer MS; Columbia University, New York, NY, USA., Helmke S; Columbia University, New York, NY, USA., Scherrer-Crosbie M; University of Pennsylvania, Philadelphia, PA, USA., Soltani M; University of Pennsylvania, Philadelphia, PA, USA., Goyal A; Ohio State University, Columbus, OH, USA., Zareba K; Ohio State University, Columbus, OH, USA., Cheng R; University of Washington, Seattle, WA, USA., Kirkpatrick JN; University of Washington, Seattle, WA, USA., Yogeswaran V; University of Washington, Seattle, WA, USA., Kitano T; University of Occupational and Environmental Health, Kitakyushu, Japan., Takeuchi M; University of Occupational and Environmental Health, Kitakyushu, Japan., Fernandes F; Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil., Hotta VT; Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil., Campos Vieira ML; Heart Institute (InCor), São Paulo University Medical School, São Paulo, Brazil., Elissamburu P; ICBA, Buenos Aires, Argentina., Ronderos R; ICBA, Buenos Aires, Argentina., Prado A; Centro Privado de Cardiología, Tucuman, Argentina., Koutroumpakis E; University of Texas MD Anderson Cancer Center, Houston, TX, USA., Deswal A; University of Texas MD Anderson Cancer Center, Houston, TX, USA., Pursnani A; NorthShore University Health System, Evanston, IL, USA., Sarswat N; NorthShore University Health System, Evanston, IL, USA., Addetia K; University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA., Mor-Avi V; University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA., Asch FM; MedStar Health Research Institute, Washington, DC, USA., Slivnick JA; University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA., Lang RM; University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2024 May 31; Vol. 25 (6), pp. 754-761.
DOI:	10.1093/ehjci/jeae021
Abstrakt:	Aims: Although impaired left ventricular (LV) global longitudinal strain (GLS) with apical sparing is a feature of cardiac amyloidosis (CA), its diagnostic accuracy has varied across studies. We aimed to determine the ability of apical sparing ratio (ASR) and most common echocardiographic parameters to differentiate patients with confirmed CA from those with clinical and/or echocardiographic suspicion of CA but with this diagnosis ruled out. Methods and Results: We identified 544 patients with confirmed CA and 200 controls (CTRLs) as defined above (CTRL patients). Measurements from transthoracic echocardiograms were performed using artificial intelligence software (Us2.AI, Singapore) and audited by an experienced echocardiographer. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance and optimal cut-offs for the differentiation of CA patients from CTRL patients. Additionally, a group of 174 healthy subjects (healthy CTRL) was included to provide insight on how patients and healthy CTRLs differed echocardiographically. LV GLS was more impaired (-13.9 ± 4.6% vs. -15.9 ± 2.7%, P < 0.0005), and ASR was higher (2.4 ± 1.2 vs. 1.7 ± 0.9, P < 0.0005) in the CA group vs. CTRL patients. Relative wall thickness and ASR were the most accurate parameters for differentiating CA from CTRL patients [area under the curve (AUC): 0.77 and 0.74, respectively]. However, even with the optimal cut-off of 1.67, ASR was only 72% sensitive and 66% specific for CA, indicating the presence of apical sparing in 32% of CTRL patients and even in 6% healthy subjects. Conclusion: Apical sparing did not prove to be a CA-specific biomarker for accurate identification of CA, when compared with clinically similar CTRLs with no CA. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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