Influence of Ventricular Wringing on the Preservation of Left Ventricular Ejection Fraction in Cardiac Amyloidosis - 02/07/21
, Ildefonso Roldán, MD a, Javier Bertolín, MD a, Valentina Faga, MD a, María del Mar Pérez-Gil, MD a, Ariel Saad, MD b, Rocío Serrats, MD a, Ricardo Callizo, MD a, Rosina Arbucci, MD b, Jorge Lowenstein, MD bAbstract |
Background |
The purpose of this work was to determine the influence of myocardial wringing on ventricular function in patients with cardiac amyloidosis (CA).
Methods |
Fifteen healthy volunteers (group 1) and 34 patients with CA (17 with left ventricular ejection fractions [LVEFs] ≥ 53% [group 2] and 17 with LVEFs < 53% [group 3]) were evaluated using two-dimensional speckle-tracking echocardiography. A control group of mass-matched patients (n = 20) with left ventricular (LV) hypertrophy and LVEFs ≥ 53% was also included. Longitudinal strain (LS), circumferential strain, and LV twist and torsion were calculated. Deformation index (DefI), a new parameter of wringing, calculated as twist/LS, that takes into account actions that occur simultaneously during LV systole (i.e., longitudinal shortening and twist), was evaluated. Torsional and wringing parameters were calculated according to LVEF.
Results |
Lower global values of LS and circumferential strain were observed among patients with CA (LS: group 1, −20.6 ± 2.5%; group 2, −11.6 ± 4.1%; group 3, −9.0 ± 3.1%; circumferential strain: group 1, −22.7 ± 4.9%; group 2, −14.4 ± 8.0%; group 3, −13.6 ± 3.8%; P < .001 for both). Torsion did not vary between group 2 and group 1 (2.5 ± 1.1°/cm vs 2.7 ± 0.8°/cm, P = NS). In contrast, DefI was greater in group 2 than in group 1 (−1.8 ± 0.8°/% vs −1.0 ± 0.3°/%, P < .01). Torsion and DefI were lower in group 3 (1.2 ± 0.7°/cm and −1.1 ± 0.6°/%, respectively, P < .001 for both) than in group 2. DefI was similar in patients with LV hypertrophy (−1.7 ± 0.6°/%, P = NS) and group 2.
Conclusions |
In patients with CA, preservation of LVEF depends on greater ventricular wringing. DefI, a parameter that integrates the twist and the simultaneous longitudinal shortening of the left ventricle, is a more accurate indicator of the efficacy of this mechanism.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Global LVEF is usually preserved until the advanced stages of CA. |
• | DefI reflects the simultaneous actions of twist and longitudinal shortening. |
• | DefI differs from conventional parameters used to evaluate torsion. |
• | DefI is increased when LVEF is preserved and pseudonormal when LVEF is compromised. |
• | DefI reveals changes that cannot be inferred by twist or torsion. |
Keywords : Cardiac amyloidosis, Myocardial wringing, Myocardial strain, Ventricular torsion, Ventricular function
Abbreviations : 2D, CA, CS, DefI, GCS, GLS, LA, LS, LV, LVEF, LVH, STE, TTR
Plan
| Dr. Lowenstein has received medical fees for conferences on behalf of General Electric. |
Vol 34 - N° 7
P. 767-774 - juillet 2021 Retour au numéro
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