Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis
Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis
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DOI：
10.1136/heartjnl-2012-302353
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发表时间：
2012-10-01
期刊：
影响因子：
5.7
通讯作者：
Thomas, James D.
中科院分区：
文献类型：
--
作者：
Phelan, Dermot;Collier, Patrick;Thomas, James D.
背景心脏淀粉样变性（CA）的诊断因病理学不清和超声心动图表现不特异而具有挑战性，目的应用二维斑点追踪超声心动图描述CA的纵向应变（LS）区域模式，并验证区域差异有助于CA与其他左室（LV）增大原因鉴别的假设方法和结果将55例连续的CA患者与30例对照组的LV肥大患者（n = 15例肥厚性心肌病，n = 15例主动脉瓣狭窄）进行比较。使用公式（平均顶端LS/（平均基底LS +中间LS））定义的相对顶端LS为1.0，在区分CA与对照（曲线下面积0.94）方面具有灵敏度（93%）和特异性（82%）。在Logistic回归多变量分析中，相对顶端LS是CA的唯一预测参数（p = 0.004）。结论CA的特点是LS从底部到顶端的区域变化。LS的相对“心尖保留”模式是区分CA与其他LV肥大原因的一种容易识别、准确和可重复的方法。
Background The diagnosis of cardiac amyloidosis (CA) is challenging owing to vague symptomatology and nonspecific echocardiographic findings.Objective To describe regional patterns in longitudinal strain (LS) using two-dimensional speckle-tracking echocardiography in CA and to test the hypothesis that regional differences would help differentiate CA from other causes of increased left ventricular (LV) wall thickness.Methods and results 55 consecutive patients with CA were compared with 30 control patients with LV hypertrophy (n = 15 with hypertrophic cardiomyopathy, n 15 with aortic stenosis). A relative apical LS of 1.0, defined using the equation (average apical LS/(average basal LS + mid-LS)), was sensitive (93%) and specific (82%) in differentiating CA from controls (area under the curve 0.94). In a logistic regression multivariate analysis, relative apical LS was the only parameter predictive of CA (p = 0.004).Conclusions CA is characterised by regional variations in LS from base to apex. A relative 'apical sparing' pattern of LS is an easily recognisable, accurate and reproducible method of differentiating CA from other causes of LV hypertrophy.