Left atrial structure and function in cardiac amyloidosis
Left atrial structure and function in cardiac amyloidosis
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DOI：
10.1093/ehjci/jex097
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发表时间：
2017-10-01
影响因子：
6.2
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
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作者：
Nochioka, Kotaro;Quarta, Candida Cristina;Solomon, Scott D.
目的心脏淀粉样变性(CA)患者左心房(LA)明显扩张，但LA功能的特点仍有待深入研究。方法与结果我们对124例CA伴窦性心律患者进行了斑点跟踪超声心动图检查，其中轻链(AL)68例，突变型(ATTRm)29例，野生型(ATTRUT)经甲状腺蛋白淀粉样变性(ATTRUT)27例。比较CA患者和20例年龄、性别相近的健康对照组的常规参数和应变衍生参数，包括LA峰值纵向应变(LS)和应变率(LSR峰值：储罐功能；早期LSR：管道功能；晚期LSR：主动功能)。校正了左房大小、左心室射血分数和左心室充盈压(E/E‘)后，CA患者左房各功能时相，包括左房纵向应变、LSR峰值、LSR早期和晚期均较健康对照组显著受损(均P<0.05)。LA LS峰值与LV整体LS呈中度相关(R=-0.60P<；0.001)，晚期LSR与A波在LV流入水平呈正相关(R=-0.69P<；0.001)。调整年龄、性别、体重指数、收缩压、心率、左房容量指数、二尖瓣反流严重程度、左心室射血分数、左室舒张末压(E/E‘)后，左房主动排空分数和LS峰值均低于左房和左房[P<；0.05]。淀粉样蛋白亚型之间LA功能的差异提示，淀粉样蛋白的病因学在CA心功能不全的病理生理学中起作用。
Aims Although cardiac amyloidosis (CA) is characterized by significant left atrial (LA) dilatation, the characteristics of LA function remain to be fully investigated.Methods and results We assessed LA function by speckle-tracking echocardiography in 124 patients with CA and sinus rhythm: 68 with light chain (AL), 29 with mutant (ATTRm), 27 with wild-type (ATTRwt) transthyretin amyloidosis. Conventional and strain-derived parameters, including LA peak longitudinal strain (LS) and strain rate (peak LSR: reservoir function; early LSR: conduit function; late LSR: active function), were assessed compared between CA patients and 20 healthy controls of similar age and gender. All LA function phases, including LA longitudinal strain, peak LSR, early and late LSR were significantly impaired in CA compared to healthy controls after adjusting for LA size, LV ejection fraction and LV filling pressures (E/E') (all P < 0.05). Peak LA LS was moderately correlated with LV global LS (R = -0.60, P < 0.001); late LSR was correlated with A wave at the level of LV inflow (R = - 0.69, P < 0.001). Among the different CA subtypes, peak LS and LA active emptying fraction were worse in ATTRwt than AL and ATTRm [ P < 0.05 after adjustment for age, sex, body mass index, systolic blood pressure, heart rate, LA volume index, severity of mitral regurgitation, left ejection fraction, and left ventricular end-diastolic pressure (E/E')].Conclusion In CA, LA function was severely impaired and highly correlated with LV deformation. Differences in LA function between amyloid subtypes suggest that amyloid aetiology plays a role in the pathophysiology of cardiac dysfunction in CA.