Reduced trans-mitral A-wave velocity predicts the presence of wild-type transthyretin amyloidosis in elderly patients with left ventricular hypertrophy
Reduced trans-mitral A-wave velocity predicts the presence of wild-type transthyretin amyloidosis in elderly patients with left ventricular hypertrophy
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DOI：
10.1007/s00380-016-0925-8
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发表时间：
2017-06-01
影响因子：
1.5
通讯作者：
Tsujita, Kenichi
中科院分区：
文献类型：
--
作者：
Yamamura, Satoru;Izumiya, Yasuhiro;Tsujita, Kenichi
野生型甲状腺素运载蛋白淀粉样变性（ATTRwt）在老年左心室肥大（LVH）患者中常被忽视。除了心室舒张功能障碍外，心房功能受损是心脏淀粉样变性的标志之一。在这里，我们评估了脉冲多普勒超声心动图中A波速度评估心房功能有助于区分老年LVH患者ATTRwt的假设。我们分析了133例在我们研究所接受组织活检以排除浸润性心肌病的连续患者。我们排除了年龄小于50岁、无LVH（LV厚度小于12 mm）、患有其他类型心脏淀粉样变性和慢性房颤的患者，并分析了其余51例患者（ATTRwt：16例，非ATTRwt：35例）。与非ATTRwt组相比，ATTRwt组患者明显年龄更大，并且患有晚期心力衰竭。ATTRwt组E/A、E/e '、相对室壁厚度均明显高于非ATTRwt组。与非ATTRwt组相比，ATTRWT组的A波速度显著降低（40.8 +/- 20.8 vs. 78.7 +/- 28.2 cm/s，p = 0.0001）。采用8个强制纳入模型进行多因素Logistic分析，发现经二尖瓣多普勒A波速度是ATTRwt中心脏淀粉样变性的更重要因素。在受试者工作特征（ROC）分析中，区分ATTRwt和非ATTRwt的A波速度曲线下面积（AUC）为0.86（CI 0.76-0.96，p < 0.001）。临界值为62.5 cm/s，其预测淀粉样变性的敏感性（69.7%）和特异性（87.5%）的最佳组合。我们的结论是，降低A波速度预测ATTRwt的存在，在老年患者左心室肥厚的窦性心律。
Wild-type transthyretin amyloidosis (ATTRwt) is often overlooked in elderly patients with left ventricular hypertrophy (LVH). Impaired atrial function, in addition to ventricular diastolic dysfunction, is one of the hallmarks of cardiac amyloidosis. Here, we assessed the hypothesis that atrial function evaluated by A-velocity in pulse Doppler echocardiography is useful to differentiate ATTRwt in elderly patients with LVH. We analyzed 133 consecutive patients who underwent tissue biopsy to rule out infiltrative cardiomyopathy in our institute. We excluded patients younger than 50 years, without LVH (LV thickness was less than 12 mm), with other types of cardiac amyloidosis and patients with chronic atrial fibrillation, and analyzed remaining 51 patients (ATTRwt: 16, non-ATTRwt: 35). ATTRwt patients were significantly older and had advanced heart failure compared with non-ATTRwt group. In echocardiography, E/A, E/e', and relative wall thickness was significantly higher in ATTRwt group than non-ATTRwt group. A-velocity was significantly decreased in ATTRWT group compared with non-ATTRwt group (40.8 +/- 20.8 vs. 78.7 +/- 28.2 cm/s, p = 0.0001). Multivariate logistic analysis using eight forced inclusion models identified trans-mitral Doppler A-wave velocity was more significant factor of cardiac amyloidosis in ATTRwt. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for A-wave velocity in discrimination between ATTRwt and non-ATTRwt were 0.86 (CI 0.76-0.96, p < 0.001). The cut-off value was 62.5 cm/s, and it yielded the best combination of sensitivity (69.7%) and specificity (87.5%) for prediction of amyloidosis. We concluded that reduced A-velocity predicts the presence of ATTRwt in elderly patients with LVH in sinus rhythm.