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Left atrial remodeling and the prognostic value of feature tracking derived left atrial strain in patients with light-chain amyloidosis: a cardiovascular magnetic resonance study

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Abstract

Systemic light-chain (AL) amyloidosis is characterized by the aggregation of misfolded immunoglobulin light chain, predominantly infiltrating in the heart, including left atrium (LA). LA remodeling, such as increased interatrial septal thickness and enlarged size, has been observed. However, LA strain assessed by cardiac magnetic resonance feature tracking (CMR-FT) and its prognostic role remains to be further determined. Using CMR, the current study sought to investigate the characteristic of LA remodeling and the prognostic value of LA strain in patients with AL. Eighty-seven consecutive patients who underwent CMR with histologically confirmed systemic light-chain amyloidosis were retrospectively enrolled. LA strain parameters were analyzed based on CMR-FT algorithm. Amyloid infiltration and burden loads were assessed with CMR late gadolinium enhancement (LGE) and extracellular volume (ECV). Patients were categorized according to the extent of amyloid infiltration in cardiac myocardium. The primary endpoint was defined as all-cause mortality. The prognosis value of LA strain indices was evaluated using Cox proportional hazards regression and Kaplan–Meier curves. Interatrial septal thickness (3 [2–5] vs. 4 [3–5] mm, p = 0.007) and indexed LA volume (34.6 [26.9–44.6] vs. 50.5 [36.1–58.5] ml/m2, p = 0.001) were significantly higher in patients with atrial involvement (LA-LGE). Compared with patients with low amyloid burden loads (ECV group I), those at moderate and high (ECV group II and III) show progressive impairment in LA reservoir, conduit, and booster strains and strain rates. A total of 44 patients died during a median follow-up of 12 months. In multivariate analysis, LA reservoir strain, New York Heart Association (NYHA), and ECV remained independently associated with survival. On Kaplan–Meier analyses, low LA reservoir strain (< 8.6%) increased the risk of mortality. In moderate amyloid burden loads patients, low LA reservoir strain provides additive prognosis value. Progress left atrial remodeling and dysfunction are common findings in AL cardiac amyloidosis. The CMR-FT-derived LA reservoir strain provides independent and additive prognostic value for all-cause mortality in patients with AL cardiac amyloidosis.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to data protection but are available from the corresponding author upon reasonable request.

Abbreviations

CMR:

Cardiac magnetic resonance

FT:

Feature tracking

AL-CA:

Light-chain cardiac amyloidosis

LA:

Left atrium

LV:

Left ventricle

BSA:

Body surface area

LAEF:

Left atrial emptying fraction

ICC:

Intraclass correlation coefficient

LAVi:

Indexed left atrial maximum volume

LVEDVi :

Indexed left ventricular end-diastolic volume

LVESVi :

Indexed left ventricular end-systolic volume

LVMi :

Indexed left ventricular mass

LGE:

Late gadolinium enhancement

NYHA:

New York Heart Association

NT-proBNP:

N-terminal probrain natriuretic peptide

hsTnT:

High sensitivity cardiac troponin T

SR:

Strain rate

εs:

Reservoir strain

εe:

Conduit strain

εa:

Booster strain

STE:

Echocardiography speckle tracking

ECV:

Extracellular volume

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Acknowledgements

Not applicable.

Funding

This work was supported by the Key R&D Program of Guangdong Province, China (Grant No. 2018B030339001); National Natural Science Foundation of China (No. 81974262; No. 82170731); Natural Science Foundation of Guangdong Province (Grant No. 2020A1515010650).

Author information

Author notes

  1. Zekun Tan and Yuelong Yang have contributed equally to this study and are co-first authors.

  2. Wenjian Wang and Hui Liu contributed equally to this study and shared the Co-corresponding authors.

Authors and Affiliations

  1. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China

    Zekun Tan, Yuelong Yang, Wenjian Wang & Hui Liu

  2. Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China

    Zekun Tan, Yuelong Yang, Xinyi Wu, Wenjian Wang & Hui Liu

  3. School of Medicine, South China University of Technology, Guangzhou, Guangdong, China

    Xinyi Wu & Sheng Li

  4. Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China

    Sheng Li & Wenjian Wang

  5. Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China

    Liwen Li

  6. Department of Hematology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China

    Liye Zhong & Pengjun Liao

  7. Department of Adult Echocardiography, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medicine Sciences, Guangzhou, Guangdong, China

    Qiongwen Lin & Hongwen Fei

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  1. Zekun Tan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by ZT, XW and SL. The first draft of the manuscript was written by ZT and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Wenjian Wang or Hui Liu.

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Conflict of interest

The authors have not disclosed any competing interests.

Ethical approval and consent to participate

The retrospective study was approved by the Research Ethics Committee of Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences and written informed consent was obtained from all subjects. (KY-Q-2021-130-02).

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Regarding the images attached to the manuscript, written informed consent for publication was obtained from the patients.

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Tan, Z., Yang, Y., Wu, X. et al. Left atrial remodeling and the prognostic value of feature tracking derived left atrial strain in patients with light-chain amyloidosis: a cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 38, 1519–1532 (2022). https://doi.org/10.1007/s10554-022-02534-x

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  • DOI: https://doi.org/10.1007/s10554-022-02534-x

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