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Impact of monitoring longitudinal systolic strain changes during serial echocardiography on outcome in patients with AL amyloidosis

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Abstract

Relative apical sparing of longitudinal systolic strain (LSsys) with preserved LSsys at apical and significantly reduced LSsys at mid/basal segments is a typical echocardiographic feature in AL amyloidosis patients with cardiac involvement. The present study aims to evaluate the change of this typical feature over time by serial echocardiography and its impact on outcome in AL amyloidosis patients with cardiac involvement. Echocardiography was performed in 24 consecutive patients with biopsy-proven AL amyloidosis (mean age 64 ± 9 years; 50 % male) at baseline and during a median of 257 (quartiles 103–651) days follow-up. Global and segmental LSsys were assessed by two-dimensional speckle-tracking-imaging in septal and lateral segments of the left ventricle (LV) from the apical 4-chamber view. Sixteen (67 %) patients died during a median follow-up of 487 days (quartiles 223–872). LV global and segmental LSsys remained unchanged over time in survivors (all P > 0.05), while LV global, septal-apical and lateral-apical LSsys significantly decreased in non-survivors. A decrease in lateral-apical LSsys > 3.0 % independently predicted a fivefold increased all-cause mortality risk after adjustment for age, gender, NYHA class, and treatment strategies. Further, baseline serum NT-proBNP, serum albumin decrease during follow-up, baseline septal apical-to-basal LSsys ratio and lateral-apical LSsys decrease during follow-up remained independently predictive of increased all-cause mortality risk. Serial monitoring of serological and echocardiographic parameters is valuable to predict outcome in AL amyloidosis patients with cardiac involvement. The best follow-up parameter to predict risk for imminent death is a decrease of longitudinal systolic strain at the lateral apical segment.

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Acknowledgments

This work was supported by Grants from the Bundesministerium für Bildung und Forschung (BMBF01 EO1004).

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    Authors and Affiliations

    1. Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany

      Kai Hu, Dan Liu, Peter Nordbeck, Stefan Störk, Bastian Kramer, Philipp Daniel Gaudron, Andreas Schneider, Georg Ertl & Sebastian Herrmann

    2. Comprehensive Heart Failure Center, Würzburg, Germany

      Kai Hu, Dan Liu, Peter Nordbeck, Stefan Störk, Bastian Kramer, Philipp Daniel Gaudron, Georg Ertl, Frank Weidemann & Sebastian Herrmann

    3. Department for Cardiovascular Diseases, University Hospital Center Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia

      Maja Cikes

    4. Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany

      Stefan Knop

    5. ICREA - Universitat Pompeu Fabra, Barcelona, Spain

      Bart Bijnens

    6. Katharinen-Hospital Unna, Unna, Germany

      Frank Weidemann

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    1. Kai Hu
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    Correspondence to Kai Hu.

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    Kai Hu and Dan Liu have contributed equally to this work.

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    Hu, K., Liu, D., Nordbeck, P. et al. Impact of monitoring longitudinal systolic strain changes during serial echocardiography on outcome in patients with AL amyloidosis. Int J Cardiovasc Imaging 31, 1401–1412 (2015). https://doi.org/10.1007/s10554-015-0711-1

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