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Differentiating transthyretin cardiac amyloidosis among left ventricular hypertrophy phenotypes: the role of right and left ventricular global longitudinal strain
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 06 – EXPLORANDO A AMILOIDOSE CARDÍACA: INOVAÇÕES NO DIAGNÓSTICO, PROGNÓSTICO E TRATAMENTO
Speaker:
André Manuel Martins
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
André Manuel Faustino Martins; Adriana Vazão; Joana Pereira; Mónica Amado; Carolina Gonçalves; Mariana Carvalho; Margarida Cabral; Célia Domingues; Catarina Ruivo; Hélia Martins
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">Introduction: </span></strong><span style="font-family:Calibri,sans-serif">Left ventricular hypertrophy (LVH) may result from various cardiomyopathies, complicating the differentiation of transthyretin cardiac amyloidosis (ATTR-CA) from other LVH phenotypes. The overlap in echocardiographic features can hinder timely diagnosis and limit access to targeted therapeutic interventions.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">Objectives:</span></strong><span style="font-family:Calibri,sans-serif"> Assess the diagnostic accuracy of right ventricular (RV) and left ventricular (LV) global longitudinal strain (GLS) to discriminate ATTR-CA in patients (pts) evaluated for suspected CA at a Cardiomyopathy Clinic in a regional hospital in Portugal.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">Methods:</span></strong><span style="font-family:Calibri,sans-serif"> Retrospective single-center study of 96 adult pts followed from 2018 to 2024. Inclusion criteria: pts aged ≥60 years with LV wall thickness ≥12mm and at least one cardiac/extracardiac red flag for CA. Baseline clinical data were collected, and speckle tracking echocardiography was used to analyze RV and LV GLS at the time of diagnosis. Pts were classified in the ATTR-CA group (group 1) and the non-ATTR-CA group (group 2) according to the ESC algorithm for the diagnosis of ATTR-CA. Group comparisons were performed. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">Results:</span></strong><span style="font-family:Calibri,sans-serif"> 96 pts were included (median age 79 [IQR 10] yrs, 77% male). Following the diagnostic workup, 52 pts (54%) were assigned to group 1, and 44 pts (46%) to group 2, which included 19 with hypertrophic cardiomyopathy, 13 with hypertensive heart disease, 3 with valvular heart disease, and 9 with multifactorial heart disease. Group 1 pts were older (81[IQR 8] vs 78[IQR 10] yrs, p=0.006) and more frequently had overweight (58 vs 32%, p=0.011) and chronic kidney disease (62 vs 39%, p=0.025). Regarding heart failure characterization, the majority of pts had a LV ejection fraction > 50% (67 vs 84%, p=0.06). Pts with CA had greater interventricular septum thickness (18.5±3.2 vs 15.7±2.8mm, p<0.001), lower RV GLS (-11.2±4.1 vs -15.0±4.1%, p<0.001) and lower LV GLS (-9.8±2.9 vs -13.4±4.1%, p<0.001). LV and RV GLS showed adequate diagnostic accuracy (AUC 0.743 vs. 0.770, respectively; p<0.001), <span style="color:black">with LV GLS ≥-11.7 yielding 81% sensitivity and 66% specificity, and RV GLS ≥-15.5 yielding 92% sensitivity and 48% specificity for identifying ATTR-CA. Multivariate logistic regression identified lower LV and RV GLS as independent predictors of ATTR-CA (table 1B).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-family:Calibri,sans-serif">Conclusions: </span></strong><span style="font-family:Calibri,sans-serif">In this population, pts with ATTR-CA had notably lower RV and LV GLS values compared to non-ATTR-CA pts, with both parameters showing comparable diagnostic accuracy for identifying the disease.</span></span></span></span></p>
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