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Left atrium strain analysis in wild-type transthyretin amyloid cardiomyopathy: a predictive tool for atrial fibrillation
Session:
SESSÃO DE POSTERS 38 - ANÁLISE DE DEFORMAÇÃO MIOCÁRDICA
Speaker:
Luísa Pinheiro
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Cartazes
FP Number:
---
Authors:
Luísa Pinheiro; Margarida de Castro; Emídio Mata; Bárbara Lage Garcia; Tamara Pereira; Filipa Cordeiro; Olga Azevedo; António Lourenço
Abstract
<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> </span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Left atrial (LA) deformation analysis using speckle tracking echocardiography has been established as a useful tool for predicting atrial fibrillation (AF) in the general population. Patients with wild-type transthyretin amyloid cardiomyopathy (wtATTR-CM) have a notably higher prevalence of AF, making it important to identify those at increased risk. LA strain analysis could serve as a valuable method to predict AF in this patient population.</span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Purpose: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">This study aimed to evaluate the predictive value of LA strain analysis in determining the occurrence of AF in wtATTR-CM patients.</span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Retrospective, single-center study of patients with the diagnosis of wtATTR-CM between 2014 and 2024 in sinus rhythm at the time of the diagnosis. </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The primary analysis focused on baseline echocardiographic parameters, including Peak Atrial Longitudinal Strain (PALS), Peak Atrial Contraction Strain (PACS), and Peak Atrial Conduit Strain (PCS).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">We analyzed the relationship between these baseline strain measures and the occurrence of AF. The optimal cutoff values for strain measures were determined using the Youden index, and their predictive accuracy was assessed using Odds Ratios (OR).</span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Results: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Of a total of 111 patients, 59 patients were in sinus rhythm at the time of the diagnosis (73% males, mean age 80 ± 6 years). Median follow up was 30 [IQR 16-36] months. During follow-up 30 patients (51%) developed AF.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Mean PALS value was lower in patients who developed AF (12.13 ± 4.76% vs 15.22 ±6.13%, p=0.034). PACS had significant worst values in patients that did not maintain sinus rhythm (-6.29 ± 3.84% vs -9.05 ± 5.54%, p=0.030). PCS value did not differ between the groups (-5.85 ± 2.66% vs -6.17 ± 3.37%, p=0.688).</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The optimal cutoff value for PACS was identified as -11.4%, with an OR of 7.368 (95% CI 1.449-37.462, p=0.016). For PALS, with a cutoff value of 14.6%, an OR of 0.339 (95% CI 0.114-1.008, p=0.052).</span></span></p> <p><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Conclusions: </span></span></strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">LA strain analysis, particularly PACS, shows promise as a tool for assessing the risk of AF development in wtATTR-CM patients. Although PALS demonstrated a trend toward significance, further studies with larger sample sizes are necessary to validate these findings.</span></span></p>
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