SPC365

The predictive role of right and left ventricular longitudinal strain measured by two-dimensional echocardiography in wild-type transthyretin cardiac amyloidosis

Session: Posters (Sessão 2 - Écran 5) - Doenças do miocárdio
Speaker: Tamara Pereira

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.7 Myocardial Disease - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Tamara Pereira; Mariana Tinoco; Margarida Castro; Luísa Pinheiro; Margarida Oliveira; Olga Azevedo; Francisco Ferreira; António Lourenço

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:blue"><u><strong>&nbsp;</strong></u></span><br />
<strong><span style="color:#333333">Background</span></strong><span style="color:#333333">: Wild-type transthyretin </span><span style="color:#2e2e2e">amyloid cardiomyopathy (ATTR-CM) </span>is a biventricular disease. The prognostic implications of left ventricular systolic dysfunction (LVSD) are well defined. However, there are only few studies assessing the association between right ventricular (RV) systolic function and outcomes. This study aimed to investigate the prognostic value of right and left ventricular longitudinal deformation in <span style="color:#2e2e2e">wild-type transthyretin ATTR-CM </span>patients.<br />
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<span style="color:#333333"><strong>Methods:</strong> </span><span style="background-color:white"><span style="color:#212529">This is a retrospective single-center study including all patients with diagnosis </span></span><span style="background-color:white"><span style="color:black">of wild-type ATTR-CM </span></span><span style="background-color:white"><span style="color:#212529">between January </span></span><span style="background-color:white"><span style="color:black">2014 and August 2021. ATTR-CM diagnosis was based on the AHA diagnostic criteria. </span></span>&nbsp;<span style="color:black">The primary </span>endpoint was the composite endpoint of hospitalization due to heart failure (HF) or death for any cause. Clinical and echocardiographic data were compared between patients reaching and not reaching the primary endpoint. RV strain analysis was obtained from the free wall of the RV based on the RV-focused apical 4- chamber view. &nbsp;The use of -13% as a prognostic cut-off value of RV free wall strain was supported by the receiver operating characteristic curve. Cox regression analysis was performed to identify independent predictors of the primary endpoint.<br />
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<strong><span style="color:black">Results:</span></strong><span style="color:black"> 60 patients with wild-type </span><span style="color:#2e2e2e">ATTR-CM were included. The </span><span style="color:black">median age was 87 [69; 97]. 68.3% of patients were male and baseline left ventricular ejection fraction (LVEF) was 52 &plusmn; 14%. </span><span style="color:black">The median follow-up</span> was 40 [1; 107] months. </span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During follow-up, the primary endpoint occurred in 34 patients (56.7%); 22 patients died within 2.5 years of their diagnosis, 10 of them by cardiovascular cause.<strong><u> </u></strong><br />
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Patients reaching the primary endpoint<strong><u> </u></strong><br />
<span style="color:black">had a lower </span>mean LVEF (48&plusmn;13% vs 58&plusmn;12%, p=0.003) and <span style="color:black">mean global longitudinal strain (GLS) (</span>-9&plusmn;2% vs 14&plusmn;2%, p&lt;0.001). The fractional area change (FAC) was lower (31&plusmn;9% vs 36&plusmn;8%, p=0.031) and RV free wall strain was significantly worse (-9&plusmn;2 vs -16 &plusmn;5, p&lt;0.001).</span></span><br />
&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Kaplan-Meier curves showed that primary endpoint-free survival was lower in</span> <span style="color:black">patients with reduced LVEF </span>(31&plusmn;6 vs 71&plusmn;9 months, p=0.004), GLS &lt; -12% (22&plusmn;4 vs 87&plusmn;8 months, p&lt;0.001), FAC &lt; 35% (34 &plusmn; 6% vs 68 &plusmn; 9%, p=0.024) and RV free wall strain &lt;-13%<span style="color:black"> (23&plusmn;3 vs 101&plusmn;6 months, p&lt;0.001). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">In Cox regression analysis, reduced LV GLS and RV free wall strain remained independent predictors of the primary endpoint (HR 0.80, 95% CI 0.646&ndash;0.991, p=0.041;<br />
HR 0.83 95% CI 0.698&ndash;0.987, p=0.035, respectively).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusions:</span></strong><span style="color:black"> Reduced LV GLS and RV free wall strain are independent predictors of the occurrence of the primary endpoint of hospitalization due to HF or death of any cause in </span><span style="color:#2e2e2e">wild-type ATTR-CM </span>patients. </span></span></p>