ABC | Volume 111, Nº3, September 2018

Original Article Nemes et al RA function in CA by 3DSTE Arq Bras Cardiol. 2018; 111(3):384-391 Table 3 – Comparison of 3DSTE-derived peak global and segmental peak right atrial strain parameters in patients with cardiac amyloidosis and in matched controls AL-CA patients (n = 16) Controls (n = 15) p-value Peak global strain RS (%) -13.8 ± 8.8 -15.1 ± 7.2 0.52 * CS (%) 7.1 ± 5.7 10.7 ± 9.6 0.21 * LS (%) 14.4 ± 9.8 21.9 ± 9.3 0.18 * 3DS (%) -6.9 ± 6.2 -8.1 ± 4.8 0.55 * AS (%) 16.7 ± 10.3 31.2 ± 19.4 0.01 * Peak mean segmental strain RS (%) -17.1 ± 8.8 -18.9 ± 6.6 0.54 * CS (%) 12.2 ± 6.3 16.0 ± 9.2 0.19 * LS (%) 16.1 ± 9.3 24.2 ± 9.6 0.10 * 3DS (%) -11.5 ± 6.1 -12.6 ± 4.7 0.60 * AS (%) 24.3 ± 11.1 38.6 ± 17.6 0.01 * 3DSTE: three-dimensional speckle-tracking echocardiography; CA: cardiac amyloidosis; 3DS: three-dimensional strain; AS: area strain; CS: circumferential strain; LS: longitudinal strain; RS: radial strain. Data expressed as mean ± standard deviation. * Unpaired Student t test. Table 4 – Comparison of 3DSTE-derived peak segmental right atrial strain parameters in patients with cardiac amyloidosis and in matched controls AL-CA patients (n = 16) Controls (n = 15) p-value RS basal (%) -16.3 ± 10.2 -16.8 ± 5.7 0.87 * RS mid (%) -14.9 ± 7.7 -18.5 ± 7.9 0.21 * RS superior (%) -21.7 ± 16.5 -22.5 ± 11.9 0.87 * CS basal (%) 10.2 ± 4.9 15.1 ± 7.2 0.03 * CS mid (%) 7.9 ± 5.7 13.1 ± 6.9 0.02 * CS superior (%) 21.8 ± 16.7 20.8 ± 21.9 0.53 * LS basal (%) 17.6 ± 8.6 24.4 ± 13.4 0.19 * LS mid (%) 18.0 ± 13.3 30.7 ± 13.1 0.01 * LS superior (%) 10.9 ± 10.5 16.8 ± 9.9 0.07 * 3DS basal (%) -11.6 ± 7.2 -11.2 ± 5.3 0.86 * 3DS mid (%) -9.6 ± 5.6 -12.0 ± 5.9 0.24 * 3DS superior (%) -14.3 ± 10.8 -15.4 ± 9.3 0.77 * AS basal (%) 19.9 ± 9.1 30.1 ± 12.7 0.02 * AS mid (%) 21.9 ± 15.9 41.0 ± 15.4 0.002 * AS superior (%) 34.4 ± 30.9 47.9 ± 48.3 0.66 * 3DSTE: three-dimensional speckle-tracking echocardiography; CA: cardiac amyloidosis; 3DS: three-dimensional strain; AS: area strain; CS: circumferential strain; LS: longitudinal strain; RS: radial strain. Data expressed as mean ± standard deviation. * Unpaired Student t test. the disease. 6 Doppler myocardial imaging measures of the RV can identify early impairment of cardiac function or stratify risk of death in patients with AL-CA. 26 Impaired RV function was found to be a predictor of worse prognosis of early mortality in AL-CA. 27 However, detailed analysis of AL-CA-associated RA volumetric and functional alterations was not documented. With 2D echocardiography, the assessment of RA is limited due to viewing dependency and geometric difficulties. Regularly, RA diameter and area are measured in AP4CH view. 14,15 3D echocardiography is a new clinical modality that allows the accurate measurement of atrial phasic volume changes. 12,16,17 Moreover, several functional properties, including stroke volumes and emptying fractions and strains at different phases of the cardiac cycle, could be measured at the same time from the same 3D dataset, allowing detailed analysis of the RA during 3DSTE. 16,17 In the present study, over increased RA volumes in all phases, alterations in emptying fractions and strains characterizing systolic reservoir, and late-diastolic active booster pump RA functions could be demonstrated. These findings could be explained by infiltration of the atrial wall with amyloid fibrils, impaired left and/or right heart failure, effects of cardiovascular 388