Right Atrial Deformation Analysis in Cardiac Amyloidosis – Results from the Three-Dimensional Speckle- Tracking Echocardiographic MAGYAR-Path Study
Figure 1 – Images from three-dimensional (3D) full-volume dataset showing the right atrium (RA) are presented: apical four-chamber (A) and two-chamber views (B) and short-axis views at basal (C3), mid- (C5) and superior (C7) RA levels together with a virtual 3D model of the RA (red D) and with RA volumetric data (red E). Time – segmental (longitudinal) strain curves of all 16 RA segments (coloured lines) and a time - global RA volume change curve respecting cardiac cycle (white dashed line) are also presented (red F). Yellow arrow represents peak RA strain, while yellow dashed arrow represents RA strain at atrial contraction. Vmax, Vmin and VpreA represent maximum and minimum RA volumes and RA volume at atrial contraction, respectively. LV: left ventricle; LA: left atrium; RV: right ventricle; RA: right atrium.
Background: Light-chain (AL) cardiac amyloidosis (CA) is characterized by fibril deposits, which are composed of monoclonal immunoglobulin light chains. The right ventricle is mostly involved in AL-CA and impairment of its function is a predictor of worse prognosis.
Objectives: To characterize the volumetric and functional properties of the right atrium (RA) in AL-CA by three-dimensional speckle-tracking echocardiography (3DSTE). Methods: A total of 16 patients (mean age: 64.5 ± 10.1 years, 11 males) with AL-CA were examined. Their results were compared to that of 15 age- and gender-matched healthy controls (mean age: 58.9 ± 6.9 years, 8 males). All cases have undergone complete two-dimensional Doppler and 3DSTE. A two-tailed p value of less than 0.05 was considered statistically significant.
Results: Significant differences could be demonstrated in RA volumes respecting cardiac cycle. Total (19.2 ± 9.3% vs. 27.9 ± 10.7%, p = 0.02) and active atrial emptying fractions (12.1 ± 8.1 vs. 18.6 ± 9.8%, p = 0.05) were significantly decreased in AL-CA patients. Peak global (16.7 ± 10.3% vs. 31.2 ± 19.4%, p = 0.01) and mean segmental (24.3 ± 11.1% vs. 38.6 ± 17.6%, p =0.01) RA area strains, together with some circumferential, longitudinal and segmental area strain parameters, proved to be reduced in patients with AL-CA. Global longitudinal (4.0 ± 5.2% vs. 8.2 ± 5.5%, p = 0.02) and area (7.8 ± 8.1% vs. 15.9 ± 10.3%, p = 0.03) strains at atrial contraction and some circumferential and area strain parameters at atrial contraction were reduced in AL-CA patients.
Conclusion: Significantly increased RA volumes and deteriorated RA functions could be demonstrated in AL-CA. (Arq Bras Cardiol. 2018; 111(3):384-391)
Keywords: Amyloidosis; Echocardiography, Three Dimensional / methods; Humans; Ventricular Dysfunction, Right; Speckle-Tracking.