Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis

Jeremy A. Slivnick; Cristiane Singulane; Deyu Sun; Derek Eshun; Akhil Narang; Steven Mazzone; Karima Addetia; Amit R. Patel; Karolina M. Zareba; Suzanne Smart; Jung Woo Kwon; Aliya Husain; Brittany Cody; Seth Scheetz; Federico M. Asch; Akash Goyal; Nitasha Sarswat; Victor Mor-Avi; Roberto M. Lang

doi:10.1016/j.echo.2023.08.005

Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis

Jeremy A. Slivnick, Cristiane Singulane, Deyu Sun, Derek Eshun, Akhil Narang, Steven Mazzone, Karima Addetia, Amit R. Patel, Karolina M. Zareba, Suzanne Smart, Jung Woo Kwon, Aliya Husain, Brittany Cody, Seth Scheetz, Federico M. Asch, Akash Goyal, Nitasha Sarswat, Victor Mor-Avi, Roberto M. Lang^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

Abstract

Background: In patients with cardiac amyloidosis (CA), left ventricular ejection fraction (LVEF) is frequently preserved, despite commonly reduced global longitudinal strain (GLS). We hypothesized that nonlongitudinal contraction may initially serve as a mitigating mechanism to maintain cardiac output and studied the relationship between global circumferential (GCS) and radial (GRS) strain with LVEF and extracellular volume (ECV), a marker of amyloid burden. Methods: Patients with CA who underwent cardiac magnetic resonance (CMR; n = 140, 70.7 ± 11.5 years, 66% male) or echocardiography (n = 67, 71 ± 13 years, 66% male) and normal controls (CMR, n = 20; echocardiography, n = 45) were retrospectively identified, and GCS, GLS, and GRS were quantified using feature-tracking CMR or speckle-tracking echocardiography and compared between CA patients with preserved and reduced LVEF (CA_HFpEF, CA_HFrEF) and controls. The prevalence of impaired strain (magnitudes <2.5th percentile of the controls) was compared between CA_HFpEF and CA_HFrEF and between ECV quartiles. Results: While echocardiography-derived GLS was impaired in both CA_HFpEF (−13.4% ± 3.1%, P < .003) and CA_HFrEF (−9.1% ± 3.2%, P < .003), compared with controls (−20.8% ± 2.4%), GCS was more impaired in CA_HFrEF compared with both controls (−15.6% ± 5.0% vs −32.3% ± 3.3%, P < .003) and CA_HFpEF (−30.4% ± 5.7%, P < .003) and did not differ between CA_HFpEF and controls (P = .24). The prevalence of abnormal CMR-derived GCS (P < .0001) and GRS (P < .0001) but not GLS (P = .054) varied significantly across ECV quartiles. Conclusions: Among CA patients with preserved LVEF, preserved GCS and GRS, despite near-universally impaired GLS, may be explained by an initial predominantly subendocardial involvement, where mostly longitudinal fibers are located. If confirmed in future studies, these findings may facilitate identification of patients with early stages of CA, when treatments may be most effective.

Original language	English (US)
Pages (from-to)	1290-1301
Number of pages	12
Journal	Journal of the American Society of Echocardiography
Volume	36
Issue number	12
DOIs	https://doi.org/10.1016/j.echo.2023.08.005
State	Published - Dec 2023

Keywords

Cardiac amyloidosis
Cardiac magnetic resonance
Cardiomyopathy
Echocardiography

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.echo.2023.08.005

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Slivnick, J. A., Singulane, C., Sun, D., Eshun, D., Narang, A., Mazzone, S., Addetia, K., Patel, A. R., Zareba, K. M., Smart, S., Kwon, J. W., Husain, A., Cody, B., Scheetz, S., Asch, F. M., Goyal, A., Sarswat, N., Mor-Avi, V., & Lang, R. M. (2023). Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis. Journal of the American Society of Echocardiography, 36(12), 1290-1301. https://doi.org/10.1016/j.echo.2023.08.005

@article{4e3b944b76da4ec1a55f9014ae4b1c57,

title = "Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis",

abstract = "Background: In patients with cardiac amyloidosis (CA), left ventricular ejection fraction (LVEF) is frequently preserved, despite commonly reduced global longitudinal strain (GLS). We hypothesized that nonlongitudinal contraction may initially serve as a mitigating mechanism to maintain cardiac output and studied the relationship between global circumferential (GCS) and radial (GRS) strain with LVEF and extracellular volume (ECV), a marker of amyloid burden. Methods: Patients with CA who underwent cardiac magnetic resonance (CMR; n = 140, 70.7 ± 11.5 years, 66% male) or echocardiography (n = 67, 71 ± 13 years, 66% male) and normal controls (CMR, n = 20; echocardiography, n = 45) were retrospectively identified, and GCS, GLS, and GRS were quantified using feature-tracking CMR or speckle-tracking echocardiography and compared between CA patients with preserved and reduced LVEF (CAHFpEF, CAHFrEF) and controls. The prevalence of impaired strain (magnitudes <2.5th percentile of the controls) was compared between CAHFpEF and CAHFrEF and between ECV quartiles. Results: While echocardiography-derived GLS was impaired in both CAHFpEF (−13.4% ± 3.1%, P < .003) and CAHFrEF (−9.1% ± 3.2%, P < .003), compared with controls (−20.8% ± 2.4%), GCS was more impaired in CAHFrEF compared with both controls (−15.6% ± 5.0% vs −32.3% ± 3.3%, P < .003) and CAHFpEF (−30.4% ± 5.7%, P < .003) and did not differ between CAHFpEF and controls (P = .24). The prevalence of abnormal CMR-derived GCS (P < .0001) and GRS (P < .0001) but not GLS (P = .054) varied significantly across ECV quartiles. Conclusions: Among CA patients with preserved LVEF, preserved GCS and GRS, despite near-universally impaired GLS, may be explained by an initial predominantly subendocardial involvement, where mostly longitudinal fibers are located. If confirmed in future studies, these findings may facilitate identification of patients with early stages of CA, when treatments may be most effective.",

keywords = "Cardiac amyloidosis, Cardiac magnetic resonance, Cardiomyopathy, Echocardiography",

author = "Slivnick, {Jeremy A.} and Cristiane Singulane and Deyu Sun and Derek Eshun and Akhil Narang and Steven Mazzone and Karima Addetia and Patel, {Amit R.} and Zareba, {Karolina M.} and Suzanne Smart and Kwon, {Jung Woo} and Aliya Husain and Brittany Cody and Seth Scheetz and Asch, {Federico M.} and Akash Goyal and Nitasha Sarswat and Victor Mor-Avi and Lang, {Roberto M.}",

note = "Publisher Copyright: {\textcopyright} 2023 American Society of Echocardiography",

year = "2023",

month = dec,

doi = "10.1016/j.echo.2023.08.005",

language = "English (US)",

volume = "36",

pages = "1290--1301",

journal = "Journal of the American Society of Echocardiography",

issn = "0894-7317",

publisher = "Elsevier Inc.",

number = "12",

}

Slivnick, JA, Singulane, C, Sun, D, Eshun, D, Narang, A, Mazzone, S, Addetia, K, Patel, AR, Zareba, KM, Smart, S, Kwon, JW, Husain, A, Cody, B, Scheetz, S, Asch, FM, Goyal, A, Sarswat, N, Mor-Avi, V & Lang, RM 2023, 'Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis', Journal of the American Society of Echocardiography, vol. 36, no. 12, pp. 1290-1301. https://doi.org/10.1016/j.echo.2023.08.005

Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis. / Slivnick, Jeremy A.; Singulane, Cristiane; Sun, Deyu et al.
In: Journal of the American Society of Echocardiography, Vol. 36, No. 12, 12.2023, p. 1290-1301.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis

AU - Slivnick, Jeremy A.

AU - Singulane, Cristiane

AU - Sun, Deyu

AU - Eshun, Derek

AU - Narang, Akhil

AU - Mazzone, Steven

AU - Addetia, Karima

AU - Patel, Amit R.

AU - Zareba, Karolina M.

AU - Smart, Suzanne

AU - Kwon, Jung Woo

AU - Husain, Aliya

AU - Cody, Brittany

AU - Scheetz, Seth

AU - Asch, Federico M.

AU - Goyal, Akash

AU - Sarswat, Nitasha

AU - Mor-Avi, Victor

AU - Lang, Roberto M.

PY - 2023/12

Y1 - 2023/12

N2 - Background: In patients with cardiac amyloidosis (CA), left ventricular ejection fraction (LVEF) is frequently preserved, despite commonly reduced global longitudinal strain (GLS). We hypothesized that nonlongitudinal contraction may initially serve as a mitigating mechanism to maintain cardiac output and studied the relationship between global circumferential (GCS) and radial (GRS) strain with LVEF and extracellular volume (ECV), a marker of amyloid burden. Methods: Patients with CA who underwent cardiac magnetic resonance (CMR; n = 140, 70.7 ± 11.5 years, 66% male) or echocardiography (n = 67, 71 ± 13 years, 66% male) and normal controls (CMR, n = 20; echocardiography, n = 45) were retrospectively identified, and GCS, GLS, and GRS were quantified using feature-tracking CMR or speckle-tracking echocardiography and compared between CA patients with preserved and reduced LVEF (CAHFpEF, CAHFrEF) and controls. The prevalence of impaired strain (magnitudes <2.5th percentile of the controls) was compared between CAHFpEF and CAHFrEF and between ECV quartiles. Results: While echocardiography-derived GLS was impaired in both CAHFpEF (−13.4% ± 3.1%, P < .003) and CAHFrEF (−9.1% ± 3.2%, P < .003), compared with controls (−20.8% ± 2.4%), GCS was more impaired in CAHFrEF compared with both controls (−15.6% ± 5.0% vs −32.3% ± 3.3%, P < .003) and CAHFpEF (−30.4% ± 5.7%, P < .003) and did not differ between CAHFpEF and controls (P = .24). The prevalence of abnormal CMR-derived GCS (P < .0001) and GRS (P < .0001) but not GLS (P = .054) varied significantly across ECV quartiles. Conclusions: Among CA patients with preserved LVEF, preserved GCS and GRS, despite near-universally impaired GLS, may be explained by an initial predominantly subendocardial involvement, where mostly longitudinal fibers are located. If confirmed in future studies, these findings may facilitate identification of patients with early stages of CA, when treatments may be most effective.

AB - Background: In patients with cardiac amyloidosis (CA), left ventricular ejection fraction (LVEF) is frequently preserved, despite commonly reduced global longitudinal strain (GLS). We hypothesized that nonlongitudinal contraction may initially serve as a mitigating mechanism to maintain cardiac output and studied the relationship between global circumferential (GCS) and radial (GRS) strain with LVEF and extracellular volume (ECV), a marker of amyloid burden. Methods: Patients with CA who underwent cardiac magnetic resonance (CMR; n = 140, 70.7 ± 11.5 years, 66% male) or echocardiography (n = 67, 71 ± 13 years, 66% male) and normal controls (CMR, n = 20; echocardiography, n = 45) were retrospectively identified, and GCS, GLS, and GRS were quantified using feature-tracking CMR or speckle-tracking echocardiography and compared between CA patients with preserved and reduced LVEF (CAHFpEF, CAHFrEF) and controls. The prevalence of impaired strain (magnitudes <2.5th percentile of the controls) was compared between CAHFpEF and CAHFrEF and between ECV quartiles. Results: While echocardiography-derived GLS was impaired in both CAHFpEF (−13.4% ± 3.1%, P < .003) and CAHFrEF (−9.1% ± 3.2%, P < .003), compared with controls (−20.8% ± 2.4%), GCS was more impaired in CAHFrEF compared with both controls (−15.6% ± 5.0% vs −32.3% ± 3.3%, P < .003) and CAHFpEF (−30.4% ± 5.7%, P < .003) and did not differ between CAHFpEF and controls (P = .24). The prevalence of abnormal CMR-derived GCS (P < .0001) and GRS (P < .0001) but not GLS (P = .054) varied significantly across ECV quartiles. Conclusions: Among CA patients with preserved LVEF, preserved GCS and GRS, despite near-universally impaired GLS, may be explained by an initial predominantly subendocardial involvement, where mostly longitudinal fibers are located. If confirmed in future studies, these findings may facilitate identification of patients with early stages of CA, when treatments may be most effective.

KW - Cardiac amyloidosis

KW - Cardiac magnetic resonance

KW - Cardiomyopathy

KW - Echocardiography

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UR - http://www.scopus.com/inward/citedby.url?scp=85171375436&partnerID=8YFLogxK

U2 - 10.1016/j.echo.2023.08.005

DO - 10.1016/j.echo.2023.08.005

M3 - Article

C2 - 37574149

AN - SCOPUS:85171375436

SN - 0894-7317

VL - 36

SP - 1290

EP - 1301

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

IS - 12

ER -

Preservation of Circumferential and Radial Left Ventricular Function as a Mitigating Mechanism for Impaired Longitudinal Strain in Early Cardiac Amyloidosis

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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