Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis

Dermot Phelan, Patrick Collier, Paaladinesh Thavendiranathan, Zoran B. Popović, Mazen Hanna, Juan Carlos Plana, Thomas H. Marwick, James D. Thomas*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

340 Scopus citations

Abstract

Background: The diagnosis of cardiac amyloidosis (CA) is challenging owing to vague symptomatology and non-specific echocardiographic findings. Objective: To describe regional patterns in longitudinal strain (LS) using two-dimensional speckle-tracking echocardiography in CA and to test the hypothesis that regional differences would help differentiate CA from other causes of increased left ventricular (LV) wall thickness. Methods and results: 55 consecutive patients with CA were compared with 30 control patients with LV hypertrophy (n=15 with hypertrophic cardiomyopathy, n=15 with aortic stenosis). A relative apical LS of 1.0, defined using the equation (average apical LS/(average basal LS + mid-LS)), was sensitive (93%) and specific (82%) in differentiating CA from controls (area under the curve 0.94). In a logistic regression multivariate analysis, relative apical LS was the only parameter predictive of CA (p=0.004). Conclusions: CA is characterised by regional variations in LS from base to apex. A relative 'apical sparing' pattern of LS is an easily recognisable, accurate and reproducible method of differentiating CA from other causes of LV hypertrophy.

Original languageEnglish (US)
Pages (from-to)1442-1448
Number of pages7
JournalHeart
Volume98
Issue number19
DOIs
StatePublished - Oct 1 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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