{"title":"Prognostic value of echocardiographic cardiac chamber longitudinal strains in advanced light chain cardiac amyloidosis.","authors":"Xinhao Li, Xiaohang Liu, Xiaojin Feng, Tianchen Guo, Guangcheng Liu, Danni Wu, Xue Lin, Ligang Fang, Wei Chen","doi":"10.1016/j.hjc.2024.12.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Patients with advanced light chain cardiac amyloidosis (AL-CA) have a poor prognosis. We aimed to (1) assess the prognostic significance of all cardiac chamber longitudinal strains and (2) to further determine whether the combination of longitudinal strains with the Mayo staging system could provide additional prognostic value.</p><p><strong>Methods: </strong>Patients classified as Mayo 2012 stage III and IV were included in our study. We documented major adverse cardiac events (MACEs), including hospitalization for heart failure and all-cause mortality. Right ventricular free wall strain (RV-FWS), left ventricular global longitudinal strain (LV-GLS), left atrial longitudinal peak strain (LAPS), and right atrial longitudinal peak strain (RAPS) were assessed using echocardiography.</p><p><strong>Results: </strong>This research enrolled 140 advanced AL-CA patients, with 49.3% at Mayo 2012 stage IV. During follow-up, 84 patients developed MACEs. LV-GLS, RV-FWS, LAPS, and RAPS were independent risk factors for advanced AL-CA patients. Kaplan-Meier curves revealed that cutoff values of all heart-chamber longitudinal strains had significant additional prognostic values for the Mayo 2012 stage. According to multivariate Cox regression, Age, gender, Mayo 2012, LAPS, RAPS, RV-FWS, and LV-GLS were included in the predictive model. The AUCs of the Model were 0.887, 0.907, and 0.883 for 1-, 3-, and 5-year MACEs, respectively. The model was internally validated using 200 bootstrapped resamples, yielding a corrected C-index of 0.810. A nomogram was developed and dynamically accessed via the following link: https://lxhadvancedalliexiantu.shinyapps.io/ALCA/.</p><p><strong>Conclusion: </strong>In patients with advanced AL-CA, it is essential to thoroughly evaluate all cardiac chamber longitudinal strains, particularly focusing on LV-GLS, RV-FWS, LAPS, and RAPS.</p>","PeriodicalId":55062,"journal":{"name":"Hellenic Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hellenic Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hjc.2024.12.004","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Patients with advanced light chain cardiac amyloidosis (AL-CA) have a poor prognosis. We aimed to (1) assess the prognostic significance of all cardiac chamber longitudinal strains and (2) to further determine whether the combination of longitudinal strains with the Mayo staging system could provide additional prognostic value.
Methods: Patients classified as Mayo 2012 stage III and IV were included in our study. We documented major adverse cardiac events (MACEs), including hospitalization for heart failure and all-cause mortality. Right ventricular free wall strain (RV-FWS), left ventricular global longitudinal strain (LV-GLS), left atrial longitudinal peak strain (LAPS), and right atrial longitudinal peak strain (RAPS) were assessed using echocardiography.
Results: This research enrolled 140 advanced AL-CA patients, with 49.3% at Mayo 2012 stage IV. During follow-up, 84 patients developed MACEs. LV-GLS, RV-FWS, LAPS, and RAPS were independent risk factors for advanced AL-CA patients. Kaplan-Meier curves revealed that cutoff values of all heart-chamber longitudinal strains had significant additional prognostic values for the Mayo 2012 stage. According to multivariate Cox regression, Age, gender, Mayo 2012, LAPS, RAPS, RV-FWS, and LV-GLS were included in the predictive model. The AUCs of the Model were 0.887, 0.907, and 0.883 for 1-, 3-, and 5-year MACEs, respectively. The model was internally validated using 200 bootstrapped resamples, yielding a corrected C-index of 0.810. A nomogram was developed and dynamically accessed via the following link: https://lxhadvancedalliexiantu.shinyapps.io/ALCA/.
Conclusion: In patients with advanced AL-CA, it is essential to thoroughly evaluate all cardiac chamber longitudinal strains, particularly focusing on LV-GLS, RV-FWS, LAPS, and RAPS.
期刊介绍：
The Hellenic Journal of Cardiology (International Edition, ISSN 1109-9666) is the official journal of the Hellenic Society of Cardiology and aims to publish high-quality articles on all aspects of cardiovascular medicine. A primary goal is to publish in each issue a number of original articles related to clinical and basic research. Many of these will be accompanied by invited editorial comments.
Hot topics, such as molecular cardiology, and innovative cardiac imaging and electrophysiological mapping techniques, will appear frequently in the journal in the form of invited expert articles or special reports. The Editorial Committee also attaches great importance to subjects related to continuing medical education, the implementation of guidelines and cost effectiveness in cardiology.
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