Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis
Abstract Aims To determine whether echocardiographic longitudinal systolic strain (LS) parameters identify short-term improvement following chemotherapy for light-chain (AL) cardiac amyloidosis (CA). Among patients with CA, standard echocardiographic measures are commonly unchanged at 1 year followi...
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| Veröffentlicht in: | European heart journal cardiovascular imaging 2017-09, Vol.18 (9), p.1057-1064 |
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| creator | Salinaro, Francesco Meier-Ewert, Hans K. Miller, Edward J. Pandey, Shivda Sanchorawala, Vaishali Berk, John L. Seldin, David C. Ruberg, Frederick L. |
| description | Abstract
Aims
To determine whether echocardiographic longitudinal systolic strain (LS) parameters identify short-term improvement following chemotherapy for light-chain (AL) cardiac amyloidosis (CA). Among patients with CA, standard echocardiographic measures are commonly unchanged at 1 year following successful chemotherapy, despite observed reductions in cardiac biomarkers.
Methods and results
We retrospectively identified 61 patients with AL-CA treated with high-dose melphalan or bortezomib-based regimens. Patients were classified by hematologic response at 1 year into two groups: complete response (CR; n = 18, or 30%) or non-CR (non-CR; n = 43, or 70%), and followed for 20 months. Serum free light chains (FLC), B-type natriuretic peptide (BNP), troponin I (TnI), and echocardiography including LS, were acquired at baseline and 1 year. Seven patients died (11.5%), all in the non-CR group (P |
| doi_str_mv | 10.1093/ehjci/jew298 |
| format | Article |
| fullrecord | <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_ehjci_jew298</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ehjci/jew298</oup_id><sourcerecordid>10.1093/ehjci/jew298</sourcerecordid><originalsourceid>FETCH-LOGICAL-c361t-7ec8eb75bac7ed58866ee3fb9d96a07941978c60a3b1fd630604531eb7371cc53</originalsourceid><addsrcrecordid>eNp9kD1PwzAQQC0Eoqh0Y0beAKmhdpzYyVhVfEmRWGCOHNtpXSV2ZDutuvPDSQl05Ja74d0bHgA3GD1ilJOF2myFXmzVPs6zM3AVo4RFcYLj89ONkgmYeb9Fw6QJTWJ8CSYxy2kaZ-gKfBXWrHXopTa8gf7gg220gD44rs0cCu6k5gLWvRFBWwN12zm7U60yYQ65kdD3bqd3w29tm8butVnD4BQPRwLaGjZ6vQmR2Aw6eL8sHk5K3h4aq6X12l-Di5o3Xs1-9xR8Pj99rF6j4v3lbbUsIkEoDhFTIlMVSysumJJpllGqFKmrXOaUI5YnOGeZoIiTCteSEkRRkhI8vBCGhUjJFMxHr3DWe6fqsnO65e5QYlQee5Y_Pcux54DfjnjXV62SJ_iv3gDcjYDtu_9V32wqgvE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Salinaro, Francesco ; Meier-Ewert, Hans K. ; Miller, Edward J. ; Pandey, Shivda ; Sanchorawala, Vaishali ; Berk, John L. ; Seldin, David C. ; Ruberg, Frederick L.</creator><creatorcontrib>Salinaro, Francesco ; Meier-Ewert, Hans K. ; Miller, Edward J. ; Pandey, Shivda ; Sanchorawala, Vaishali ; Berk, John L. ; Seldin, David C. ; Ruberg, Frederick L.</creatorcontrib><description>Abstract
Aims
To determine whether echocardiographic longitudinal systolic strain (LS) parameters identify short-term improvement following chemotherapy for light-chain (AL) cardiac amyloidosis (CA). Among patients with CA, standard echocardiographic measures are commonly unchanged at 1 year following successful chemotherapy, despite observed reductions in cardiac biomarkers.
Methods and results
We retrospectively identified 61 patients with AL-CA treated with high-dose melphalan or bortezomib-based regimens. Patients were classified by hematologic response at 1 year into two groups: complete response (CR; n = 18, or 30%) or non-CR (non-CR; n = 43, or 70%), and followed for 20 months. Serum free light chains (FLC), B-type natriuretic peptide (BNP), troponin I (TnI), and echocardiography including LS, were acquired at baseline and 1 year. Seven patients died (11.5%), all in the non-CR group (P < 0.01). At 1 year, while reductions were observed in BNP (44% CR, 18% non-CR) and FLC (94% CR, 73% non-CR), both P < 0.05 from baseline, there were no differences in wall thickness, EF, or diastolic function in either group. LS improved only in the CR group with notable improvement in apical to basal strain ratio (P < 0.05). Strain improvement and BNP reduction were correlated (R = 0.6, P < 0.01). Baseline global LS < -10.2% was associated with survival and proved superior to BNP and TnI. The addition of global LS to biomarkers identified the patients at highest risk of mortality.
Conclusion
These data suggest that LS is a sensitive measure of pre-treatment cardiac functional impairment in AL-CA, can predict survival over and above that of cardiac biomarkers, and detect early cardiac functional improvement following chemotherapy.</description><identifier>ISSN: 2047-2404</identifier><identifier>EISSN: 2047-2412</identifier><identifier>DOI: 10.1093/ehjci/jew298</identifier><identifier>PMID: 27965280</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Antineoplastic Combined Chemotherapy Protocols ; Biomarkers - blood ; Bortezomib - administration & dosage ; Boston ; Cardiomyopathies - complications ; Cardiomyopathies - diagnosis ; Cardiomyopathies - drug therapy ; Cohort Studies ; Echocardiography, Doppler, Color - methods ; Female ; Follow-Up Studies ; Heart Function Tests ; Hospitals, University ; Humans ; Immunoglobulin Light-chain Amyloidosis - complications ; Immunoglobulin Light-chain Amyloidosis - diagnosis ; Immunoglobulin Light-chain Amyloidosis - drug therapy ; Kaplan-Meier Estimate ; Male ; Melphalan - administration & dosage ; Middle Aged ; Prognosis ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Survival Analysis ; Treatment Outcome ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Left - etiology ; Ventricular Dysfunction, Left - mortality</subject><ispartof>European heart journal cardiovascular imaging, 2017-09, Vol.18 (9), p.1057-1064</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions, please email: journals.permissions@oup.com. 2016</rights><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-7ec8eb75bac7ed58866ee3fb9d96a07941978c60a3b1fd630604531eb7371cc53</citedby><cites>FETCH-LOGICAL-c361t-7ec8eb75bac7ed58866ee3fb9d96a07941978c60a3b1fd630604531eb7371cc53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27965280$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salinaro, Francesco</creatorcontrib><creatorcontrib>Meier-Ewert, Hans K.</creatorcontrib><creatorcontrib>Miller, Edward J.</creatorcontrib><creatorcontrib>Pandey, Shivda</creatorcontrib><creatorcontrib>Sanchorawala, Vaishali</creatorcontrib><creatorcontrib>Berk, John L.</creatorcontrib><creatorcontrib>Seldin, David C.</creatorcontrib><creatorcontrib>Ruberg, Frederick L.</creatorcontrib><title>Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis</title><title>European heart journal cardiovascular imaging</title><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><description>Abstract
Aims
To determine whether echocardiographic longitudinal systolic strain (LS) parameters identify short-term improvement following chemotherapy for light-chain (AL) cardiac amyloidosis (CA). Among patients with CA, standard echocardiographic measures are commonly unchanged at 1 year following successful chemotherapy, despite observed reductions in cardiac biomarkers.
Methods and results
We retrospectively identified 61 patients with AL-CA treated with high-dose melphalan or bortezomib-based regimens. Patients were classified by hematologic response at 1 year into two groups: complete response (CR; n = 18, or 30%) or non-CR (non-CR; n = 43, or 70%), and followed for 20 months. Serum free light chains (FLC), B-type natriuretic peptide (BNP), troponin I (TnI), and echocardiography including LS, were acquired at baseline and 1 year. Seven patients died (11.5%), all in the non-CR group (P < 0.01). At 1 year, while reductions were observed in BNP (44% CR, 18% non-CR) and FLC (94% CR, 73% non-CR), both P < 0.05 from baseline, there were no differences in wall thickness, EF, or diastolic function in either group. LS improved only in the CR group with notable improvement in apical to basal strain ratio (P < 0.05). Strain improvement and BNP reduction were correlated (R = 0.6, P < 0.01). Baseline global LS < -10.2% was associated with survival and proved superior to BNP and TnI. The addition of global LS to biomarkers identified the patients at highest risk of mortality.
Conclusion
These data suggest that LS is a sensitive measure of pre-treatment cardiac functional impairment in AL-CA, can predict survival over and above that of cardiac biomarkers, and detect early cardiac functional improvement following chemotherapy.</description><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols</subject><subject>Biomarkers - blood</subject><subject>Bortezomib - administration & dosage</subject><subject>Boston</subject><subject>Cardiomyopathies - complications</subject><subject>Cardiomyopathies - diagnosis</subject><subject>Cardiomyopathies - drug therapy</subject><subject>Cohort Studies</subject><subject>Echocardiography, Doppler, Color - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Function Tests</subject><subject>Hospitals, University</subject><subject>Humans</subject><subject>Immunoglobulin Light-chain Amyloidosis - complications</subject><subject>Immunoglobulin Light-chain Amyloidosis - diagnosis</subject><subject>Immunoglobulin Light-chain Amyloidosis - drug therapy</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Melphalan - administration & dosage</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Left - etiology</subject><subject>Ventricular Dysfunction, Left - mortality</subject><issn>2047-2404</issn><issn>2047-2412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQQC0Eoqh0Y0beAKmhdpzYyVhVfEmRWGCOHNtpXSV2ZDutuvPDSQl05Ja74d0bHgA3GD1ilJOF2myFXmzVPs6zM3AVo4RFcYLj89ONkgmYeb9Fw6QJTWJ8CSYxy2kaZ-gKfBXWrHXopTa8gf7gg220gD44rs0cCu6k5gLWvRFBWwN12zm7U60yYQ65kdD3bqd3w29tm8butVnD4BQPRwLaGjZ6vQmR2Aw6eL8sHk5K3h4aq6X12l-Di5o3Xs1-9xR8Pj99rF6j4v3lbbUsIkEoDhFTIlMVSysumJJpllGqFKmrXOaUI5YnOGeZoIiTCteSEkRRkhI8vBCGhUjJFMxHr3DWe6fqsnO65e5QYlQee5Y_Pcux54DfjnjXV62SJ_iv3gDcjYDtu_9V32wqgvE</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Salinaro, Francesco</creator><creator>Meier-Ewert, Hans K.</creator><creator>Miller, Edward J.</creator><creator>Pandey, Shivda</creator><creator>Sanchorawala, Vaishali</creator><creator>Berk, John L.</creator><creator>Seldin, David C.</creator><creator>Ruberg, Frederick L.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20170901</creationdate><title>Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis</title><author>Salinaro, Francesco ; Meier-Ewert, Hans K. ; Miller, Edward J. ; Pandey, Shivda ; Sanchorawala, Vaishali ; Berk, John L. ; Seldin, David C. ; Ruberg, Frederick L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-7ec8eb75bac7ed58866ee3fb9d96a07941978c60a3b1fd630604531eb7371cc53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Antineoplastic Combined Chemotherapy Protocols</topic><topic>Biomarkers - blood</topic><topic>Bortezomib - administration & dosage</topic><topic>Boston</topic><topic>Cardiomyopathies - complications</topic><topic>Cardiomyopathies - diagnosis</topic><topic>Cardiomyopathies - drug therapy</topic><topic>Cohort Studies</topic><topic>Echocardiography, Doppler, Color - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Function Tests</topic><topic>Hospitals, University</topic><topic>Humans</topic><topic>Immunoglobulin Light-chain Amyloidosis - complications</topic><topic>Immunoglobulin Light-chain Amyloidosis - diagnosis</topic><topic>Immunoglobulin Light-chain Amyloidosis - drug therapy</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Melphalan - administration & dosage</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><topic>Ventricular Dysfunction, Left - etiology</topic><topic>Ventricular Dysfunction, Left - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Salinaro, Francesco</creatorcontrib><creatorcontrib>Meier-Ewert, Hans K.</creatorcontrib><creatorcontrib>Miller, Edward J.</creatorcontrib><creatorcontrib>Pandey, Shivda</creatorcontrib><creatorcontrib>Sanchorawala, Vaishali</creatorcontrib><creatorcontrib>Berk, John L.</creatorcontrib><creatorcontrib>Seldin, David C.</creatorcontrib><creatorcontrib>Ruberg, Frederick L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>European heart journal cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Salinaro, Francesco</au><au>Meier-Ewert, Hans K.</au><au>Miller, Edward J.</au><au>Pandey, Shivda</au><au>Sanchorawala, Vaishali</au><au>Berk, John L.</au><au>Seldin, David C.</au><au>Ruberg, Frederick L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis</atitle><jtitle>European heart journal cardiovascular imaging</jtitle><addtitle>Eur Heart J Cardiovasc Imaging</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>18</volume><issue>9</issue><spage>1057</spage><epage>1064</epage><pages>1057-1064</pages><issn>2047-2404</issn><eissn>2047-2412</eissn><abstract>Abstract
Aims
To determine whether echocardiographic longitudinal systolic strain (LS) parameters identify short-term improvement following chemotherapy for light-chain (AL) cardiac amyloidosis (CA). Among patients with CA, standard echocardiographic measures are commonly unchanged at 1 year following successful chemotherapy, despite observed reductions in cardiac biomarkers.
Methods and results
We retrospectively identified 61 patients with AL-CA treated with high-dose melphalan or bortezomib-based regimens. Patients were classified by hematologic response at 1 year into two groups: complete response (CR; n = 18, or 30%) or non-CR (non-CR; n = 43, or 70%), and followed for 20 months. Serum free light chains (FLC), B-type natriuretic peptide (BNP), troponin I (TnI), and echocardiography including LS, were acquired at baseline and 1 year. Seven patients died (11.5%), all in the non-CR group (P < 0.01). At 1 year, while reductions were observed in BNP (44% CR, 18% non-CR) and FLC (94% CR, 73% non-CR), both P < 0.05 from baseline, there were no differences in wall thickness, EF, or diastolic function in either group. LS improved only in the CR group with notable improvement in apical to basal strain ratio (P < 0.05). Strain improvement and BNP reduction were correlated (R = 0.6, P < 0.01). Baseline global LS < -10.2% was associated with survival and proved superior to BNP and TnI. The addition of global LS to biomarkers identified the patients at highest risk of mortality.
Conclusion
These data suggest that LS is a sensitive measure of pre-treatment cardiac functional impairment in AL-CA, can predict survival over and above that of cardiac biomarkers, and detect early cardiac functional improvement following chemotherapy.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>27965280</pmid><doi>10.1093/ehjci/jew298</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Aged Antineoplastic Combined Chemotherapy Protocols Biomarkers - blood Bortezomib - administration & dosage Boston Cardiomyopathies - complications Cardiomyopathies - diagnosis Cardiomyopathies - drug therapy Cohort Studies Echocardiography, Doppler, Color - methods Female Follow-Up Studies Heart Function Tests Hospitals, University Humans Immunoglobulin Light-chain Amyloidosis - complications Immunoglobulin Light-chain Amyloidosis - diagnosis Immunoglobulin Light-chain Amyloidosis - drug therapy Kaplan-Meier Estimate Male Melphalan - administration & dosage Middle Aged Prognosis Retrospective Studies ROC Curve Sensitivity and Specificity Survival Analysis Treatment Outcome Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - mortality |
| title | Longitudinal systolic strain, cardiac function improvement, and survival following treatment of light-chain (AL) cardiac amyloidosis |
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