Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis
This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further char...
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creator | Boldrini, Michele Cappelli, Francesco Chacko, Liza Restrepo-Cordoba, Maria Alejandra Lopez-Sainz, Angela Giannoni, Alberto Aimo, Alberto Baggiano, Andrea Martinez-Naharro, Ana Whelan, Carol Quarta, Cristina Passino, Claudio Castiglione, Vincenzo Chubuchnyi, Vladyslav Spini, Valentina Taddei, Claudia Vergaro, Giuseppe Petrie, Aviva Ruiz-Guerrero, Luis Moñivas, Vanessa Mingo-Santos, Susana Mirelis, Jesus G. Dominguez, Fernando Gonzalez-Lopez, Esther Perlini, Stefano Pontone, Gianluca Gillmore, Julian Hawkins, Philip N. Garcia-Pavia, Pablo Emdin, Michele Fontana, Marianna |
description | This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration.
Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool.
We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance.
A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e′ wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical–to–base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90).
Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
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doi_str_mv | 10.1016/j.jcmg.2019.10.011 |
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Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool.
We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance.
A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e′ wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical–to–base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90).
Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
[Display omitted]</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2019.10.011</identifier><identifier>PMID: 31864973</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Amyloid Neuropathies, Familial - diagnostic imaging ; Amyloid Neuropathies, Familial - pathology ; Amyloid Neuropathies, Familial - physiopathology ; Biopsy ; cardiac amyloidosis ; Cardiomyopathy, Hypertrophic - diagnostic imaging ; Diagnosis, Differential ; Echocardiography ; Europe ; Female ; global longitudinal strain ; Humans ; hypertrophy ; Immunoglobulin Light-chain Amyloidosis - diagnostic imaging ; Immunoglobulin Light-chain Amyloidosis - pathology ; Immunoglobulin Light-chain Amyloidosis - physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myocardium - pathology ; Predictive Value of Tests ; Ventricular Function, Left ; Ventricular Remodeling ; wall thickness</subject><ispartof>JACC. Cardiovascular imaging, 2020-04, Vol.13 (4), p.909-920</ispartof><rights>2020</rights><rights>Copyright © 2020. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-fa637cfc55fea97a414e520ddab35b410bb80df4d3c15463810a7c525213c4b3</citedby><cites>FETCH-LOGICAL-c466t-fa637cfc55fea97a414e520ddab35b410bb80df4d3c15463810a7c525213c4b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1936878X19310071$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31864973$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boldrini, Michele</creatorcontrib><creatorcontrib>Cappelli, Francesco</creatorcontrib><creatorcontrib>Chacko, Liza</creatorcontrib><creatorcontrib>Restrepo-Cordoba, Maria Alejandra</creatorcontrib><creatorcontrib>Lopez-Sainz, Angela</creatorcontrib><creatorcontrib>Giannoni, Alberto</creatorcontrib><creatorcontrib>Aimo, Alberto</creatorcontrib><creatorcontrib>Baggiano, Andrea</creatorcontrib><creatorcontrib>Martinez-Naharro, Ana</creatorcontrib><creatorcontrib>Whelan, Carol</creatorcontrib><creatorcontrib>Quarta, Cristina</creatorcontrib><creatorcontrib>Passino, Claudio</creatorcontrib><creatorcontrib>Castiglione, Vincenzo</creatorcontrib><creatorcontrib>Chubuchnyi, Vladyslav</creatorcontrib><creatorcontrib>Spini, Valentina</creatorcontrib><creatorcontrib>Taddei, Claudia</creatorcontrib><creatorcontrib>Vergaro, Giuseppe</creatorcontrib><creatorcontrib>Petrie, Aviva</creatorcontrib><creatorcontrib>Ruiz-Guerrero, Luis</creatorcontrib><creatorcontrib>Moñivas, Vanessa</creatorcontrib><creatorcontrib>Mingo-Santos, Susana</creatorcontrib><creatorcontrib>Mirelis, Jesus G.</creatorcontrib><creatorcontrib>Dominguez, Fernando</creatorcontrib><creatorcontrib>Gonzalez-Lopez, Esther</creatorcontrib><creatorcontrib>Perlini, Stefano</creatorcontrib><creatorcontrib>Pontone, Gianluca</creatorcontrib><creatorcontrib>Gillmore, Julian</creatorcontrib><creatorcontrib>Hawkins, Philip N.</creatorcontrib><creatorcontrib>Garcia-Pavia, Pablo</creatorcontrib><creatorcontrib>Emdin, Michele</creatorcontrib><creatorcontrib>Fontana, Marianna</creatorcontrib><title>Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration.
Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool.
We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance.
A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e′ wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical–to–base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90).
Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
[Display omitted]</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amyloid Neuropathies, Familial - diagnostic imaging</subject><subject>Amyloid Neuropathies, Familial - pathology</subject><subject>Amyloid Neuropathies, Familial - physiopathology</subject><subject>Biopsy</subject><subject>cardiac amyloidosis</subject><subject>Cardiomyopathy, Hypertrophic - diagnostic imaging</subject><subject>Diagnosis, Differential</subject><subject>Echocardiography</subject><subject>Europe</subject><subject>Female</subject><subject>global longitudinal strain</subject><subject>Humans</subject><subject>hypertrophy</subject><subject>Immunoglobulin Light-chain Amyloidosis - diagnostic imaging</subject><subject>Immunoglobulin Light-chain Amyloidosis - pathology</subject><subject>Immunoglobulin Light-chain Amyloidosis - physiopathology</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Predictive Value of Tests</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Remodeling</subject><subject>wall thickness</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1OwzAQRi0EoqVwARYoSzYJduw4icSmKuVHKkKILthZzthpHSV1sROk3oazcDIStbBkNaNPbz5pHkKXBEcEE35TRRU0qyjGJO-DCBNyhMYkS3mYJjk57vec8jBLs_cROvO-wphjztJTNKIk4yxP6Ri9Pnd1a7bSyUa3zkAwh7UF6ZSxKye3613wBtZpH5TWBe1aB3dGrjbWGx_YMpgNoITvr2mzq61RQ36OTkpZe31xmBO0vJ8vZ4_h4uXhaTZdhMA4b8NScppCCUlSapmnkhGmkxgrJQuaFIzgosiwKpmiQBLGaUawTCGJk5hQYAWdoOt97dbZj077VjTGg65rudG28yKmtP83zuK8R-M9Cs5673Qpts400u0EwWIwKSoxmBSDySHrTfZHV4f-rmi0-jv5VdcDt3tA909-Gu2EB6M3oJVxGlqhrPmv_wfBDYZF</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Boldrini, Michele</creator><creator>Cappelli, Francesco</creator><creator>Chacko, Liza</creator><creator>Restrepo-Cordoba, Maria Alejandra</creator><creator>Lopez-Sainz, Angela</creator><creator>Giannoni, Alberto</creator><creator>Aimo, Alberto</creator><creator>Baggiano, Andrea</creator><creator>Martinez-Naharro, Ana</creator><creator>Whelan, Carol</creator><creator>Quarta, Cristina</creator><creator>Passino, Claudio</creator><creator>Castiglione, Vincenzo</creator><creator>Chubuchnyi, Vladyslav</creator><creator>Spini, Valentina</creator><creator>Taddei, Claudia</creator><creator>Vergaro, Giuseppe</creator><creator>Petrie, Aviva</creator><creator>Ruiz-Guerrero, Luis</creator><creator>Moñivas, Vanessa</creator><creator>Mingo-Santos, Susana</creator><creator>Mirelis, Jesus G.</creator><creator>Dominguez, Fernando</creator><creator>Gonzalez-Lopez, Esther</creator><creator>Perlini, Stefano</creator><creator>Pontone, Gianluca</creator><creator>Gillmore, Julian</creator><creator>Hawkins, Philip N.</creator><creator>Garcia-Pavia, Pablo</creator><creator>Emdin, Michele</creator><creator>Fontana, Marianna</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202004</creationdate><title>Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis</title><author>Boldrini, Michele ; Cappelli, Francesco ; Chacko, Liza ; Restrepo-Cordoba, Maria Alejandra ; Lopez-Sainz, Angela ; Giannoni, Alberto ; Aimo, Alberto ; Baggiano, Andrea ; Martinez-Naharro, Ana ; Whelan, Carol ; Quarta, Cristina ; Passino, Claudio ; Castiglione, Vincenzo ; Chubuchnyi, Vladyslav ; Spini, Valentina ; Taddei, Claudia ; Vergaro, Giuseppe ; Petrie, Aviva ; Ruiz-Guerrero, Luis ; Moñivas, Vanessa ; Mingo-Santos, Susana ; Mirelis, Jesus G. ; Dominguez, Fernando ; Gonzalez-Lopez, Esther ; Perlini, Stefano ; Pontone, Gianluca ; Gillmore, Julian ; Hawkins, Philip N. ; Garcia-Pavia, Pablo ; Emdin, Michele ; Fontana, Marianna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-fa637cfc55fea97a414e520ddab35b410bb80df4d3c15463810a7c525213c4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amyloid Neuropathies, Familial - diagnostic imaging</topic><topic>Amyloid Neuropathies, Familial - pathology</topic><topic>Amyloid Neuropathies, Familial - physiopathology</topic><topic>Biopsy</topic><topic>cardiac amyloidosis</topic><topic>Cardiomyopathy, Hypertrophic - diagnostic imaging</topic><topic>Diagnosis, Differential</topic><topic>Echocardiography</topic><topic>Europe</topic><topic>Female</topic><topic>global longitudinal strain</topic><topic>Humans</topic><topic>hypertrophy</topic><topic>Immunoglobulin Light-chain Amyloidosis - diagnostic imaging</topic><topic>Immunoglobulin Light-chain Amyloidosis - pathology</topic><topic>Immunoglobulin Light-chain Amyloidosis - physiopathology</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardium - pathology</topic><topic>Predictive Value of Tests</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Remodeling</topic><topic>wall thickness</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boldrini, Michele</creatorcontrib><creatorcontrib>Cappelli, Francesco</creatorcontrib><creatorcontrib>Chacko, Liza</creatorcontrib><creatorcontrib>Restrepo-Cordoba, Maria Alejandra</creatorcontrib><creatorcontrib>Lopez-Sainz, Angela</creatorcontrib><creatorcontrib>Giannoni, Alberto</creatorcontrib><creatorcontrib>Aimo, Alberto</creatorcontrib><creatorcontrib>Baggiano, Andrea</creatorcontrib><creatorcontrib>Martinez-Naharro, Ana</creatorcontrib><creatorcontrib>Whelan, Carol</creatorcontrib><creatorcontrib>Quarta, Cristina</creatorcontrib><creatorcontrib>Passino, Claudio</creatorcontrib><creatorcontrib>Castiglione, Vincenzo</creatorcontrib><creatorcontrib>Chubuchnyi, Vladyslav</creatorcontrib><creatorcontrib>Spini, Valentina</creatorcontrib><creatorcontrib>Taddei, Claudia</creatorcontrib><creatorcontrib>Vergaro, Giuseppe</creatorcontrib><creatorcontrib>Petrie, Aviva</creatorcontrib><creatorcontrib>Ruiz-Guerrero, Luis</creatorcontrib><creatorcontrib>Moñivas, Vanessa</creatorcontrib><creatorcontrib>Mingo-Santos, Susana</creatorcontrib><creatorcontrib>Mirelis, Jesus G.</creatorcontrib><creatorcontrib>Dominguez, Fernando</creatorcontrib><creatorcontrib>Gonzalez-Lopez, Esther</creatorcontrib><creatorcontrib>Perlini, Stefano</creatorcontrib><creatorcontrib>Pontone, Gianluca</creatorcontrib><creatorcontrib>Gillmore, Julian</creatorcontrib><creatorcontrib>Hawkins, Philip N.</creatorcontrib><creatorcontrib>Garcia-Pavia, Pablo</creatorcontrib><creatorcontrib>Emdin, Michele</creatorcontrib><creatorcontrib>Fontana, Marianna</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boldrini, Michele</au><au>Cappelli, Francesco</au><au>Chacko, Liza</au><au>Restrepo-Cordoba, Maria Alejandra</au><au>Lopez-Sainz, Angela</au><au>Giannoni, Alberto</au><au>Aimo, Alberto</au><au>Baggiano, Andrea</au><au>Martinez-Naharro, Ana</au><au>Whelan, Carol</au><au>Quarta, Cristina</au><au>Passino, Claudio</au><au>Castiglione, Vincenzo</au><au>Chubuchnyi, Vladyslav</au><au>Spini, Valentina</au><au>Taddei, Claudia</au><au>Vergaro, Giuseppe</au><au>Petrie, Aviva</au><au>Ruiz-Guerrero, Luis</au><au>Moñivas, Vanessa</au><au>Mingo-Santos, Susana</au><au>Mirelis, Jesus G.</au><au>Dominguez, Fernando</au><au>Gonzalez-Lopez, Esther</au><au>Perlini, Stefano</au><au>Pontone, Gianluca</au><au>Gillmore, Julian</au><au>Hawkins, Philip N.</au><au>Garcia-Pavia, Pablo</au><au>Emdin, Michele</au><au>Fontana, Marianna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2020-04</date><risdate>2020</risdate><volume>13</volume><issue>4</issue><spage>909</spage><epage>920</epage><pages>909-920</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration.
Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool.
We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance.
A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e′ wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical–to–base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90).
Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31864973</pmid><doi>10.1016/j.jcmg.2019.10.011</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Aged, 80 and over Amyloid Neuropathies, Familial - diagnostic imaging Amyloid Neuropathies, Familial - pathology Amyloid Neuropathies, Familial - physiopathology Biopsy cardiac amyloidosis Cardiomyopathy, Hypertrophic - diagnostic imaging Diagnosis, Differential Echocardiography Europe Female global longitudinal strain Humans hypertrophy Immunoglobulin Light-chain Amyloidosis - diagnostic imaging Immunoglobulin Light-chain Amyloidosis - pathology Immunoglobulin Light-chain Amyloidosis - physiopathology Magnetic Resonance Imaging Male Middle Aged Myocardium - pathology Predictive Value of Tests Ventricular Function, Left Ventricular Remodeling wall thickness |
title | Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis |
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