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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Veröffentlicht in:JACC. Cardiovascular imaging 2020-04, Vol.13 (4), p.909-920
Hauptverfasser: 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
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container_end_page 920
container_issue 4
container_start_page 909
container_title JACC. Cardiovascular imaging
container_volume 13
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. [Display omitted]
doi_str_mv 10.1016/j.jcmg.2019.10.011
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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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Cardiovascular imaging, 2020-04, Vol.13 (4), p.909-920</ispartof><rights>2020</rights><rights>Copyright © 2020. 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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. 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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. 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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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identifier ISSN: 1936-878X
ispartof JACC. Cardiovascular imaging, 2020-04, Vol.13 (4), p.909-920
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1876-7591
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source MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals
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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