Arq. Bras. Cardiol. 2018; 111(3): 384-391

Right Atrial Deformation Analysis in Cardiac Amyloidosis – Results from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study

Attila Nemes, Dóra Földeák, Péter Domsik, Anita Kalapos, Árpád Kormányos, Zita Borbényi, Tamás Forster

DOI: 10.5935/abc.20180150

This Original Article is referred by the Short Editorial "Three-dimensional Speckle Tracking Echocardiography in Amyloidosis: A New Assessment Method for a Rare Disease".

Abstract

Background:

Light-chain (AL) cardiac amyloidosis (CA) is characterized by fibril deposits, which are composed of monoclonal immunoglobulin light chains. The right ventricle is mostly involved in AL-CA and impairment of its function is a predictor of worse prognosis.

Objectives:

To characterize the volumetric and functional properties of the right atrium (RA) in AL-CA by three-dimensional speckle-tracking echocardiography (3DSTE).

Methods:

A total of 16 patients (mean age: 64.5 ± 10.1 years, 11 males) with AL-CA were examined. Their results were compared to that of 15 age- and gender-matched healthy controls (mean age: 58.9 ± 6.9 years, 8 males). All cases have undergone complete two-dimensional Doppler and 3DSTE. A two-tailed p value of less than 0.05 was considered statistically significant.

Results:

Significant differences could be demonstrated in RA volumes respecting cardiac cycle. Total (19.2 ± 9.3% vs. 27.9 ± 10.7%, p = 0.02) and active atrial emptying fractions (12.1 ± 8.1 vs. 18.6 ± 9.8%, p = 0.05) were significantly decreased in AL-CA patients. Peak global (16.7 ± 10.3% vs. 31.2 ± 19.4%, p = 0.01) and mean segmental (24.3 ± 11.1% vs. 38.6 ± 17.6%, p =0.01) RA area strains, together with some circumferential, longitudinal and segmental area strain parameters, proved to be reduced in patients with AL-CA. Global longitudinal (4.0 ± 5.2% vs. 8.2 ± 5.5%, p = 0.02) and area (7.8 ± 8.1% vs. 15.9 ± 10.3%, p = 0.03) strains at atrial contraction and some circumferential and area strain parameters at atrial contraction were reduced in AL-CA patients.

Conclusion:

Significantly increased RA volumes and deteriorated RA functions could be demonstrated in AL-CA.