Abstract
Background
Light-chain amyloidosis (AL) is a plasma cell disorder characterized by the extracellular
deposition of insoluble fibril-forming monoclonal immunoglobulin, aggregating in heart
and leading to cardiac amyloidosis (CA). Transthoracic echocardiography is a noninvasive
method used for the evaluation of cardiac diastolic dysfunction. The left atrium (LA)
plays an important role in modulating cardiovascular performance, with its function
participating left ventricular filling and its size being affected by diastolic function.
Therefore, we aimed to assess prognostic values of LA size measured by a simple echocardiographic
parameter, LA diameter indexed to body surface area, in CA and to explore risk factors
associated with LA enlargement as well as the incidence of severe heart failure (HF).
Materials and Methods
A retrospective analysis of echocardiography of patients with biopsy-proven cardiac
AL amyloidosis was conducted. LA enlargement was defined as LA diameter indexed to
body surface area greater than 23 mm/m2.
Results
A total of 104 patients with CA were included in the final analysis, 61 (58.7%) of
which showed a presentation of LA enlargement. Age, New York Heart Association, ejection
fraction and early-to-atrial transmitral flow velocity ratio were independently associated
with LA enlargement. During a mean follow-up period of 39 months, LA enlargement was
strongly related with all-cause mortality (hazard ratio = 1.94; 95% CI: 1.14-3.29;
P = 0.015) and increased risk of severe HF (hazard ratio = 2.18; 95% CI: 1.12-4.23;
P = 0.022).
Conclusions
In cardiac AL amyloidosis, age and early-to-atrial transmitral flow velocity ratio
were main independent risk factors with regard to LA enlargement. LA enlargement was
strongly associated with incidence of severe HF and was also a significant predictor
of all-cause mortality.
Key Indexing Terms
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References
- Cardiac amyloidosis: the great pretender.Heart Fail Rev. 2015; 20: 117-124
- Emerging advances in the management of cardiac amyloidosis.Curr Cardiol Rep. 2015; 17: 1-9
- Infiltrative cardiomyopathies. Clinical medicine insights.Cardiology. 2015; 9: 29
- Cardiac amyloidosis: updates in diagnosis and management.Arch Cardiovasc Dis. 2013; 106: 528-540
- Prognostic value of depressed midwall systolic function in cardiac light-chain amyloidosis.J Hypertens. 2014; 32: 1121-1131
- Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications.Am Heart J. 2008; 156: 1056-1064
- Left atrial size.J Am Coll Cardiol. 2006; 47: 2357-2363
- A comparison of immunohistochemistry and mass spectrometry for determining the amyloid fibril protein from formalin-fixed biopsy tissue.J Clin Pathol. 2015; 68: 314-317
- Diagnostic value of poor R‐wave progression in electrocardiograms for diabetic cardiomyopathy in type 2 diabetic patients.Clin Cardiol. 2010; 33: 559-564
- Correlation of postmortem anatomic findings with electrocardiographic changes in patients with myocardial infarction: retrospective study of patients with typical anterior and posterior infarcts.Circulation. 1977; 55: 279-285
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging.J Am Soc Echocardiog. 2015; 28: 1-39
- Left atrial physiology and pathophysiology: role of deformation imaging.World J Cardiol. 2015; 7: 299
- Changes in regional left atrial function with aging: evaluation by Doppler tissue imaging.Eur J Echocardiogr. 2003; 4: 92-100
- Left atrium function assessment by echocardiography-physiological and clinical implications.Med Ultrason. 2014; 16: 152-159
- Predictors of clinical outcomes in elderly patients with heart failure.Eur J Heart Fail. 2011; 13: 528-536
- Clinical utility and prognostic value of left atrial volume assessment by cardiovascular magnetic resonance in non‐ischaemic dilated cardiomyopathy.Eur J Heart Fail. 2013; 15: 660-670
- Predictors and prognostic value of left atrial remodelling after acute myocardial infarction.Open Heart. 2015; 2: e000223
- Measurement of myocardial extracellular volume fraction by using equilibrium contrast-enhanced CT: validation against histologic findings.Radiology. 2013; 269: 396-403
- Comparison of different types of cardiac amyloidosis by cardiac magnetic resonance imaging.Amyloid. 2015; 22: 132-141
Article info
Footnotes
☆The authors declare that there is no conflict of interest.
☆☆This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.
Identification
Copyright
© 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
