Alterations in multi-layer strain in AL amyloidosis

Background Cardiac involvement in AL amyloidosis portends a poor prognosis. 2D-speckle tracking echocardiography (2D-STE) strain can identify subclinical cardiac involvement. This study performed multilayer and multiplanar 2D-STE myocardial strain analysis. Methods We compared 75 AL amyloidosis patients to 49 hypertensive patients and 49 healthy controls. Longitudinal strain was obtained from epicardial, mid-myocardial and endocardial layers; segmental strain was measured from mid-myocardial basal, mid and apical segments. Results Global longitudinal strain was reduced in epicardial (-14.3 +/- -4.0% vs. -17.4 +/- 2.2% vs. -17.5 +/- -2.0%, p < .001), mid-myocardial (-16.3 +/- -4.5% vs. -19.7 +/- 2.5% vs. -19.7 +/- -2.2%, p < .001) and endocardial layers (-18.7 +/- -4.9% vs. -22.2 +/- 3.0% vs. -22.3 +/- -2.6%, p < .001) in amyloid patients compared to hypertensive and healthy controls. Segmental strain confirmed significant reduction in basal (-11.2 +/- -3.9% vs. -17.6 +/- 2.7% vs. -20.9 +/- -3.4%, p < .001) and mid (-14.8 +/- -4.3% vs. -19.2 +/- 2.5% vs. -19.6 +/- -2.2%, p < .001) LV segments in the AL amyloid group. Receiver operating curve analysis demonstrated that an optimal cut-off of -16% for basal segmental strain better differentiated AL amyloid from hypertensive group (sensitivity 96%, specificity 70%, AUC 0.93), compared to relative apical sparing (AUC of 0.85). Conclusion Strain demonstrated myocardial involvement in all layers in AL amyloidosis, with reduced basal segmental longitudinal strain a likely marker of early disease.

Automated summary

This study utilized 2D-STE myocardial strain analysis to compare cardiac involvement in AL amyloidosis patients, hypertensive patients, and healthy controls. The results showed significant reductions in global and segmental strain in AL amyloidosis patients, with basal segmental longitudinal strain potentially serving as an early marker of the disease.