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Journal of Cardiovascular Magnetic Resonance

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Open Access 01-12-2017 | Research

Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis

Authors: Marco M. Ochs, Thomas Fritz, Nisha Arenja, Johannes Riffel, Florian Andre, Derliz Mereles, Fabian aus dem Siepen, Ute Hegenbart, Stefan Schönland, Hugo A. Katus, Matthias G. W. Friedrich, Sebastian J. Buss

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Abstract

Background

To compare the prognostic value of cardiac valve plane displacement (CVPD) on various locations in cardiac light chain (AL) amyloidosis.

Methods

Consecutive patients with biopsy-proven cardiac involvement in AL amyloidosis who had undergone cardiovascular magnetic resonance (CMR) between 2005 and 2014 in our institution, were retrospectively identified and data analyzed. The primary combined endpoint was all-cause mortality or heart transplantation. Systolic CVPD were obtained from standard cine bSSFP in 2-, 3- and 4-chamber views at anterior aortic plane systolic excursion (AAPSE); anterior, anterolateral, inferolateral, inferior, inferoseptal mitral (MAPSE); and lateral tricuspid (TAPSE) annular segments.

Results

We identified 68 patients (58 ± 10 years; 59% male). Median follow-up period was 1.2 years (IQR, 0.3-4.1). Significant differences in CVPD between patients who reached a primary endpoint (n = 44) and transplant-free survivors were found only for AAPSE (6.1 mm (IQR, 4.6-9.4) vs. 8.8 mm (IQR, 6.9-10.4); p = 0.02) and MAPSE_{anterolateral} (7.3 mm (IQR, 5.4-11.7) vs. 10.5 mm (IQR, 8.1-13.4); p = 0.03). AAPSE (χ² = 15.6; p = 0.0002) provided the best predictive value for transplant-free survival compared to all other valvular plane locations. A high-risk cutoff (AAPSE ≤ 7.6 mm) was calculated by ROC analysis to predict all-cause death or heart transplantation within 6 months from index examination (AUC = 0.80; CI: 0.68 to 0.89; p < 0.0001). AAPSE added incremental prognostic power to an imaging prediction model of late gadolinium enhancement and global longitudinal strain (GLS) (∆χ² = 5.8, p = 0.02) as well as to a clinical model including Karnofsky index and NT-proBNP (∆χ² = 6.2, p = 0.01).

Conclusion

In patients with cardiac involvement in AL amyloidosis, systolic CVPD obtained from standard long axis cine views appear to indicate outcome better, when obtained in the anterior aortic plane (AAPSE) and provide incremental prognostic value to LGE and strain measurements.

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Title: Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
Authors: Marco M. Ochs
Thomas Fritz
Nisha Arenja
Johannes Riffel
Florian Andre
Derliz Mereles
Fabian aus dem Siepen
Ute Hegenbart
Stefan Schönland
Hugo A. Katus
Matthias G. W. Friedrich
Sebastian J. Buss
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-017-0402-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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