• Vanessa Moñivas Palomero, Alejandro Durante-Lopez, Mario Torres Sanabria, CuberoJavier SegoviaJSDepartment of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain., Jesús González-Mirelis, Lopez-IborJorge VazquezJVDepartment of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain., Sara M Navarro Rico, Isabel Krsnik, Fernando Dominguez, Alejandro Martinez Mingo, Francisco J Hernandez-Perez, Gibanel Cavero, and SantosSusana MingoSMDepartment of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain. Electronic address: susana.mingo.sm@gmail.com..
• Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain.
• J Am Soc Echocardiogr. 2019 Jul 1; 32 (7): 845-853.e1.

BackgroundCardiac amyloidosis (CA) causes restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic light-chain CA (ALCA) and transthyretin-derived CA (either wild type transthyretin amyloidosis [TTRwt] or mutant transthyretin amyloidosis [TTRm]). Left ventricular (LV) apical sparing has been extensively studied using speckle-tracking echocardiography for diagnosis, but the right ventricular (RV) deformation pattern has not been described. The aims of this study were to characterize RV involvement in patients with CA and to identify parameters that may help in the differential diagnosis between ALCA and transthyretin-derived CA subtypes.MethodsSeventy-eight patients with CA (47 with ALCA, 20 with TTRwt, and 11 with TTRm) and 24 healthy control subjects were included. Global longitudinal strain (GLS) was analyzed in 16 LV and six RV segments. LV and RV apical ratios (ARs) were obtained. GLS was expressed as an absolute value.ResultsLV GLS and free-wall RV longitudinal strain were impaired in all patients (LV GLS: 11.9 ± 2.9% in ALCA, 12.5 ± 3.8% in TTRwt, 14.9 ± 2.7% in TTRm, and 21.9 ± 2.6% in control subjects [P < .01]; free-wall RV longitudinal strain: 13.1 ± 6.8%, 14.9 ± 4.5%, 17.2 ± 3.4%, and 22.1 ± 3.1%, respectively [P < .01]). LV and RV ARs were higher in ALCA compared with both TTRwt, TTRm, and control subjects (LV AR: 1.1 ± 0.2, 0.8 ± 0.2, 0.9 ± 0.1, and 0.7 ± 0.1, respectively [P < .001]; RV AR: 1.1 ± 0.2, 0.6 ± 0.2, 0.6 ± 0.1, and 0.6 ± 0.1, respectively [P < .001]). Cutoff values of LV AR > 0.96 and RV AR > 0.8 showed high accuracy to differentiate between ALCA and transthyretin-derived CA.ConclusionsRV dysfunction is common in patients with CA. Analysis of RV strain showed an apical sparing pattern, as previously described in the left ventricle, with a higher AR as a specific finding in patients with ALCA. RV AR may be a parameter that can differentiate the subtypes of amyloidosis on the basis of speckle-tracking echocardiographic analysis.Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

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