Diagnostic And Prognostic Value Of Three Dimensional Speckle Tracking Imaging In Cardiac Amyloidosis

Objectives:To differentiate cardiac amyloidosis(CA)with preserved LVEF and hypertrophy cardiomyopathy(HCM),and evaluate the prognosis of cardiac amyloidosis by using the strain index of three dimensional speckle tracking imaging(3D-STI).Methods:A total of 32 patients with pathologically confirmed cardiac amyloidosis with preserved LVEF and 34 patients with hypertrophic cardiomyopathy and 16 normal controls were enrolled in the First Affiliated Hospital of Zhejiang University from June 2013 to January 2018,college of Medicine.The color Doppler echocardiography and three-dimensional speckle tracking echocardiography were used to measure each group,and the Logistic regression equation was used to analyze the index differences.The cut-off values were analyzed using the Receiver Operating Characteristic(ROC),and Kaplan-Meier and Cox were used for survival regression analysis.Results:The globe radial strain(GRS)((16±7%vs23±9%)、Left ventricular wall peak time difference(PSD)(52±17vs77±25)ms,Sokolow-Lyon index(20±6vs34±14)mm were having significantly difference by3D-STI,which had been high sensitivity and specificity value.The area under the ROC curve of GRS is 0.757,PSD is 0.812,Sokolow-Lyon index is 0.832.Therefore,the globe radial strain<19.4%combined with PSD<51ms and Sokolowlyon index<27.5mm were indicators having high sensitivity and specificity for diagnosing CA.3D-STI measured the overall apical/basal longitudinal strain of the CA group and the HCM group(1.49±0.65vs0.93±0.5),and the overall apex/(basal+middle)longitudinal strain was compared(0.59±0.15vs0.44±0.19),which were higher than HCM group;The septum apical/basal longitudinal strain of CA group and control group were compared as(3.05±1.49vs1.4±0.34),septum apex/(basal+middle)longitudinal strain(1.09±0.35vs0.64±0.12),which were higher than the control group;The overall apical/basal longitudinal strain of the HCM group and the control group were compared as(0.93±0.5vs1.24±0.25),and the overall apex/(basal+middle)longitudinal strain was compared as(0.44±0.19vs0.59±0.11),which were lower than the control group.This strain ratio has significant significance for distinguishing between the CA group,the HCM group and the control group.In addition,the area strain at-19%and atrial septal thickness at 10.5mm had significant Prognosis significance.Conclusions:Unlike echocardiographic parameters,use of 3D-STI strain indicators serve as useful tool for the differential diagnosis of cardiac amyloidosis from hypertrophic cardiomyopathy,such as the globe radial strain and Left ventricular wall peak time difference,reflecting obvious diagnostic advantages.In addition,combination of area strain could be used to predict the prognosis,which were having great significance.And for the prognostic evaluation of cardiac amyloidosis with preserved LVEF,combination of area strain and atrial septal thickness has a unique predictive significance.