Biventricular Assessment Of Cardiac Amyloidosis Using 2D Speckle Tracking Imaging:Differentiation From Non Obstructive Hypertrophic Cardiomyopathy

Objective:The present study was to evaluate biventricular function using two-dimensional speckle tracking imaging(2D-STI)inpatients with cardiac amyloidosis(CA),and to explore the value of left ventricular and right ventricular strain parameters in the diagnosis of CA and differential diagnosis with non obstructive hypertrophic cardiomyopathy(NOHCM).Methods:A total of 21 patients with cardiac amyloidosis(CA)admitted to Fuwai Hospital,Chinese Academy of Medical Sciences from January 2021 to March 2023 were retrospectively collected,22 patients with NOHCM admitted and confirmed at the same time were enrolled,and 23 healthy controls were enrolled for outpatient physical examination at the same time.Age,gender,height,weight,and body mass index(BMI)between each group were matched.Collecting general baseline clinical data of each group of patients.Conventional two-dimensional echocardiography and 2D-STI technology were used to measure conventional parameters and performed strain analysis of biventricles of study subjects.Obtain the overall strain parameters of the left ventricle,strain parameters of each segment of the left ventricular wall,and strain parameters of the right ventricle.Analyze the differences in general clinical data,two-dimensional echocardiography,and strain parameters between groups,and use logistic regression method to analyze the differences in indicators.Results:(1)In this study,the left atrial diameter(LAd),left ventricular posterior wall thickness(LVPWt),E peak,E/A,E/e’ and tricuspid valve annular plane systolic excursion(TAPSE)of patients in CA group were significantly higher than those in NOHCM group and normal control group(P<0.05).The e ’were significantly reduced compared to the NOHCM group and the normal control group(P<0.05),while the LVEF of the NOHCM group increased compared to the normal control group,with a statistically significant difference(P<0.05).(2)The left ventricular strain parameters of CA patients were significantly reduced compared to the NOHCM group and the normal control group,and the difference was statistically significant(P<0.05).Through one-way logistic regression analysis,it was closely related to the diagnosis of CA and can be used as a differential between the CA group and the NOHCM group.The left ventricular relative apical strain[apical LS/(basal LS+mid LS)]in the CA group was higher than that in the NOHCM group(1.30 ± 0.43 vs 0.69 ± 0.26),and the difference was statistically significant(P<0.05).This special strain pattern has significant significance in the differential diagnosis of the CA and NOHCM groups(P<0.05),and can be used as a differential indicator between the CA and NOHCM groups.(3)The right ventricular strain parameters of the CA group were significantly reduced compared to the NOHCM group and the normal control group,and the difference was statistically significant.Through oneway logistic regression analysis,it was closely related to the diagnosis of CA and can be used as a differential indicator between the CA group and the NOHCM group.Incorporating a multivariate logistic analysis model,the right ventricular free wall longitudinal strain(RVFWS)was independently correlated with the diagnosis of CA.Conclusion:For the population included in this study,the application of 2D STI technology can non-invasive and quantitatively detect and evaluate the impairment of biventricular function in CA patients.The combination of reduced LVGLS,"relative apical sparing" strain pattern,and reduced right ventricular strain is helpful in the differential diagnosis of CA and NOHCM.2D-STI strain parameters have a significant advantage over conventional echocardiography parameters in evaluating biventricular function in patients with CA.RVFWS is independently associated with the diagnosis of CA.