70912
document
Visual Assessment of Relative Apical Sparing Pattern Is More Useful Than Quantitative Assessment for Diagnosing Cardiac Amyloidosis in Borderline or Mildly Increased Left Ventricular Wall Thickness . BACKGROUND Relative apical sparing pattern of longitudinal strain ( RapSP-LS ) was suggested in advanced cardiac amyloidosis ( CA ) . It is unclear whether it is present in less advanced CA . METHODS AND RESULTS Patients with presumptive diagnosis of CA and mean left ventricular wall thickness ( LVWT ) ≤14 mm were recruited . Apart from RapSP-LS visually identified , relative apical longitudinal strain index ( RapLSI ) was defined as [ average apical LS/ ( average basal LS+average mid-ventricle LS ) ] . Among 119 patients included , 47 were finally diagnosed with CA . RapLSI was higher in the CA group compared to other causes of increased mean LVWT ( P < 0.001 ) , but with a significant range of overlap noted . In contrast , RapSP-LS visually assessed was noted in most CA patients ( 31/47 , 66.0 % ) except in those with preserved LV ejection fraction , normal LVWT , and mildly decreased global LS , suggesting least advanced CA . On multivariate analysis of the added diagnostic role of RapSP-LS or RapLSI on top of clinical , electrocardiographic , and conventional echocardiographic parameters , addition of RapLSI produced only borderline increase in area under the curve of the multivariate model ( P=0.05 ) , whereas addition of RapSP-LS significantly increased it ( P < 0.001 ) . CONCLUSIONS Visual identification of RapSP-LS is useful in terms of added diagnostic value compared with quantitative calculation of RapLSI . Its clinical application , however , should be used with caution in patients with less advanced CA .
70913
Intervention_Educational
Visual Assessment of Relative Apical Sparing Pattern
70914
Intervention_Educational
Relative apical sparing pattern of longitudinal strain
70915
Intervention_Physical
( RapSP-LS )
70916
Outcome_Physical
CA . RapLSI
70917
Outcome_Physical
increased mean LVWT
70918
Outcome_Physical
added diagnostic value
70919
Participant_Condition
Borderline or Mildly Increased Left Ventricular Wall Thickness .
70920
Participant_Condition
Patients with presumptive diagnosis of CA and mean left ventricular wall thickness ( LVWT ) ≤14 mm were recruited
70921
Participant_Sample-size
119
70922
Participant_Sample-size
47
70923
Participant_Condition
CA
70924
Participant_Condition
in patients with less advanced CA