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

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) betwee...

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Autores principales: Ochs, Marco M., Fritz, Thomas, Arenja, Nisha, Riffel, Johannes, Andre, Florian, Mereles, Derliz, Siepen, Fabian aus dem, Hegenbart, Ute, Schönland, Stefan, Katus, Hugo A., Friedrich, Matthias G. W., Buss, Sebastian J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680757/
https://www.ncbi.nlm.nih.gov/pubmed/29121956
http://dx.doi.org/10.1186/s12968-017-0402-2
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author Ochs, Marco M.
Fritz, Thomas
Arenja, Nisha
Riffel, Johannes
Andre, Florian
Mereles, Derliz
Siepen, Fabian aus dem
Hegenbart, Ute
Schönland, Stefan
Katus, Hugo A.
Friedrich, Matthias G. W.
Buss, Sebastian J.
author_facet Ochs, Marco M.
Fritz, Thomas
Arenja, Nisha
Riffel, Johannes
Andre, Florian
Mereles, Derliz
Siepen, Fabian aus dem
Hegenbart, Ute
Schönland, Stefan
Katus, Hugo A.
Friedrich, Matthias G. W.
Buss, Sebastian J.
author_sort Ochs, Marco M.
collection PubMed
description 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 (χ(2) = 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) (∆χ(2) = 5.8, p = 0.02) as well as to a clinical model including Karnofsky index and NT-proBNP (∆χ(2) = 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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spelling pubmed-56807572017-11-17 Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis Ochs, Marco M. Fritz, Thomas Arenja, Nisha Riffel, Johannes Andre, Florian Mereles, Derliz Siepen, Fabian aus dem Hegenbart, Ute Schönland, Stefan Katus, Hugo A. Friedrich, Matthias G. W. Buss, Sebastian J. J Cardiovasc Magn Reson Research 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 (χ(2) = 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) (∆χ(2) = 5.8, p = 0.02) as well as to a clinical model including Karnofsky index and NT-proBNP (∆χ(2) = 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. BioMed Central 2017-11-09 /pmc/articles/PMC5680757/ /pubmed/29121956 http://dx.doi.org/10.1186/s12968-017-0402-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Ochs, Marco M.
Fritz, Thomas
Arenja, Nisha
Riffel, Johannes
Andre, Florian
Mereles, Derliz
Siepen, Fabian aus dem
Hegenbart, Ute
Schönland, Stefan
Katus, Hugo A.
Friedrich, Matthias G. W.
Buss, Sebastian J.
Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
title Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
title_full Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
title_fullStr Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
title_full_unstemmed Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
title_short Regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
title_sort regional differences in prognostic value of cardiac valve plane displacement in systemic light-chain amyloidosis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5680757/
https://www.ncbi.nlm.nih.gov/pubmed/29121956
http://dx.doi.org/10.1186/s12968-017-0402-2
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