通过心脏弹性成像评估转甲状腺素淀粉样变性患者的右心室心肌僵硬度。

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2024-10-10 DOI:10.1016/j.cpcardiol.2024.102867

Aristóteles Comte de Alencar Neto MD, PhD , Natália de Melo Pereira MD , Cristhian Espinoza Romero MD, MSc , Caio Rebouças Fonseca Cafezeiro MD, PhD , Bruno Vaz Kerges Bueno MD , Joao Henrique Rissato MD , Fernando Linhares Pereira MD , Maria Cristina Chammas MD, PhD , Félix José Alvarez Ramires MD, PhD , Charles Mady MD, PhD , Wilson Mathias Junior MD, PhD , Roberto Kalil Filho MD, PhD , Fabio Fernandes MD, PhD

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引用次数: 0

摘要

简介淀粉样变性是一组以错误折叠的蛋白质片段沉积在器官和组织中形成不溶性纤维为特征的疾病。转甲状腺素（ATTR）淀粉样变性，尤其是心脏淀粉样变性（CA），会导致心肌僵硬和心力衰竭。右心室（RV）受累在 CA 中很常见，但用无创方法评估右心室僵硬度具有挑战性。本研究旨在使用剪切波弹性成像（SWE）评估右心室僵硬度，并将评估结果与临床、实验室和超声心动图参数相关联：在这项前瞻性、单中心、横断面研究中，60 名患者被分为三组：20 名心源性 ATTR 淀粉样变性（ATTR-CM）患者、20 名非心源性 ATTR 淀粉样变性（ATTR 非 CM）患者和 20 名健康对照组。心肌僵硬度采用心室游离壁的 SWE 测量。采用皮尔逊和斯皮尔曼相关系数进行统计分析，显著性以 p < 0.05 为限：RV SWE 值与功能分级呈强正相关，与 BNP 和肌钙蛋白 I 水平呈中度相关。发现左心室 SWE 值与 6 分钟步行测试距离呈明显负相关。SWE 还与超声心动图变量（如室间隔厚度和 RV 基底直径）相关。SWE 临界值≥ 4.6 kPa 与心脏受累相关，显示出 65% 的敏感性和 76% 的特异性：SWE是评估CA患者RV僵硬度的一种有价值的无创技术，与临床和超声心动图参数有很好的相关性。RV SWE值≥4.6 kPa有助于早期发现ATTR淀粉样变性的心脏受累情况，从而改善诊断和治疗。

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Assessment of right ventricular myocardial stiffness by cardiac elastography in patients with transthyretin amyloidosis

Introduction

Amyloidosis is a group of diseases characterized by the deposition of misfolded protein fragments, forming insoluble fibrils in organs and tissues. Transthyretin (ATTR) amyloidosis, particularly cardiac amyloidosis (CA), leads to myocardial stiffness and heart failure. Right ventricular (RV) involvement is common in CA, but assessing RV stiffness noninvasively is challenging. This study aimed to evaluate RV stiffness using shear wave elastography (SWE) and correlate the findings with clinical, laboratory, and echocardiographic parameters.

Materials and Methods

In this prospective, single-center, cross-sectional study, 60 patients were divided into three groups: 20 with cardiac ATTR amyloidosis (ATTR-CM), 20 with non-cardiac ATTR amyloidosis (ATTR non-CM), and 20 healthy controls. Myocardial stiffness was measured using SWE in the free wall of the RV. Pearson's and Spearman's correlation coefficients were used for statistical analysis, with significance set at p < 0.05.

Results

RV SWE values showed a strong positive correlation with functional class and a moderate correlation with BNP and troponin I levels. A significant negative correlation was found between RV SWE values and the 6-minute walk test distance. SWE also correlated with echocardiographic variables like interventricular septum thickness and RV basal diameter. An SWE cutoff of ≥ 4.6. kPa was associated with cardiac involvement, showing 65 % sensitivity and 76 % specificity.

Conclusions

SWE is a valuable noninvasive technique for assessing RV stiffness in CA patients, correlating well with clinical and echocardiographic parameters. An RV SWE value of ≥ 4.6 kPa could aid in early detection of cardiac involvement in ATTR amyloidosis, improving diagnosis and management.

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.