Introduction
Aim of the study
Methods
Study design
Subjects
Echocardiography
Histological analyses of myocardial biopsies
Statistical analysis
Results
Conventional echocardiographical parameters (Table 1, upper part)
Parameter | Healthy n = 150 | CAM all n = 59 | ATTR-CAM n = 29 | AL-CAM n = 30 | NC n = 30 | p value |
---|---|---|---|---|---|---|
Left atrial volume index (mm/m2) | 22.5 ± 4.6 | 45 ± 13 | 48 ± 14 | 42 ± 12 | 52 ± 18 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM:0.082
healthy vs NC: < 0.000
CAM vs NC: 0.0385
|
LV-EDD (mm) | 50 ± 5 | 45 ± 7 | 46 ± 7 | 45 ± 7 | 62 ± 9 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM:0.5854
healthy vs NC: < 0.0001
CAM vs NC: < 0.0001
|
LV-ESD(mm) | 31 ± 4 | 31 ± 8 | 32 ± 8 | 30 ± 7 | 50 ± 12 | Healthy vs CAM: 1.0 AL- vs ATTR-CAM:0.3107
healthy vs NC: < 0.000
CAM vs NC: < 0.0001
|
LV-EDV (ml) | 89 ± 33 | 64 ± 29 | 72 ± 29 | 57 ± 29 | 142 ± 57 |
Healthy vs CAM < 0.0001
AL- vs ATTR-CAM:0.0518
healthy vs NC: < 0.0001
CAM vs NC: < 0.0001
|
LV-ESV (ml) | 34 ± 15 | 31 ± 19 | 34 ± 17 | 29 ± 20 | 100 ± 54 | Healthy vs CAM: 0.2301
AL- vs ATTR-CAM:0.036
healthy vs NC: < 0.0001
CAM vs NC: < 0.0001
|
LV-EF (%) | 63 ± 5 | 52 ± 11 | 53 ± 10 | 52 ± 11 | 34 ± 15 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM:0.7165
healthy vs NC: < 0.0001
CAM vs NC: < 0.0001
|
E/A | 1.7 ± 0.52 | 2.4 ± 1.7 (n = 40/59 with SR) | 2.4 ± 1.44 (n = 16/29 with SR) | 2.5 ± 1.83 (n = 24/30 with SR) | 1.6 ± 0.8 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM: 0.855 healthy vs NC: 0.386
CAM vs NC: 0.0168
|
LV-E/e´ | 6.6 ± 1.57 | 21.0 ± 7.19 | 20.4 ± 6.29 | 21.5 ± 8.03 | 14.7 ± 7.3 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM:0.561
healthy vs NC: < 0.0001
CAM vs NC: 0.0002
|
Body surface area (m2) | 1.87 ± 0.24 | 1.90 ± 0.20 | 1.90 ± 0.1 | 1.90 ± 0.2 | 1.80 ± 0.24 | |
Heart rate b/min | 64.4 ± 11 | 72.8 ± 13.7 | 67.2 ± 12.5 | 78.3 ± 12.8 | 79.6 ± 16.8 | |
LV mass index area length (g/m2) | 65 ± 14 | 143 ± 38 | 149 ± 40 | 137 ± 35 | 144 ± 51 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM:0.2247
healthy vs NC: < 0.0001
CAM vs NC: 0.917 |
LV mass index triple plane (g/m2) | 64 ± 17 | 124 ± 32 | 134 ± 33 | 114 ± 28 | 115 ± 34 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM:0.0148
healthy vs NC: < 0.0001
CAM vs NC: 0.2227 |
Peak systolic longitudinal strain (%) | − 21.1 ± 3.2 | − 10.8 ± 4.59 | − 11.5 ± 4.62 | − 10.0 ± 4.4 | − 8.8 ± 6.5 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM: 0.208
healthy vs NC: < 0.0001
CAM vs NC: 0.0962 |
Peak systolic longitudinal strain rate (%/s) | − 1.23 ± 0.31 | − 0.75 ± 0.34 | − 0.76 ± 0.33 | − 0.75 ± 0.34 | − 0.64 ± 0.32 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM: 0.909
healthy vs NC: < 0.0001
CAM vs NC: 0.145 |
Time-to-peak syst. longitudinal strain (ms) | 371 ± 42 | 350 ± 70 | 371 ± 66 | 330 ± 68 | 389 ± 74 |
Healthy vs CAM: 0.0085
AL- vs ATTR-CAM:0.0223
healthy vs. NC: 0.0661
CAM vs NC: 0.0168
|
Time-to-peak syst. longitudinal strain rate (ms) | 181 ± 47 | 155 ± 63 | 170 ± 55 | 139 ± 60 | 200 ± 83 |
Healthy vs CAM: 0.0013
AL- vs ATTR-CAM:0.0433
healthy vs. NC: 0.0831
CAM vs NC: 0.0054
|
Pre-systolic stretch index (%) | 1.3 ± 2.8 | 4.8 ± 12.5 | 5.1 ± 10.9 | 4.6 ± 12.5 | 13.2 ± 26.3 |
Healthy vs CAM: 0.0014
AL- vs ATTR-CAM: 0.871
healthy vs NC: < 0.0001
CAM vs NC: 0.0436
|
Post-systolic index (%) | 2.5 ± 3.1 | 6.0 ± 8.7 | 5.7 ± 7.8 | 6.2 ± 9.3 | 15.9 ± 20.7 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM: 0.824
healthy vs NC: < 0.0001
CAM vs NC: 0.0021
|
Peak longitudinal displacement (mm) | 12.1 ± 2.5 | 7.3 ± 3.2 | 8.1 ± 3.1 | 6.6 ± 3.0 | 5.6 ± 3.8 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM: 0.064
healthy vs NC: < 0.0001
CAM vs NC: 0.0289
|
EF/S | 3.0 ± 0.5 | 4.9 ± 1.3 | 4.6 ± 1.1 | 5.2 ± 1.5 | 4.23 ± 1.9 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM: 0.0860
healthy vs NC: < 0.0001
CAM vs NC: 0.0535 |
Relative apical longitudinal strain | 0.66 ± 0.09 | 1.06 ± 0.27 | 1.15 ± 0.30 | 0.98 ± 0.22 | 0.73 ± 0.44 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM:0.0158
healthy vs NC: 0.0755
CAM vs NC: < 0.0001
|
Mechanical dispersion (ms) | 32 ± 8 | 54 ± 18 | 59 ± 17 | 50 ± 18 | 62 ± 22 |
Healthy vs CAM: < 0.0001
AL- vs ATTR-CAM: 0.0533
healthy vs NC: < 0.0001
CAM vs NC: 0.0697 |
Global systolic longitudinal myocardial LV mechanics (Table 1, lower part)
Segmental systolic longitudinal myocardial LV mechanics
Parameter | Comparison CAM all n = 59 ATTR-CAM n = 29 AL-CAM n = 30 Healthy n = 150 NC n = 30 | p value | ||
---|---|---|---|---|
Basal | Mid-ventricular | Apical | ||
Peak systolic longitudinal strain | CAM all vs healthy | < 0.0001 | < 0.0001 | < 0.0001 |
ATTR-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
AL-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
CAM all vs NC | 0.3060 | 0.0303 | 0.0001 | |
ATTR-CAM vs NC | 0.3930 | 0.0255 | < 0.0001 | |
AL-CAM vs NC | 0.4610 | 0.2581 | 0.0161 | |
ATTR-CAM vs AL-CAM | 0.8440 | 0.0943 | 0.0166 | |
Peak systolic longitudinal strain-rate | CAM all vs healthy | < 0.0001 | < 0.0001 | < 0.0001 |
ATTR-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
AL-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
CAM all vs NC | 0.0031 | 0.0032 | 0.0001 | |
ATTR-CAM vs NC | 0.0077 | 0.0115 | < 0.0001 | |
AL-CAM vs NC | 0.0237 | 0.0132 | 0.0043 | |
ATTR-CAM vs AL-CAM | 0.4750 | 0.7110 | 0.5376 | |
Time-to-peak longitudinal strain | CAM all vs healthy | 0.0684 | 0.0013 | < 0.0001 |
ATTR-CAM vs healthy | 0.0494 | 0.7684 | 0.0345 | |
AL-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
CAM all vs NC | 0.0037 | 0.0003 | 0.0094 | |
ATTR-CAM vs NC | 0.3982 | 0.0397 | 0.2906 | |
AL-CAM vs NC | < 0.0001 | 0.0001 | 0.0009 | |
ATTR-CAM vs AL-CAM | 0.0003 | 0.0183 | 0.0085 | |
Time-to-peak longitudinal strain-rate | CAM all vs healthy | < 0.0001 | < 0.0001 | 0.0001 |
ATTR-CAM vs healthy | 0.0068 | 0.1788 | 0.2659 | |
AL-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
CAM all vs NC | < 0.0001 | < 0.0001 | 0.2978 | |
ATTR-CAM vs NC | 0.0003 | 0.0121 | 0.6997 | |
AL-CAM vs NC | < 0.0001 | < 0.0001 | 0.0440 | |
ATTR-CAM vs AL-CAM | 0.0011 | 0.0028 | 0.0265 | |
Pre-stretch index | CAM all vs healthy | < 0.0001 | 0.0001 | 0.0216 |
ATTR-CAM vs healthy | < 0.0001 | 0.0010 | 0.7958 | |
AL-CAM vs healthy | < 0.0001 | 0.0001 | 0.0004 | |
CAM all vs NC | 0.0259 | < 0.0001 | 0.0134 | |
ATTR-CAM vs NC | 0.1695 | 0.0003 | 0.0060 | |
AL-CAM vs NC | 0.0275 | 0.0004 | 0.2068 | |
ATTR-CAM vs AL-CAM | 0.3003 | 0.7116 | 0.0723 | |
Post-systolic index | CAM all vs healthy | < 0.0001 | < 0.0001 | 0.0682 |
ATTR-CAM vs healthy | < 0.0001 | < 0.0001 | 0.4294 | |
AL-CAM vs healthy | < 0.0001 | < 0.0001 | 0.0104 | |
CAM all vs NC | 0.0001 | < 0.0001 | < 0.0001 | |
ATTR-CAM vs NC | 0.0007 | < 0.0001 | 0.0003 | |
AL-CAM vs NC | 0.0015 | 0.0001 | 0.0005 | |
ATTR-CAM vs AL-CAM | 0.9201 | 0.4647 | 0.5113 | |
Peak longitudinal displacement | CAM all vs healthy | < 0.0001 | < 0.0001 | < 0.0001 |
ATTR-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
AL-CAM vs healthy | < 0.0001 | < 0.0001 | < 0.0001 | |
CAM all vs NC | 0.0068 | 0.0010 | 0.5377 | |
ATTR-CAM vs NC | 0.0068 | 0.0001 | 0.5518 | |
AL-CAM vs NC | 0.3573 | 0.0738 | 0.7825 | |
ATTR-CAM vs AL-CAM | 0.0291 | 0.0144 | 0.0131 |
Intraventricular baso-apical gradients of longitudinal myocardial mechanics
Intraventricular circumferential gradients of the longitudinal myocardial mechanics
Relative apical longitudinal systolic strain (Table 1)
Discussion
The diastolic LV-function
The global systolic LV-function using LV-EF
The global systolic longitudinal myocardial LV mechanics using STE-derived parameters
Strain, time-to-peak strain and time-to-peak strain-rate
Pre-systolic stretch-index, post-systolic index, and systolic longitudinal displacement
Parameter | Healthy hearts (n = 150) | CAM all (n = 59) | LV-NC (n = 30) | p value CAM vs LV-NC |
---|---|---|---|---|
Peak systolic longitudinal strain (%) | Ø | ↓↓ | ↓↓(↓) | 0.0962 |
Peak systolic longitudinal strain rate (%/s) | Ø | ↓↓ | ↓↓(↓) | 0.145 |
Time-to-peak systolic longitudinal strain (ms) | Ø | ↓ | ↑ | 0.0168 |
Time-to-peak systolic longitudinal strain rate (ms) | Ø | ↓ | ↑ | 0.0054 |
Pre-systolic stretch index (%) | Ø | ↑ | ↑↑↑ | 0.0436 |
Post-systolic index (%) | Ø | ↑ | ↑↑↑ | 0.0021 |
Peak longitudinal displacement (mm) | Ø | ↓ | ↓↓↓ | 0.0289 |