Relative apical sparing obtained with speckle tracking echocardiography is not a sensitive parameter for diagnosing light-chain cardiac amyloidosis

Pei-Na Huang; Ya-Ni Liu; Xue-Qing Cheng; Hong-Yun Liu; Jun Zhang; Li Li; Jie Sun; Yi-Ping Gao; Rui-Rui Lu; Yi-Peng Gao; You-Bin Deng

doi:10.21037/qims-23-1292

Relative apical sparing obtained with speckle tracking echocardiography is not a sensitive parameter for diagnosing light-chain cardiac amyloidosis

Quant Imaging Med Surg. 2024 Mar 15;14(3):2357-2369. doi: 10.21037/qims-23-1292. Epub 2024 Mar 7.

Authors

Pei-Na Huang¹, Ya-Ni Liu¹, Xue-Qing Cheng¹, Hong-Yun Liu¹, Jun Zhang¹, Li Li¹, Jie Sun¹, Yi-Ping Gao¹, Rui-Rui Lu¹, Yi-Peng Gao¹, You-Bin Deng¹

Affiliation

¹ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Background: Distinguishing light-chain cardiac amyloidosis (AL CA) from left ventricular wall thickening (LVWT) resulted from other etiologies has proven to be challenging. This study aimed to determine the sensitivity and specificity of relative apical sparing in diagnosing AL CA and investigate the differences in clinical and echocardiographic characteristics between AL CA patients with apical sparing and those with non-apical sparing.

Methods: A total of 63 consecutive patients with AL CA, 102 consecutive patients with LVWT (including 51 hypertrophic cardiomyopathy (HCM) and 51 hypertension) and 33 healthy individuals were recruited retrospectively at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Conventional and speckle tracking echocardiography were performed on all subjects.

Results: Although wall thickening was observed in all patients, almost all functional parameters were worse in AL CA, except for relative apical longitudinal strain (LS) (P=0.906). Of 63 patients with AL CA, only 17.5% (n=11) showed an apical sparing pattern. Patients with apical sparing had poorer cardiac performance than those with non-apical sparing. Relative apical sparing showed the lowest diagnostic accuracy with an area under the curve (AUC) of 0.58 [95% confidence interval (CI): 0.49-0.67, sensitivity: 17.5%, specificity: 98.0%, P=0.095] to detect AL CA, but right ventricular strain (RVS) (AUC: 0.86, P<0.001) showed the highest among all echocardiographic parameters. When diagnosing AL CA patients with non-apical sparing, RVS continued to maintain excellent diagnostic accuracy (AUC: 0.84, P<0.001), followed by left atrial reservoir strain (LASr) (AUC: 0.77, P<0.001).

Conclusions: The diagnostic value of relative apical sparing for AL CA was limited with low sensitivity. In clinical practice, the diagnosis of early AL CA patients should not solely rely on relative apical sparing.

Keywords: Light-chain cardiac amyloidosis (AL CA); left atrial strain (LAS); relative apical sparing; right ventricular strain (RVS); speckle tracking echocardiography.