Abstract 15645: The Prognostic Impact of Left and Right Atrial Segmental Strain Analysis in Cardiac Amyloidosis Patients

Abstract

Introduction: Little is known about global and segmental atrial function in cardiac amyloidosis. Atrial function plays an important role to maintain adequate ventricular filling. Hypothesis: We hypothesized left atrial (LA) and right atrial (RA) segmental strain analysis is prognostic in patients with cardiac amyloidosis. Methods: We studied 121 patients with biopsy-proven cardiac amyloidosis and speckle-tracking strain echocardiography. The LA and RA were divided into 6 segments each (basal, mid, and apical segments of free wall and septum). We determined LA and RA free wall/septal wall peak strain ratios. The primary outcome was all-cause mortality (median follow-up; 5.0 years). Results: Regional LA strain analysis was feasible in 104 patients (86%) and RA in 92 patients (76%). Average LA global peak strain was 18.3±12.1% and RA global peak strain was 20.0±15.0%. We compared LA and RA strain free wall and septal wall segments. Atrial septal strain was significantly reduced compared to free wall strain in RA (10.8±9.9 % vs 30.7± 23.8%, p< 0.01). Free wall/septal wall strain ratio of LA was significantly reduced compared with the ratio of RA (p< 0.01). During the follow up, 60 patients died. All atrial regions showed reduction in peak strain in non-survivors compared with survivors. When dividing patients into 2 groups using LA free wall strain and RA free wall strain median values, low atrial free wall strain was associated with worse prognosis (Log-rank p < 0.001, HR 4.9, 95% CI= 2.6-9.3). Conclusions: LA and RA atrial strain have significant prognostic value in patients with cardiac amyloidosis. Free wall/septal wall strain ratio in LA was significantly reduced compared with RA. Assessment of atrial dysfunction has promise for clinical applications cardiac amyloidosis patients.