Abstract
Introduction: The role of speckle-tracking echocardiography (STE) for establishing the diagnosis of cardiac amyloidosis (CA) has been primarily studied in patients with preserved EF (HFpEF). Hypothesis: We sought to determine the prevalence of abnormal STE indices among HF patients with CA who have reduced EF (HFrEF). Methods: We reviewed electronic health records to identify patients consecutively referred for the evaluation of CA by Tc99m PYP imaging between December 2014 to December 2020. Only patients with LVEF < 40% were included. Left ventricular (LV) and atrial (LA) global and segmental strain, relative apical sparing (RELAPS), and end-diastolic wall stress (EDWS) were measured using STE (TomTec). Results: Among 138 patients, 65 (47%) were identified with CA+; they were older compared to amyloid negative group (CA-). LV-GLS was similar in both groups. However, basal segments LV strain, LA strain, and LA fractional area change (LA-FAC) were significantly lower, and RELAPS was higher in CA+ patients (Figure). End-diastolic wall stress was also lower in CA+ (for all p< 0.01, Figure). After adjusting for age and sex, impaired basal segment strain, EDWS, and LA-FAC remained independent predictors of identifying CA+ patients (p< 0.05). Conclusions: The presence of CA among HFrEF patients is associated with regional variability in LV strain, greater impairment of LA function, and lower EDWS.
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