Abstract 19334: Long-Term Prognostic Significance of Diastolic Wall Strain, and Heart Rate in Patients With Light-Chain Amyloidosis

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Introduction: Recent study suggested that diastolic wall strain (DWS) calculated from M-mode in left ventricular (LV) posterior wall (PW) as the following equation {(LVPWs - LVPWd)/LVPWs} (s, at end-systole; d, at end-diastole) is useful in noninvasively assessing LV wall distensibility.

Hypothesis: We hypothesized that reduced DWS is associated with adverse outcome in patients with light-chain (AL) amyloidosis.

Methods: We prospectively examined 126 consecutive, untreated patients with biopsy-proven systemic AL amyloidosis. The prognostic value of the DWS was compared with standard 2-dimensional echocardiographic and Doppler flow measurements, and LV global longitudinal strain (GLS) by speckle tracking echocardiography. We also assessed mid-wall shortening (MWS), heart rate (HR), and blood pressure during echocardiography. Plasma levels of human atrial and brain natriuretic peptide (BNP) were measured on the day of echocardiography.

Results: Forty-three patients (34%) died during a mean follow-up period of 1287 ± 1532 days. Univariate analysis showed that DWS, MWS, GLS, e’ of mitral annulus, plasma BNP levels, and HR during echocardiography were statistically significant predictors of outcome. Multivariate analysis showed that the DWS, e’ (septum), BNP and HR during echocardiography were the only independent predictors of death. GLS was not an independent predictor of death.

Conclusions: Simple measurements of the DWS derived from M-mode trace and the HR during echocardiography can predict long-term prognosis in patients with light-chain amyloidosis.

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