P878Regional left ventricular function in patients with cardiac amyloidosis: a typical deformation pattern shown by speckle tracking imaging

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Objective: The confirmation of cardiac involvement in patients with amyloidosis is important because of its impact on prognosis. Thus, a typical echocardiographic pattern for cardiac amyloidosis (CA) would be of clinical value during work up of these patients.Methods: In this prospective clinical study, we assessed cardiac morphology and function in 22 patients with cardiac amyloidosis and in 22 controls. Morphology and global left ventricular systolic and diastolic function were measured by standard echocardiography. Regional myocardial deformation was assessed by tissue Doppler imaging (TDI) and by 2-dimensional speckle tracking imaging (STI). Using these two methods, both peak systolic strain rate and systolic strain were extracted from the basal, mid and apical segments of the septum and the lateral wall.Results: 73% of the patients with CA showed the typical sparkling texture of the myocardium and 45% patients had a small pericardial effusion. When compared to controls, patients with cardiac amyloidosis had significantly thicker walls (end-diastolic posterior wall thickness: control = 9±1mm, CA =14±4mm; p < 0.001), larger left atrium (control = 35±2mm, CA = 43±9mm; p<0.05) and higher E/E' (control = 10±3, CA = 23±9; p<0.05). By the use of TDI both peak systolic strain rate and systolic strain showed an intra wall gradient with lower values at the base and higher values at the apex (septal TDI strain: basal = -11±4%, apical = -14±7%). In contrast, regional deformation values were more homogenous within one wall in controls. The typical gradient for deformation within one wall in CA was confirmed by STI (septal STI strain: basal = -8±5%, middle = -11±5%, apical = -22±5%). Using a cut off value of at least 100% higher strain in the apex compared to the base by STI, typical gradient pattern was presented in 17 patients (77% of all CA patients) and in none of the controls (p<0.0001). Conclusion: Beside the traditional parameters for cardiac involvement, the assessment of regional myocardial deformation provides important information on cardiac function for patients with cardiac amyloidosis. The typical pattern for regional myocardial function is a base to apex gradient within one wall which can be easily assessed by tissue Doppler imaging as well as by speckle tracking imaging.

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