Alterations in multi-layer strain in AL amyloidosis
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Cardiac involvement in AL amyloidosis portends a poor prognosis. 2D-speckle tracking echocardiography (2D-STE) strain can identify subclinical cardiac involvement. This study performed multilayer and multiplanar 2D-STE myocardial strain analysis. We compared 75 AL amyloidosis patients to 49 hypertensive patients and 49 healthy controls. Longitudinal strain was obtained from epicardial, mid-myocardial and endocardial layers; segmental strain was measured from mid-myocardial basal, mid and apical segments. Global longitudinal strain was reduced in epicardial (−14.3 ± −4.0% vs. −17.4 ± 2.2% vs. −17.5 ± −2.0%, <i>p</i> < .001), mid–myocardial (−16.3 ± −4.5% vs. −19.7 ± 2.5% vs. −19.7 ± −2.2%, <i>p</i> < .001) and endocardial layers (−18.7 ± −4.9% vs. −22.2 ± 3.0% vs. −22.3 ± −2.6%, <i>p</i> < .001) in amyloid patients compared to hypertensive and healthy controls. Segmental strain confirmed significant reduction in basal (−11.2 ± −3.9% vs. −17.6 ± 2.7% vs. −20.9 ± −3.4%, <i>p</i> < .001) and mid (−14.8 ± −4.3% vs. −19.2 ± 2.5% vs. −19.6 ± −2.2%, <i>p</i> < .001) LV segments in the AL amyloid group. Receiver operating curve analysis demonstrated that an optimal cut-off of −16% for basal segmental strain better differentiated AL amyloid from hypertensive group (sensitivity 96%, specificity 70%, AUC 0.93), compared to relative apical sparing (AUC of 0.85). Strain demonstrated myocardial involvement in all layers in AL amyloidosis, with reduced basal segmental longitudinal strain a likely marker of early disease.
AL型淀粉样变性累及心脏往往提示不良预后。二维斑点追踪超声心动图（2D-speckle tracking echocardiography，2D-STE）心肌应变可识别亚临床心脏受累情况。本研究开展了多层及多平面二维斑点追踪超声心动图心肌应变分析，纳入75例AL型淀粉样变性患者、49例高血压患者及49例健康对照者进行对照分析。研究分别于心外膜层、心肌中层与心内膜层采集纵向应变数据，并于心肌中层的左心室基底段、中段及心尖段测量节段应变。与高血压患者及健康对照者相比，AL型淀粉样变性患者的心外膜层（-14.3±-4.0% vs. -17.4±2.2% vs. -17.5±-2.0%，*p*<0.001）、心肌中层（-16.3±-4.5% vs. -19.7±2.5% vs. -19.7±-2.2%，*p*<0.001）及心内膜层（-18.7±-4.9% vs. -22.2±3.0% vs. -22.3±-2.6%，*p*<0.001）的整体纵向应变均显著降低。节段应变分析证实，AL型淀粉样变性组患者的左心室基底段（-11.2±-3.9% vs. -17.6±2.7% vs. -20.9±-3.4%，*p*<0.001）及中段（-14.8±-4.3% vs. -19.2±2.5% vs. -19.6±-2.2%，*p*<0.001）应变均显著降低。受试者工作特征（ROC）曲线分析显示，相较于心尖相对保留的情况（AUC=0.85），基底节段应变的最优截断值为-16%，可更有效地区分AL型淀粉样变性患者与高血压患者（灵敏度96%、特异度70%，AUC=0.93）。应变分析证实AL型淀粉样变性患者的各层心肌均存在受累情况，基底节段纵向应变降低或可作为早期疾病的潜在生物标志物。
