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Heart failure and cardiomyopathies
Original research
Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis?
  1. Aénora Roger-Rollé1,2,
  2. Eve Cariou1,2,
  3. Khailène Rguez1,2,
  4. Pauline Fournier1,2,
  5. Yoan Lavie-Badie1,2,3,
  6. Virginie Blanchard1,2,3,4,
  7. Jérôme Roncalli1,4,
  8. Michel Galinier1,2,4,
  9. Didier Carrié1,2,4 and
  10. Olivier Lairez1,2,3,4
  11. on behalf of the Toulouse Amyloidosis Research Network collaborators
  1. 1Cardiology, Rangueil University Hospital, Toulouse, France
  2. 2Cardiac Imaging Center, University Hospital of Toulouse, Toulouse, France
  3. 3Department of Nuclear Medicine, University Hospital of Toulouse, Toulouse, France
  4. 4Medical School, Toulouse III Paul Sabatier University, Toulouse, France
  1. Correspondence to Professor Olivier Lairez; lairez{at}gmail.com

Abstract

Background Cardiac amyloidosis (CA) is a life-threatening restrictive cardiomyopathy. Identifying patients with a poor prognosis is essential to ensure appropriate care. The aim of this study was to compare myocardial work (MW) indices with standard echocardiographic parameters in predicting mortality among patients with CA.

Methods Clinical, biological and transthoracic echocardiographic parameters were retrospectively compared among 118 patients with CA. Global work index (GWI) was calculated as the area of left ventricular pressure–strain loop. Global work efficiency (GWE) was defined as percentage ratio of constructive work to sum of constructive and wasted works. Sixty-one (52%) patients performed a cardiopulmonary exercise.

Results GWI, GWE, global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and myocardial contraction fraction (MCF) were correlated with N-terminal prohormone brain natriuretic peptide (R=−0.518, R=−0.383, R=−0.553, R=−0.382 and R=−0.336, respectively; p<0.001). GWI and GLS were correlated with peak oxygen consumption (R=0.359 and R=0.313, respectively; p<0.05). Twenty-eight (24%) patients died during a median follow-up of 11 (4–19) months. The best cut-off values to predict all-cause mortality for GWI, GWE, GLS, LVEF and MCF were 937 mm Hg/%, 89%, 10%, 52% and 15%, respectively. The area under the receiver operator characteristic curve of GWE, GLS, GWI, LVEF and MCF were 0.689, 0.631, 0.626, 0.511 and 0.504, respectively.

Conclusion In CA population, MW indices are well correlated with known prognosis markers and are better than LVEF and MCF in predicting mortality. However, MW does not perform better than GLS.

  • heart failure with preserved ejection fraction
  • echocardiography
  • restrictive cardiomyopathy
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001346

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    Footnotes

    • Collaborators Toulouse Amyloidosis Research Network collaborators: Laurent Alric, MD, PhD (Department of Internal Medicine and Digestive Diseases, Purpan University Hospital, Toulouse, France); Christophe Bureau, MD, PhD (Department of Hepatology-Gastroenterology, Rangueil University Hospital, Toulouse, France); Dominique Chauveau, MD, PhD (Department of Nephrology and Referral Center for Rare Diseases, Rangueil University Hospital, Toulouse, France); Pascal Cintas, MD, PhD (Department of Neurology, Purpan University Hospital, Toulouse, France); Magali Colombat, MD (Department of Pathology, IUCT Oncopôle, Toulouse, France); Audrey Delas, MD (Department of Pathology, IUCT Oncopôle, Toulouse, France); Delphine Dupin-Deguine, MD (Department of Genetic, Toulouse University Hospital, Toulouse, France); Stanislas Faguer, MD, PhD (Department of Nephrology and Referral Center for Rare Diseases, Rangueil University Hospital, Toulouse, France); Antoine Huart, MD (Department of Nephrology and Referral Center for Rare Diseases, Rangueil University Hospital, Toulouse, France); Bénédicte Puissant, MD (Immunology Laboratory, Toulouse University Hospital, Toulouse, France); Grégory Pugnet (Department of Internal Medicine, Toulouse University Hospital, Toulouse, France); Grégoire Prévot, MD (Department of Pneumology, Toulouse University Hospital, Toulouse, France); David Ribes, MD (Department of Nephrology and Referral Center for Rare Diseases, Rangueil University Hospital, Toulouse, France); Murielle Roussel MD (Department of Hematology, Toulouse University Hospital, Toulouse, France); Laurent Sailler, MD, PhD (Department of Internal Medicine and Digestive Diseases, Purpan University Hospital, Toulouse, France).

    • Contributors AR-R analysed the echographic data and wrote the manuscript, EC and KR collected, analysed and interpreted the clinical, biological data. YL-B performed the statistical analysis. MG critically contributed to the manuscript. VB and PF contributed to the discussion and the reviewing. DC critically contributed to the manuscript and revised the last version of the manuscript after the reviewers’ comments. JR and OL designed and led the study, revised the manuscript and gave final approval of the version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study is conformed to the principles outlined in the Declaration of Helsinki. According to French law on ethics, patients were informed that their codified data will be used for the study. According to the French ethic and regulatory law (public health code) retrospective studies based on the exploitation of usual care data should not be submit at an ethic committee but they have to be declared or cover by reference methodology of the French National Commission for Informatics and Liberties. A collection and computer processing of personal and medical data were implemented to analyse the results of the research. Toulouse University Hospital signed a commitment of compliance to the reference methodology MR-004 of the French National Commission for Informatics and Liberties. After evaluation and validation by the data protection officer and according to the General Data Protection Regulation, this study completing all the criteria, it is registered in the register of retrospective study of the Toulouse University Hospital (number’s register: RIPH 2020-22) and cover by the MR-004 (French National Commission for Informatics and Liberties number: 2206723v0). This study was approved by Toulouse University Hospital and confirmed that ethic requirements were totally respected in this report.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request to lairez.o@chu-toulouse.fr.