ISSN 2996-8215
International Journal of Cardiology | Vol. 5, No. 2, February 2014 | pp. 9–16
DOI: 10.46882/2014/IJC/000059
Original Research Article
Long-Term Prognostic Utility of Global Longitudinal Strain in Patients with Light-Chain Cardiac Amyloidosis
Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²
¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark
Abstract:
Light-chain (AL) cardiac amyloidosis is characterized by progressive extracellular amyloid fibril deposition, leading to restrictive cardiomyopathy and severe heart failure. Early recognition of myocardial involvement is essential, as conventional metrics like LVEF often remain preserved until advanced stages. This study evaluated the long-term prognostic value of speckle-tracking derived global longitudinal strain (GLS) and the relative apical sparing pattern in patients with biopsy-proven AL amyloidosis. We prospectively followed 85 patients with systemic AL amyloidosis. All patients underwent comprehensive baseline echocardiography with off-line speckle-tracking deformation imaging. The primary endpoint was all-cause mortality over a 3-year follow-up period. Myocardial involvement was defined by standard extracellular volume metrics and wall thickness. An absolute baseline GLS less than 14.5% was identified in 64.7% of the cohort. Classic apical sparing, characterized by a preserved apical strain with severely reduced basal and mid-ventricular segment deformation, was present in 52.9% of patients. Over a median follow-up of 28 months, 32 patients (37.6%) died. Kaplan-Meier survival curves showed significantly worse survival in patients with a baseline absolute GLS less than 14.5% (log-rank p < 0.001). Multivariable Cox proportional hazards regression confirmed that baseline GLS was a potent, independent predictor of 3-year all-cause mortality (hazard ratio: 1.24 per 1% absolute reduction, 95% CI: 1.11–1.38, p < 0.001), outperforming traditional biomarkers like NT-proBNP and high-sensitivity troponin T. Two-dimensional global longitudinal strain is a powerful independent predictor of mortality in light-chain cardiac amyloidosis, serving as a critical tool for early risk stratification.
Keywords: Cardiac amyloidosis, Light-chain amyloidosis, Echocardiography, Global longitudinal strain, Apical sparing, Prognosis
Received: November 08, 2013; Revised: December 20, 2013; Accepted: January 12, 2014; Published: February 22, 2014
Citation: International Journal of Cardiology, 2014, Vol. 5, No. 2, pp. 9–16, DOI: 10.46882/2014/IJC/000059