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Echocardiographic features of amyloid cardiomyopathy phenotypes in patients with different types of amyloidosis

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1. Title Title of document Echocardiographic features of amyloid cardiomyopathy phenotypes in patients with different types of amyloidosis
2. Creator Author's name, affiliation, country Olga Ya. Сhaikovskaya; Chazov National Medical Research Center of Cardiology
; Russian Federation
2. Creator Author's name, affiliation, country Marina A. Saidova; Chazov National Medical Research Center of Cardiology
; Russian Federation
2. Creator Author's name, affiliation, country Svetlana V. Dobrovolskaya; Chazov National Medical Research Center of Cardiology
; Russian Federation
2. Creator Author's name, affiliation, country Anastasia A. Shoshina; Chazov National Medical Research Center of Cardiology
; Russian Federation
2. Creator Author's name, affiliation, country Svetlana N. Nasonova; Chazov National Medical Research Center of Cardiology
; Russian Federation
2. Creator Author's name, affiliation, country Igor V. Zhirov; Chazov National Medical Research Center of Cardiology; Russian Federation
2. Creator Author's name, affiliation, country Sergey N. Tereshchenko; Chazov National Medical Research Center of Cardiology
; Russian Federation
3. Subject Discipline(s)
3. Subject Keyword(s) amyloid cardiomyopathy; transthyretin amyloidosis; light chain amyloidosis; echocardiography
4. Description Abstract

Aim. To determine the echocardiographic variants of phenotype presentation of amyloid cardiomyopathy (ACM) in patients with different types of amyloidosis.

Materials and methods. The study included 54 patients with ACM: 27 with light chain amyloidosis (15 [56%] males; the median age was 63.0 [56.5; 67.0]) and 27 patients with transthyretin amyloidosis (20 [74%] males; the median age was 73.0 [65.5; 78.5]). Standard echocardiographic parameters and the left ventricular (LV) global longitudinal strain in both groups were evaluated.

Results. Among patients with ACM, the following phenotypes were reported: hypertrophic phenotype (HP), a combination of hypertrophic and restrictive phenotypes (HP+RP), a combination of hypertrophic, restrictive phenotypes and ejection fraction (EF) less than 50% (HP+RP+EF<50%), and patients with minimal structural changes. In patients with HP+RP+EF<50%, significantly greater thickness of the LV posterior wall (p=0.025) and the relative wall thickness (p=0.010) were found; the LV global longitudinal strain was lower (p=0.001). There were significant differences in the size of the right atrium (p=0.036), the systolic pressure in the pulmonary artery (p<0.001), and the presence of a thickening of the free wall of the right ventricle (p<0.007) in the HP+RP group. Involvement of the heart valves was more common in patients with ATTR ACM.

Conclusion. After reviewing the echocardiographic data of patients, various phenotypic presentations of ACM and several correlations between echocardiographic characteristics depending on the type of amyloidosis were determined. Further study of echocardiographic parameters in patients with various types of amyloidosis may be promising for early diagnosis and proper treatment of ACM.

5. Publisher Organizing agency, location LLC Obyedinennaya Redaktsiya
6. Contributor Sponsor(s)
7. Date (DD-MM-YYYY) 08.05.2025
8. Type Status & genre Peer-reviewed Article
8. Type Type Research Article
9. Format File format
10. Identifier Uniform Resource Identifier https://ter-arkhiv.ru/0040-3660/article/view/646293
10. Identifier Digital Object Identifier (DOI) 10.26442/00403660.2025.04.203168
11. Source Title; vol., no. (year) Terapevticheskii arkhiv; Vol 97, No 4 (2025): Вопросы диагностики
12. Language English=en ru
13. Relation Supp. Files Fig. 1. Typical pattern of echocardiography speckle-tracking in a patient with amyloid cardiomyopathy (ACM) with a decrease in the global longitudinal strain of the basal and middle segments of the LV (pale blue and pink) with preserved strain of the apical segments (red). (60KB)
Fig. 2. Pattern of echocardiography speckle-tracking in a patient with HCM. A decrease in LV global longitudinal strain was found in both basal and apical segments. (68KB)
Fig. 3. Prevalence of phenotypes among patients with ACM, %. (64KB)
Fig. 4. Clinical case 1. Patient A. with AL-amyloidosis of the HP+RP phenotype: a, b – biventricular thickening of the walls with a specific "luminous" structure and atrial cavity dilation; c – restrictive impairment of LV diastolic function (E/A>2); d – a typical pattern of impaired LV global longitudinal strain with a basal-apical gradient. (175KB)
Fig. 5. Clinical case 3. Patient M. with HP AL-amyloidosis: a–c – pronounced thickening of the LV myocardial walls with a typical pattern of impaired LV global longitudinal strain. (174KB)
Fig. 6. Clinical case 4. Patient A. with true RP AL-amyloidosis: a–c – both atria dilation, restrictive impairment of LV diastolic function (E/A>2), the LV myocardium wall <1.2 cm. Pattern of impaired LV global longitudinal strain, corresponding to cardiac amyloidosis. (191KB)
Fig. 7. Clinical case 2. Patient X. with ATTRh-amyloidosis of the HP+RP+EF<50% phenotype and heart valve involvement: a–d – pronounced thickening of LV and RV walls, restrictive impairment of LV diastolic function (E/A>2), thickening of the mitral and tricuspid valve leaflets, a typical pattern of impaired LV global longitudinal strain, LV EF 42%. (163KB)
Fig. 8. Clinical case 5. Patient K. with AL-amyloidosis and minimal structure changes. Global longitudinal strain index (GLSavg) 16.9% with no basal-apical gradient; LV myocardial wall thickness 1.1–1.2 cm. (90KB)
14. Coverage Geo-spatial location, chronological period, research sample (gender, age, etc.)
15. Rights Copyright and permissions Copyright (c) 2025 Consilium Medicum
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