Myocardial perfusion imaging-derived left ventricular strain: Regional abnormalities associated with transthyretin cardiac amyloidosis

• Type of Material: Article
• Authors: Steven Lewis, Emory University; Jingwen Huang, Emory University; Nidhi Patel, Emory University; Russell Folks, Emory University; James Galt, Emory University; C. David Cooke, Emory University; Ziduo Zheng, Emory University; Rebecca Zhang, Emory University; Ernest Garcia, Emory University; Jonathon Nye, Emory University; Marina Piccinelli, Emory University; Valeria M. Moncayo, Emory University; Kunal Nikhil Bhatt, Emory University; Adam Mitchell, Emory University
• Language: English
• Date: 2024-04
• Publisher: Elsevier
• Publication Version: Final Published Version
• Copyright Statement: © 2024 The Authors
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016%2Fj.ahjo.2024.100377
• Title of Journal or Parent Work: American Heart Journal Plus: Cardiology Research and Practice
• Volume: 40
• Start Page: 100377
• Grant/Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
• Keywords: ATTR amyloidosis; Myocardial strain; Myocardial perfusion imaging
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Background Transthyretin (ATTR) cardiac amyloidosis is associated with an apical-sparing strain pattern on TTE. We hypothesize that strain indices derived from myocardial perfusion imaging (MPI) can identify this abnormality. Methods A group with ATTR amyloidosis was compared to age-matched controls with LVH but without amyloidosis who underwent PET or SPECT MPI. Strain values were used to calculate the apical strain index (ASI), apex-to-base ratio (ABR), and ejection fraction to global strain ratio in multiple planes. Results A direct comparison using Welch's t-tests reveals 6 statistically significant metrics. After regression analysis, the circumferential ASI and ABR at rest remain significantly greater in the ATTR group compared to controls. Conclusion MPI-derived strain from the circumferential plane at rest may distinguish cardiac amyloidosis from other forms of LVH. If these findings are confirmed with validation studies, routine MPI-derived strain analysis could identify patients with subclinical amyloidosis who may benefit from further testing.