Basal inferoseptal segment is highly susceptible to deformation in the clinical spectrum of transthyretin-derived amyloid cardiomyopathy

Toshihiro Tsuruda; Hiroshi Nakada; Yoshimasa Yamamura; Yunosuke Matsuura; Miyuki Ogata; Miyo Tanaka; Yosuke Suiko; Soichi Komaki; Hiroki Tanaka; Kohei Moribayashi; Takeshi Ideguchi; Tamasa Terada; Tomomi Ota; Keisuke Yamamoto; Kensaku Nishihira; Yoshisato Shibata; Koichi Kaikita

doi:10.1093/ehjopen/oeae076

Basal inferoseptal segment is highly susceptible to deformation in the clinical spectrum of transthyretin-derived amyloid cardiomyopathy

Eur Heart J Open. 2024 Sep 2;4(5):oeae076. doi: 10.1093/ehjopen/oeae076. eCollection 2024 Sep.

Authors

Toshihiro Tsuruda^{1

2}, Hiroshi Nakada³, Yoshimasa Yamamura², Yunosuke Matsuura², Miyuki Ogata⁴, Miyo Tanaka⁴, Yosuke Suiko², Soichi Komaki², Hiroki Tanaka², Kohei Moribayashi², Takeshi Ideguchi², Tamasa Terada³, Tomomi Ota⁵, Keisuke Yamamoto⁶, Kensaku Nishihira⁶, Yoshisato Shibata⁶, Koichi Kaikita²

Affiliations

¹ Cardiorenal Research Laboratory, Department of Hemo-Vascular Advanced Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
² Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
³ Department of Radiology, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
⁴ Heart Center, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
⁵ Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
⁶ Department of Cardiology, Miyazaki Medical Association Hospital, 1173, Arita, Miyazaki 880-2102, Japan.

Abstract

Aims: While the prevalence of transthyretin-derived amyloid cardiomyopathy (ATTR-CM) is on the rise, detailed understanding of its morphological and functional characteristics within the left ventricle (LV) across heart failure (HF) remains limited.

Methods and results: Utilizing two-dimensional (2D) speckle-tracking echocardiography, we assessed longitudinal strain (LS) in 63 histology-confirmed ATTR-CM patients. Additionally, cardiac magnetic resonance (CMR) images measured native T1 and extracellular volume (ECV), compared with LS across 18 LV segments. Patients were categorized into three groups based on HF status: Group 1 (no HF symptoms), Group 2 (HF with preserved LV ejection fraction), and Group 3 (HF with reduced LV ejection fraction). LS analysis unveiled susceptibility to deformation in the basal inferoseptal segment, persisting even in asymptomatic cases. CMR demonstrated increasing native T1 deviation, particularly evident in segments distant from the inferoseptal region. Contrastingly, maximal ECV was consistently observed in the basal and mid-ventricular inferior-septum, even in asymptomatic individuals. Segmental LS decline correlated with ECV expansion but not with native T1 values.

Conclusion: Our findings suggest that the inferoseptal segment is highly susceptible to amyloid infiltration, and 2D speckle-tracking echocardiography and CMR may serve as a valuable tool for its early detection.

Keywords: Longitudinal strain; Magnetic resonance image; Segmental analysis.