CMR left ventricular strains beyond global longitudinal strain in differentiating light-chain cardiac amyloidosis from hypertrophic cardiomyopathy

Fangqing Wang; Yan Deng; Shunjia Li; Qichao Cheng; Qing Wang; Dexin Yu; Qian Wang

doi:10.3389/fcvm.2023.1108408

CMR left ventricular strains beyond global longitudinal strain in differentiating light-chain cardiac amyloidosis from hypertrophic cardiomyopathy

Front Cardiovasc Med. 2023 May 3:10:1108408. doi: 10.3389/fcvm.2023.1108408. eCollection 2023.

Authors

Fangqing Wang^#¹, Yan Deng^#¹, Shunjia Li², Qichao Cheng¹, Qing Wang¹, Dexin Yu¹, Qian Wang¹

Affiliations

¹ Department of Radiology, Qilu Hospital, Shandong University, Jinan, China.
² Department of Radiation Oncology, Qilu Hospital, Shandong University, Jinan, China.

^# Contributed equally.

Abstract

Background: The clinical value of left ventricular (LV) global longitudinal strain (GLS) in the differential diagnosis of light-chain cardiac amyloidosis (AL-CA) and hypertrophic cardiomyopathy (HCM) has been previously reported. In this study, we analyzed the potential clinical value of the LV long-axis strain (LAS) to discriminate AL-CA from HCM. Furthermore, we analyzed the association between all the LV global strain parameters derived from cardiac magnetic resonance (CMR) feature tracking and LAS in both the AL-CA and HCM patients to assess the differential diagnostic efficacies of these global peak systolic strains.

Materials and methods: Thus, this study enrolled 89 participants who underwent cardiac MRI (CMRI), consisting of 30 AL-CA patients, 30 HCM patients, and 29 healthy controls. The intra- and inter-observer reproducibility of the LV strain parameters including GLS, global circumferential strain (GCS), global radial strain (GRS), and LAS were assessed in all the groups and compared. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic performances of the CMR strain parameters in discriminating AL-CA from HCM.

Results: The intra- and inter-observer reproducibility of the LV global strains and LAS were excellent (range of interclass correlation coefficients: 0.907-0.965). ROC curve analyses showed that the differential diagnostic performances of the global strains in discriminating AL-CA from HCM were good to excellent (GRS, AUC = 0.921; GCS, AUC = 0.914; GLS, AUC = 0.832). Furthermore, among all the strain parameters analyzed, LAS showed the highest diagnostic efficacy in differentiating between AL-CA and HCM (AUC = 0.962).

Conclusion: CMRI-derived strain parameters such as GLS, LAS, GRS, and GCS are promising diagnostic indicators that distinguish AL-CA from HCM with high accuracy. LAS showed the highest diagnostic accuracy among all the strain parameters.

Keywords: cardiovascular magnetic resonance; global longitudinal strain; hypertrophic cardiomyopathy; left ventricular function; light-chain cardiac amyloidosis; long-axis strain.