Abstract：
Although impaired left ventricular (LV) global longitudinal strain (GLS) with apical sparing is a feature of cardiac amyloidosis (CA), its diagnostic accuracy has varied across studies. We aimed to determine the ability of apical sparing ratio (ASR) and most common echocardiographic parameters to differentiate patients with confirmed CA from those with clinical and/or echocardiographic suspicion of CA but with this diagnosis ruled out.
We identified 544 patients with confirmed CA and 200 controls (CTRLs) as defined above (CTRL patients). Measurements from transthoracic echocardiograms were performed using artificial intelligence software (Us2.AI, Singapore) and audited by an experienced echocardiographer. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance and optimal cut-offs for the differentiation of CA patients from CTRL patients. Additionally, a group of 174 healthy subjects (healthy CTRL) was included to provide insight on how patients and healthy CTRLs differed echocardiographically. LV GLS was more impaired (-13.9 ± 4.6% vs. -15.9 ± 2.7%, P < 0.0005), and ASR was higher (2.4 ± 1.2 vs. 1.7 ± 0.9, P < 0.0005) in the CA group vs. CTRL patients. Relative wall thickness and ASR were the most accurate parameters for differentiating CA from CTRL patients [area under the curve (AUC): 0.77 and 0.74, respectively]. However, even with the optimal cut-off of 1.67, ASR was only 72% sensitive and 66% specific for CA, indicating the presence of apical sparing in 32% of CTRL patients and even in 6% healthy subjects.
Apical sparing did not prove to be a CA-specific biomarker for accurate identification of CA, when compared with clinically similar CTRLs with no CA.
We identified 544 patients with confirmed CA and 200 controls (CTRLs) as defined above (CTRL patients). Measurements from transthoracic echocardiograms were performed using artificial intelligence software (Us2.AI, Singapore) and audited by an experienced echocardiographer. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance and optimal cut-offs for the differentiation of CA patients from CTRL patients. Additionally, a group of 174 healthy subjects (healthy CTRL) was included to provide insight on how patients and healthy CTRLs differed echocardiographically. LV GLS was more impaired (-13.9 ± 4.6% vs. -15.9 ± 2.7%, P < 0.0005), and ASR was higher (2.4 ± 1.2 vs. 1.7 ± 0.9, P < 0.0005) in the CA group vs. CTRL patients. Relative wall thickness and ASR were the most accurate parameters for differentiating CA from CTRL patients [area under the curve (AUC): 0.77 and 0.74, respectively]. However, even with the optimal cut-off of 1.67, ASR was only 72% sensitive and 66% specific for CA, indicating the presence of apical sparing in 32% of CTRL patients and even in 6% healthy subjects.
Apical sparing did not prove to be a CA-specific biomarker for accurate identification of CA, when compared with clinically similar CTRLs with no CA.
摘要：
背景：尽管伴有根尖保留的左心室（LV）整体纵向应变（GLS）受损是心脏淀粉样变性（CA）的特征，其诊断准确性因研究而异。我们旨在确定根尖保留率（ASR）和最常见的超声心动图参数，以区分确诊CA的患者与临床和/或超声心动图怀疑CA的患者。但是这个诊断被排除了。
方法：我们确定了544例确诊CA的患者和200例上述对照组（CTRL患者）。使用人工智能软件（Us2。AI,新加坡），并由经验丰富的超声心动图医师进行审计。使用受试者工作特征曲线分析来评估CA患者与CTRL患者的诊断性能和最佳截止值。此外,纳入了174名健康受试者(HealthyCTRL),以了解患者和健康对照组在超声心动图上的差异.
结果：LVGLS受损更多（-13.9±4.6％vs-15.9±2.7％，p<0.0005），并且CA组的ASR更高（2.4±1.2vs1.7±0.9，p<0.0005）CTRL患者。相对壁厚和ASR是区分CA与CTRL患者的最准确参数(AUC:分别为0.77和0.74)。然而,即使最佳临界值为1.67，ASR对CA也只有72%的敏感性和66%的特异性，表明32%的CTRL患者存在根尖保留，甚至6%的健康CTRL患者存在根尖保留。
结论：根尖保留并不能证明是准确鉴定CA的CA特异性生物标志物，与没有CA的临床相似对照相比。
方法：我们确定了544例确诊CA的患者和200例上述对照组（CTRL患者）。使用人工智能软件（Us2。AI,新加坡），并由经验丰富的超声心动图医师进行审计。使用受试者工作特征曲线分析来评估CA患者与CTRL患者的诊断性能和最佳截止值。此外,纳入了174名健康受试者(HealthyCTRL),以了解患者和健康对照组在超声心动图上的差异.
结果：LVGLS受损更多（-13.9±4.6％vs-15.9±2.7％，p<0.0005），并且CA组的ASR更高（2.4±1.2vs1.7±0.9，p<0.0005）CTRL患者。相对壁厚和ASR是区分CA与CTRL患者的最准确参数(AUC:分别为0.77和0.74)。然而,即使最佳临界值为1.67，ASR对CA也只有72%的敏感性和66%的特异性，表明32%的CTRL患者存在根尖保留，甚至6%的健康CTRL患者存在根尖保留。
结论：根尖保留并不能证明是准确鉴定CA的CA特异性生物标志物，与没有CA的临床相似对照相比。
