Echocardiographic score for the screening of cardiac amyloidosis with positive 99m technetium pyrophosphate scintigraphy result

Abstract

Introduction: Speckle-tracking-derived strains in cardiac chambers may provide better solutions for transthyretin amyloid cardiomyopathy (ATTR-CM) screening. This study aimed to evaluate the efficacy of biventricular strain measurements using speckle tracking for screening 99mTc-pyrophosphate (99mTc-PYP) scintigraphy-positive cardiomyopathy, which is nearly equivalent to ATTR-CM. Methods: We performed a retrospective analysis of transthoracic echocardiographic studies using vendor-independent speckle tracking analysis in older patients (≥65 years) who underwent 99mTc-PYP scintigraphy to evaluate the etiology of suspected ATTR-CM in our institute between January 2019 and December 2022. Results: The entire cohort (n = 89) was divided into two subgroups positive 99mTc-PYP scan results (n = 34) and negative 99mTc-PYP scan results (n = 55). In the multivariate analysis, posterior wall thickness (p =.003, odds ratio [OR]:1.48, 95% confidence interval [CI]:1.14 –1.92), left ventricular longitudinal strain apical/basal ratio (LVLSapi/bas) (p =.015, OR: 2.78, 95% CI: 1.23–6.32, and right ventricular longitudinal strain (RVLS) (p =.003, OR: 1.15, 95% CI: 1.05 –1.26) were selected to be the most representative echocardiographic findings in 99mTc-PYP positive cardiomyopathy. The receiver operating characteristic analysis indicated that posterior wall thickness (p