Echocardiographic Markers of Cardiac Response to Therapy in Patients with Light Chain Amyloidosis.

The study identified 16 cardiac responders and 23 cardiac non-responders among 39 patients with AL cardiac amyloidosis treated at City of Hope.

• Total cohort consisted of 39 patients with light chain cardiac amyloidosis (AL-CA)
• Cardiac responders were defined by improvement in global longitudinal strain (GLS) over time
• Cardiac non-responders were defined by no change or worsening in GLS
• 16 patients were classified as cardiac responders and 23 as cardiac non-responders

Change in GLS correlated significantly with changes in left ventricular ejection fraction and stroke volume index.

• Change in GLS correlated with change in LVEF (r = -0.44, p < 0.01)
• Change in GLS correlated with change in stroke volume index (r = -0.05, p < 0.01)
• Negative correlation with LVEF reflects the inverse directionality of GLS measurement conventions

Change in GLS correlated significantly with change in posterior wall thickness.

• Correlation between change in GLS and change in posterior wall thickness was r = 0.41, p = 0.01
• This suggests structural remodeling of the left ventricle tracks with functional strain improvement

Change in GLS showed strong correlations with changes in right ventricular strain measurements.

• Change in GLS correlated with change in RV free wall strain (r = 0.66, p < 0.01)
• Change in GLS correlated with change in RV four-chamber longitudinal strain (r = 0.67, p < 0.01)
• These correlations were among the strongest observed for any echocardiographic parameter

Change in GLS correlated significantly with changes in multiple left atrial strain parameters.

• Change in GLS correlated with change in left atrial conduit strain (r = 0.46, p < 0.01)
• Change in GLS correlated with change in left atrial reservoir strain (r = -0.63, p < 0.01)
• Change in GLS correlated with change in left atrial contractile strain (r = 0.48, p < 0.01)
• Left atrial reservoir strain showed the strongest correlation among the left atrial parameters

At less than 1 year of treatment, changes in RV strain were particularly strongly correlated with changes in GLS.

• At less than 1 year, change in GLS correlated with change in RV free wall strain (r = 0.73, p < 0.01)
• At less than 1 year, change in GLS correlated with change in RV four-chamber longitudinal strain (r = 0.75, p < 0.01)
• These early correlations were stronger than the overall correlations observed across the full follow-up period
• The authors concluded that 'changes in RV strain were seen early, within 1 year of treatment'

The authors concluded that strain imaging in conjunction with cardiac biomarkers can provide a comprehensive assessment of cardiac response in AL-CA.

• GLS was used as the primary definition of cardiac response
• RV and left atrial strain measurements correlated with improvements in GLS
• The study suggests a multiparametric approach combining strain imaging with cardiac biomarkers for monitoring treatment response