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Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis
  1. Dermot Phelan,
  2. Patrick Collier,
  3. Paaladinesh Thavendiranathan,
  4. Zoran B Popović,
  5. Mazen Hanna,
  6. Juan Carlos Plana,
  7. Thomas H Marwick,
  8. James D Thomas
  1. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr James D Thomas, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA; thomasj{at}


Background The diagnosis of cardiac amyloidosis (CA) is challenging owing to vague symptomatology and non-specific echocardiographic findings.

Objective To describe regional patterns in longitudinal strain (LS) using two-dimensional speckle-tracking echocardiography in CA and to test the hypothesis that regional differences would help differentiate CA from other causes of increased left ventricular (LV) wall thickness.

Methods and results 55 consecutive patients with CA were compared with 30 control patients with LV hypertrophy (n=15 with hypertrophic cardiomyopathy, n=15 with aortic stenosis). A relative apical LS of 1.0, defined using the equation (average apical LS/(average basal LS + mid-LS)), was sensitive (93%) and specific (82%) in differentiating CA from controls (area under the curve 0.94). In a logistic regression multivariate analysis, relative apical LS was the only parameter predictive of CA (p=0.004).

Conclusions CA is characterised by regional variations in LS from base to apex. A relative ‘apical sparing’ pattern of LS is an easily recognisable, accurate and reproducible method of differentiating CA from other causes of LV hypertrophy.

  • Cardiac amyloidosis
  • 2D speckle tracking echocardiography
  • myocardial strain
  • cardiac function
  • cardiac remodelling
  • diastolic dysfunction
  • hypertension
  • hypertensive heart disease
  • imaging and diagnostics
  • echocardiography
  • CT scanning
  • MRI
  • myocardium
  • myocardial function
  • diastolic function
  • ventricular function
  • heart failure
  • heart failure treatment
  • heart failure with normal ejection fraction
  • EBM
  • contrast echocardiography
  • tissue Doppler
  • stress echocardiography
  • Doppler
  • echocardiography (three-dimensional)
  • Doppler ultrasound

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  • DP and PC contributed equally to this work.

  • Competing interests None.

  • Ethics approval Ethics approval provided by Cleveland Clinic Foundation institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.