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Left ventricular rotational mechanics in cardiac amyloidosis – What is its clinical importance?

Attila Nemes

PII: S0167-5273(21)01476-5

DOI: https://doi.org/10.1016/j.ijcard.2021.09.035

Reference: IJCA 29798

To appear in: International Journal of Cardiology Received date: 13 September 2021

Accepted date: 16 September 2021

Please cite this article as: A. Nemes, Left ventricular rotational mechanics in cardiac amyloidosis – What is its clinical importance?, International Journal of Cardiology (2018),https://doi.org/10.1016/j.ijcard.2021.09.035

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

© 2018 © 2021 Published by Elsevier B.V.

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Left ventricular rotational mechanics in cardiac amyloidosis – what is its clinical importance?

Attila Nemes, MD, PhD, DSc, FESC

* nemes.attila@med.u-szeged.hu Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary

*Corresponding author at: Department of Medicine, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, H-6725 Szeged, Semmelweis street 8, Hungary, P.O.

Box 427.

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I am reading the paper of Monda et al. in which the role of a multiparametric echocardiographic score in the diagnosis of cardiac amyloidosis (CA) was investigated [1].

The results were interesting and impressive, but I feel some additional comments are necessary. Under normal circumstances, LV apex and base rotate in opposite directions resulting in a towel-wringing-like LV motion called LV twist, which has an important role in LV function and a significant contribution to LV ejection [2-5]. However, absence of LV twist called as LV ‘rigid body rotation’ (LV-RBR) could be detected in several disorders with different incidence rates with 6% in a normal population [2-5]. In these cases, LV apex and base rotate in the same clockwise or counterclockwise direction with some apico-basal gradient defined as a net difference between the clockwise/counterclockwise LV basal or apical rotations [2]. Noncompaction (50-100%), dilated (50%) and hypertensive (32%) cardiomyopathies, corrected tetralogy of Fallot (38%) and acromegaly (20%) are the most examined disorders with highest rate of LV-RBR [2-5]. LV rotational mechanics were examined in CA patients in several studies [2,3]. Although only limited number of CA patients were investigated, 3 out of 10 patients had LV-RBR with less than 3 degrees apico- basal LV gradient, while another 3 patients showed LV-RBR with 6-10 degrees apico-basal LV gradient [3]. The remaining cases showed normo-, hypo and hyperrotations of LV segments in normal directions suggesting several patterns of LV rotational mechanics in CA.

The relationship between the new multiparametric echocardiographic score and LV rotational mechanics in CA would be interesting and requires further investigations.

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References

1. E. Monda, G. Palmiero, M. Lioncino, M. Rubino, M. Caiazza, F. Dongiglio, G.

Limongelli. External validation of the increased wall thickness score for the diagnosis of cardiac amyloidosis Int. J. Cardiol. 339 (2021) 99-101.

DOI: 10.1016/j.ijcard.2021.07.035

2. Á. Kormányos, A. Kalapos, P. Domsik, C. Lengyel, T. Forster, A. Nemes. Normal values of left ventricular rotational parameters in healthy adults-Insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study.

Echocardiography. 36 (2019) 714-721.

3. A. Nemes, D. Földeák, P. Domsik, A. Kalapos, R. Sepp, Z. Borbényi, T. Forster.

Different patterns of left ventricular rotational mechanics in cardiac amyloidosis- results from the three-dimensional speckle-tracking echocardiographic MAGYAR- Path Study. Quant. Imaging Med. Surg. 5 (2015) 853-857.

4. A. Nemes, G. Rácz, Á. Kormányos, P. Domsik, A. Kalapos, N. Gyenes, N. Ambrus, I.

Hartyánszky, G. Bogáts, K. Havasi. Left ventricular rotational abnormalities in adult patients with corrected tetralogy of Fallot following different surgical procedures (Results from the CSONGRAD Registry and MAGYAR-Path Study). Cardiovasc.

Diagn. Ther. (in press)

5. Á. Kormányos, P. Domsik, A. Kalapos, A. Orosz, C. Lengyel, Z. Valkusz, A.

Trencsányi, T. Forster, A. Nemes. Left ventricular twist is impaired in acromegaly:

Insights from the three-dimensional speckle tracking echocardiographic MAGYAR- Path Study. J. Clin. Ultrasound. 46 (2018) 122-128.

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