Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Systemic Vascular Resistance and Myocardial Work Analysis in Hypertrophic Cardiomyopathy and Transthyretin Cardiac Amyloidosis with Preserved Left Ventricular Ejection Fraction

Cesare De Gregorio
* ORCID logo ,
Giancarlo Trimarchi
ORCID logo ,
Denise Cristiana Faro
ORCID logo ,
Cristina Poleggi
,
Lucio Teresi
,
Fabrizio De Gaetano
,
Concetta Zito
ORCID logo ,
Francesca Lofrumento
,
Ioanna Koniari
ORCID logo ,
Roberto Licordari
ORCID logo ,
Nicholas G. Kounis
ORCID logo ,
Ines Paola Monte
,
Gianluca Di Bella
Version 1 : Received: 9 March 2024 / Approved: 10 March 2024 / Online: 11 March 2024 (10:00:11 CET)

A peer-reviewed article of this Preprint also exists.

de Gregorio, C.; Trimarchi, G.; Faro, D.C.; Poleggi, C.; Teresi, L.; De Gaetano, F.; Zito, C.; Lofrumento, F.; Koniari, I.; Licordari, R.; Kounis, N.G.; Monte, I.P.; Di Bella, G. Systemic Vascular Resistance and Myocardial Work Analysis in Hypertrophic Cardiomyopathy and Transthyretin Cardiac Amyloidosis with Preserved Left Ventricular Ejection Fraction. J. Clin. Med. 2024, 13, 1671. de Gregorio, C.; Trimarchi, G.; Faro, D.C.; Poleggi, C.; Teresi, L.; De Gaetano, F.; Zito, C.; Lofrumento, F.; Koniari, I.; Licordari, R.; Kounis, N.G.; Monte, I.P.; Di Bella, G. Systemic Vascular Resistance and Myocardial Work Analysis in Hypertrophic Cardiomyopathy and Transthyretin Cardiac Amyloidosis with Preserved Left Ventricular Ejection Fraction. J. Clin. Med. 2024, 13, 1671.

Abstract

The impact of systemic vascular resistance (SVR) in hypertrophic (HCM) and amyloid cardio-myopathies has been seldom investigated. We studied pressure-strain loop derived myocardial work (MW) indices and SVR in patients with either sarcomere HCM or wild type transthyretin cardiac amyloidosis (ATTR), presented with heart failure and preserved left ventricular ejection fraction (HFpEF) at the outpatient cardiology units at Messina and Catania University Hospitals (Italy). Patients were in sinus rhythm and needed to have good transthoracic ultrasound imaging quality to undergo transthoracic strain-echocardiography. Other than conventional parameters, SVR and GWI (global work index) were measured. Based on cross-tabulation (a way to assess the ventricular-arterial coupling), the patients were then classified in 4 classes according to the cut-off values suggested by previous studies of 1,440 dyne/s/cm-5 for SVR (Stefadouros et al., 1973) and 1576 mm Hg% for GWI (Olsen et al., 2022). Sixty patients, 30 in each group, aged 61±16 years, 78% males, were studied. HCM were younger than ATTR patients and in a better clinical status (23% HCM vs 77% ATTR were NYHA class 3, p<0.001). Overall, 51 patients (85%) showed high SVR, of whom 21 were HCM (70%) and 30 ATTR (100%) (p<0.005). Both, SVR and GWI were impaired (the poorest class C) in 43% HCM patients (with greater left ventricular concentric hypertrophy) vs 93% of ATTR patients (in advanced NYHA class) (p<0.001). In conclusion, assessing SVR and GWI in HFpEF patients with HCM or ATTR can help clinicians to interpret the pathophysiological and clinical features of such complex diseases.

Keywords

Cardiac Amyloidosis; Hypertrophic Cardiomyopathy; Preserved Left Ventricular Ejection Fraction; Systemic Vascular Resistance; Strain Echocardiography; Ventricular-Arterial Coupling.

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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