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. 2023 Jan 27:10:1085824.
doi: 10.3389/fcvm.2023.1085824. eCollection 2023.

Stroke volume and myocardial contraction fraction in transthyretin amyloidosis cardiomyopathy: A systematic review

Serenelli Matteo  1 , Cantone Anna  1 , Sanguettoli Federico  1 , Maio Daniele  1 , Fabbri Gioele  1 , Dal Passo Beatrice  1 , Pavasini Rita  1 , Tonet Elisabetta  1 , Passarini Giulia  1 , Rapezzi Claudio  1 , Campo Gianluca  1
Affiliations

Stroke volume and myocardial contraction fraction in transthyretin amyloidosis cardiomyopathy: A systematic review

Serenelli Matteo et al. Front Cardiovasc Med. .

Abstract

Background: Cardiac amyloidosis (CA) is primarily a restrictive cardiomyopathy in which the impairment of diastolic function is dominant. Despite this, the left ventricular ejection fraction (LVEF) may be depressed in the late stage of the disease, but it poorly predicts prognosis in the earlier phases and does not represent well the pathophysiology of CA. Many echocardiographic parameters resulted important diagnostic and prognostic tools in patients with CA. Stroke volume (SV) and myocardial contraction fraction (MCF) may be obtained both with echocardiography and cardiac magnetic resonance (MRI). They reflect many factors intrinsically related to the pathophysiology of CA and are therefore potentially associated with symptoms and prognosis in CA.

Objectives: To collect and summarize the current evidence on SV and MCF and their clinical and prognostic role in transthyretin (TTR-CA).

Methods and results: We performed a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We searched the literature database for studies focusing on SV and MCF in patients with TTR-CA. We analysed the following databases: PUBMED, Cochrane Library, EMBASE, and Web of Science database. Fourteen studies were included in the review. Both SV and MCF have important prognostic implications and are related to mortality. Furthermore, SV is more related to symptoms than LVEF and predicts tolerability of beta-blocker therapy in TTR-CA. Finally, SV showed to be an excellent measure to suggest the presence of TTR-CA in patients with severe aortic stenosis.

Conclusion: Stroke volume and MCF are very informative parameters that should be routinely assessed during the standard echocardiographic examination of all patients with TTR-CA. They carry a prognostic role while being associated with patients' symptoms.

Systematic review registration: https://doi.org/10.17605/OSF.IO/ME7DS.

Keywords: amyloidosis; heart failure; myocardial contraction fraction (MCF); prognosis; stroke volume (SV); transthyretin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewers DT and GS declared a past co-authorship with the authors PR and RC to the handling editor.

Figures

FIGURE 1
FIGURE 1
Determinants of low stroke volume and low cardiac output in patients with cardiac amyloidosis. The figure summarized the main determinants of low cardiac output in patients with cardiac amyloidosis.
FIGURE 2
FIGURE 2
Study flow diagram.
FIGURE 3
FIGURE 3
Baseline left ventricular ejection fraction, stroke volume index [panel (A)] and stroke volume [panel (B)] in patients with cardiac amyloidosis.
See this image and copyright information in PMC

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