In a study of 72 patients with cardiac amyloidosis, researchers assessed myocardial stiffness using transthoracic three-dimensional shear wave elastography, with findings evaluated alongside echocardiography, scintigraphy, biopsy, and blood testing. The findings are scheduled to be presented as a poster at the American Society of Echocardiography (ASE) 2026 Scientific Sessions and published in the Journal of the American Society of Echocardiography.
Cardiac amyloidosis results from myocardial amyloid deposition that increases myocardial stiffness and contributes to diastolic dysfunction. The two primary forms of cardiac amyloidosis are light chain cardiac amyloidosis and transthyretin cardiac amyloidosis. Transthyretin amyloidosis generally follows a slower disease course and is managed with transthyretin-directed therapies, whereas light chain amyloidosis progresses more rapidly and typically requires prompt chemotherapy. The researchers evaluated whether myocardial stiffness measured with three-dimensional shear wave elastography could differentiate the two disease subtypes.
The cohort included 44 patients with transthyretin cardiac amyloidosis, 24 patients with light chain cardiac amyloidosis, and 4 patients with nontypable amyloidosis, all of whom underwent echocardiography, scintigraphy, biopsy, blood testing, and three-dimensional shear wave elastography. Mean age was 80 years among patients with transthyretin cardiac amyloidosis, 66 years among those with light chain cardiac amyloidosis, and 87 years among those with nontypable amyloidosis.
The researchers acquired 10 three-dimensional shear wave elastography measurements in each myocardial segment, including the anterior free wall of the right ventricle, the basal anteroseptal wall visualized in the parasternal long-axis view, and the apex visualized in the apical four-chamber view. Shear wave velocity was measured within a myocardial volume of 10 × 16 × 16 mm³ during diastasis using electrocardiographic gating.
None of the echocardiographic parameters discriminated between transthyretin and light chain cardiac amyloidosis. Shear wave velocity was higher among patients with transthyretin cardiac amyloidosis than among those with light chain cardiac amyloidosis in the basal anteroseptal wall and right ventricular wall. No difference was observed at the apex.
The researchers also developed an algorithm incorporating patient age, N-terminal pro-B-type natriuretic peptide, and median shear wave velocity measurements in the basal anteroseptal and right ventricular walls. According to the study, the algorithm achieved 100% sensitivity and 100% specificity.
The researchers concluded that a three-dimensional shear wave elastography–based algorithm was able to distinguish transthyretin and light chain cardiac amyloidosis with what they described as excellent accuracy and that the approach shows promise for the diagnosis and monitoring of cardiac amyloidosis.
No disclosure information was provided.
