![]() 8–11 However, the GLS depends on the load, which may lead to a misinterpretation of the contractile function of the myocardium. 2 3 More recently, LV global longitudinal strain (GLS) has emerged as a robust and reproducible index to estimate the global and segmental ventricular function, to detect subclinical myocardial dysfunction and to predict outcomes. 7 Myocardial contraction fraction (MCF) has been reported to be superior to LVEF in predicting survival in AL–CA and both variant-type and wild-type ATTR–CA. Transthoracic echocardiography (TTE) remains the first imaging examination used for the initial assessment of cardiac involvement but the left ventricular ejection fraction (LVEF) may remain preserved until advanced stages of the disease. ![]() ![]() 4–6 Consequently, identifying patients with a poor prognosis is fundamental to ensure adequate treatment and a timely referral to specialised centres. 1–3 Untreated, CA is life threatening from few months for AL to few years for ATTR. The deposit of those proteins disrupts the structure and function of the heart with a thickening of the ventricular wall, an increase of the myocardial mass and a reduction in end-diastolic volume leading to a diastolic dysfunction, an impaired myocardial contraction, and a progressive heart failure and death. Cardiac amyloidosis (CA) is an infiltrative and restrictive cardiomyopathy characterised by myocardial deposition of insoluble misfolded proteins, most commonly immunoglobulin light-chain (AL) or transthyretin (ATTR) amyloidosis and its subtype wild-type and variant-type.
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