Ke Wan1, Weihao Li2, Jiayu Sun3, Yuanwei Xu2, Jie Wang2, Hong Liu2, Yang Dong2, Wei Cheng3, Qing Zhang2, Zhi Zeng2, Xiaoyue Zhou4, Yuchi Han5, Yucheng Chen2. 1. a Department of Geriatrics , West China Hospital, Sichuan University , Chengdu , China. 2. b Cardiology Division, Department of Cardiology , West China Hospital, Sichuan University , Chengdu , PR China. 3. c Department of Radiology , West China Hospital, Sichuan University , Chengdu , PR China. 4. d Northeast Asia MR Collaboration , Siemens Healthcare , Shanghai , China. 5. e Cardiovascular Division, Department of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Abstract
BACKGROUND: T1 mapping allows quantitative assessment of "diffuse" deposition of amyloid protein in the myocardium. Early detection of cardiac involvement and potential prognostic improvement could benefit patients with AL amyloidosis. OBJECTIVES: This study aims to evaluate the regional variation of amyloid infiltration in the left ventricle and the prognostic value of T1 mapping in patients with AL amyloidosis. METHODS: We prospectively enrolled 77 patients with AL amyloidosis who underwent cardiac magnetic resonance on a 3.0-T scanner. Native T1 and extracellular volume (ECV) were quantitated on the basal, mid, and apical levels of the left ventricle. Late gadolinium enhancement (LGE) pattern (no or non-specific LGE, sub-endocardial LGE, and transmural LGE) was also assessed. Forty healthy subjects served as controls. The primary end point was all-cause mortality. RESULTS: Basal ECV (26.9 ± 2.8% versus 31.1 ± 4.9%, p < .001) were lower than apical ECV in the healthy controls; however, basal ECV (60.6 ± 11.5% versus 53.0 ± 9.6%, p = .003) were significantly higher than apical ECV in patients with transmural LGE. During the follow-up period (median duration, 28 months; 25th-75th percentile, 13.5-38.0 months), 46 patients died. Basal ECV has the largest area under the curve of 0.845 (95% CI, 0.747-0.917) to predict all-cause mortality. Multivariable Cox analysis indicated that basal ECV was an independent prognostic factor and showed incremental prognostic value beyond NYHA class, Mayo stage, and LGE pattern. CONCLUSION: We demonstrated that T1 mapping may have the potential to detect a characteristic amyloid deposition with a decreasing gradient from base to apex. Furthermore, myocardial ECV indicated that basal amyloid infiltration provided robust and incremental prognostic value in patients with AL amyloidosis.
BACKGROUND: T1 mapping allows quantitative assessment of "diffuse" deposition of amyloid protein in the myocardium. Early detection of cardiac involvement and potential prognostic improvement could benefit patients with AL amyloidosis. OBJECTIVES: This study aims to evaluate the regional variation of amyloid infiltration in the left ventricle and the prognostic value of T1 mapping in patients with AL amyloidosis. METHODS: We prospectively enrolled 77 patients with AL amyloidosis who underwent cardiac magnetic resonance on a 3.0-T scanner. Native T1 and extracellular volume (ECV) were quantitated on the basal, mid, and apical levels of the left ventricle. Late gadolinium enhancement (LGE) pattern (no or non-specific LGE, sub-endocardial LGE, and transmural LGE) was also assessed. Forty healthy subjects served as controls. The primary end point was all-cause mortality. RESULTS: Basal ECV (26.9 ± 2.8% versus 31.1 ± 4.9%, p < .001) were lower than apical ECV in the healthy controls; however, basal ECV (60.6 ± 11.5% versus 53.0 ± 9.6%, p = .003) were significantly higher than apical ECV in patients with transmural LGE. During the follow-up period (median duration, 28 months; 25th-75th percentile, 13.5-38.0 months), 46 patients died. Basal ECV has the largest area under the curve of 0.845 (95% CI, 0.747-0.917) to predict all-cause mortality. Multivariable Cox analysis indicated that basal ECV was an independent prognostic factor and showed incremental prognostic value beyond NYHA class, Mayo stage, and LGE pattern. CONCLUSION: We demonstrated that T1 mapping may have the potential to detect a characteristic amyloid deposition with a decreasing gradient from base to apex. Furthermore, myocardial ECV indicated that basal amyloid infiltration provided robust and incremental prognostic value in patients with AL amyloidosis.
Entities:
Keywords:
Light-chain amyloidosis; Mayo staging system; T1 mapping; cardiac magnetic resonance; prognosis
Authors: Nadine Kawel-Boehm; Scott J Hetzel; Bharath Ambale-Venkatesh; Gabriella Captur; Christopher J Francois; Michael Jerosch-Herold; Michael Salerno; Shawn D Teague; Emanuela Valsangiacomo-Buechel; Rob J van der Geest; David A Bluemke Journal: J Cardiovasc Magn Reson Date: 2020-12-14 Impact factor: 5.364
Authors: Susan M Dusenbery; Jane W Newburger; Steven D Colan; Kimberlee Gauvreau; Annette Baker; Andrew J Powell Journal: Int J Cardiol Heart Vasc Date: 2021-01-18