Identification and Assessment of Cardiac Amyloidosis by Myocardial Strain Analysis of Cardiac Magnetic Resonance Imaging.
Oda Seitaro,Utsunomiya Daisuke,Nakaura Takeshi,Yuki Hideaki,Kidoh Masafumi,Morita Kosuke,Takashio Seiji,Yamamuro Megumi,Izumiya Yasuhiro,Hirakawa Kyoko,Ishida Toshifumi,Tsujita Kenichi,Ueda Mitsuharu,Yamashita Taro,Ando Yukio,Hata Hiroyuki,Yamashita Yasuyuki
Circulation journal : official journal of the Japanese Circulation Society
BACKGROUND:We explored the usefulness of myocardial strain analysis on cardiac magnetic resonance imaging (CMR) scans for the identification of cardiac amyloidosis.Methods and Results:The 61 patients with systemic amyloidosis underwent 3.0-T CMR, including CMR tagging and late-gadolinium enhanced (LGE) imaging. The circumferential strain (CS) of LGE-positive and LGE-negative patients was measured on midventricular short-axis images and compared. Logistic regression modeling of CMR parameters was performed to detect patients with LGE-positive cardiac amyloidosis. Of the 61 patients with systemic amyloidosis 48 were LGE-positive and 13 were LGE-negative. The peak CS was significantly lower in the LGE-positive than in the LGE-negative patients (-9.5±2.3 vs. -13.3±1.4%, P<0.01). The variability in the peak CS time was significantly greater in the LGE-positive than in the LGE-negative patients (46.1±24.5 vs. 21.2±20.1 ms, P<0.01). The peak CS significantly correlated with clinical biomarkers. The sensitivity, specificity, and accuracy of the diagnostic model using CS parameters for the identification of LGE-positive amyloidosis were 93.8%, 76.9%, and 90.2%, respectively. CONCLUSIONS:Myocardial strain analysis by CMR helped detect LGE-positive amyloidosis without the need for contrast medium. The peak CS and variability in the peak CS time may correlate with the severity of cardiac amyloid deposition and may be more sensitive than LGE imaging for the detection of early cardiac disease in patients with amyloidosis.
Cardiovascular magnetic resonance imaging for amyloidosis: The state-of-the-art.
Tang Chun Xiang,Petersen Steffen E,Sanghvi Mihir M,Lu Guang Ming,Zhang Long Jiang
Trends in cardiovascular medicine
Amyloidosis results from insoluble precursor proteins being deposited in the extracellular compartment. The prognosis of the disease is predominantly determined by cardiac involvement due to amyloid accumulation that contributes to cardiac dysfunction and disturbed conduction of cardiac electrical signals. The clinical and radiological manifestations of amyloidosis are often non-specific, making amyloidosis a diagnostic challenge both for clinicians and radiologists. Cardiovascular magnetic resonance imaging, including conventional sequences, late gadolinium enhancement, T1 mapping and determination of extracellular volume fraction is a multi-dimensional modality for the assessment and diagnosis of cardiac amyloidosis and, in addition, is an excellent tool for risk stratification and disease tracking.