Elsevier

JACC: Cardiovascular Imaging

Volume 3, Issue 2, February 2010, Pages 155-164
JACC: Cardiovascular Imaging

Original Research
Role of Cardiac Magnetic Resonance Imaging in the Detection of Cardiac Amyloidosis

https://doi.org/10.1016/j.jcmg.2009.09.023Get rights and content
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Objectives

Our aim was to evaluate the role and mechanism of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) in identifying cardiac amyloidosis (CA) and to investigate associations between LGE and clinical, morphologic, functional, and biochemical features.

Background

CA can be challenging to diagnose by echocardiography. Recent studies have demonstrated an emerging role for LGE-CMR.

Methods

LGE-CMR was performed in 120 patients with amyloidosis. Cardiac histology was available in 35 patients. The remaining 85 patients were divided into those with and without echocardiographic evidence of CA.

Results

Of the 35 patients with histologically verified CA, abnormal LGE was present in 34 (97%) patients and increased echocardiographic left ventricular wall thickness in 32 (91%) patients. Global transmural or subendocardial LGE (83%) was most common and was associated with greater interstitial amyloid deposition (p = 0.03). Suboptimal myocardial nulling (8%) and patchy focal LGE (6%) were also observed. LGE distribution matched the deposition pattern of interstitial amyloid. Among patients without cardiac histology, LGE was present in 86% of those with evidence of CA by echocardiography and in 47% of those without evidence of CA by echocardiography. In patients without echocardiographic evidence of CA, the presence of LGE was associated with worse clinical, electrocardiographic (ECG), and cardiac biomarker profiles. In all patients, LGE presence and pattern was associated with New York Heart Association functional class, ECG voltage, left ventricular mass index, right ventricular wall thickness, troponin-T, and B-type natriuretic peptide levels.

Conclusions

LGE is common in CA and detects interstitial expansion from amyloid deposition. Global transmural or subendocardial LGE is most common, but suboptimal myocardial nulling and focal patchy LGE are also observed. LGE-CMR may detect early cardiac abnormalities in patients with amyloidosis with normal left ventricular thickness. The presence and pattern of LGE is strongly associated with clinical, morphologic, functional, and biochemical markers of prognosis.

Key Words

amyloidosis
cardiac magnetic resonance
cardiomyopathy

Abbreviations and Acronyms

BNP
B-type natriuretic peptide
CA
cardiac amyloidosis
CMR
cardiac magnetic resonance
EF
ejection fraction
FOV
field of view
Gd
gadolinium
LGE
late gadolinium enhancement
LV
left ventricle/ventricular
LVMI
left ventricular mass index
NYHA
New York Heart Association
PF
patchy focal
RV
right ventricle/ventricular
SCA
senile cardiac amyloidosis
SN
suboptimal nulling
TE
echo time
TI
inversion time
TR
repetition time

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