Background: Cardiac amyloidosis (CA) is a serious though increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool.
Objectives:We aimed to study the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness (IWT) in whom amyloid was suspected. We also aimed to further characterise structural and functional changes associated with amyloid infiltration.
Methods:We studied 1187 consecutive patients evaluated at 3 referral centres for CA and analysed morphological, functional and strain-derived echo parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified using extracellular volume measurements at cardiac magnetic resonance.Results: 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin (ATTR) CA. Concentric remodelling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E/e'ratio, longitudinal strain and tricuspid annular plane systolic excursion had greatest diagnostic performance in AL amyloidosis (area under the curve -AUC-0.90[95% confidence interval 0.87-0.92]), whilst addition of septal apical-to -base ratio yielded the best diagnostic accuracy in the IWT group (AUC 0.87[0.85-0.9]).Conclusions: Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances, and enable to define two scores that are sensitive and specific tools to diagnose or exclude CA.
In patients with LVNC evaluated by using CMR, the degree of LV trabeculation seems to have no prognostic impact over and above LV dilation, LV systolic dysfunction, and presence of LGE.
Coronavirus disease 2019 (COVID-19) has become a rapid worldwide pandemic. While COVID-19 primarily manifests as an interstitial pneumonia and severe acute respiratory distress syndrome, severe involvement of other organs has been documented. In this article, we will review the role of non-contrast chest computed tomography in the diagnosis, follow-up and prognosis of patients affected by COVID-19 pneumonia with a detailed description of the imaging findings that may be encountered. Given that patients with COVID-19 may also suffer from coagulopathy, we will discuss the role of CT pulmonary angiography in the detection of acute pulmonary embolism. Finally, we will describe more advanced applications of CT in the differential diagnosis of myocardial injury with an emphasis on ruling out acute coronary syndrome and myocarditis.
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