A Risk Score to Diagnose Cardiac Involvement and Provide Prognosis Information in Patients at Risk of Cardiac Light-Chain Amyloidosis

Wu, Yan; Pu, Cailing; Zhu, Wenchao; He, Chengbin; Fei, Jingle; Hu, Hongjie

doi:10.3389/fcvm.2022.817456

Cited by 3 publications

(1 citation statement)

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“…The T1 mapping and ECV values of HCM and AL CA were higher than those of the normal control group (1243.5 ± 29.5 vs. 1318.2 ± 32.4 vs. 1374.6 ± 74.9 ms, both P < 0.001; 30.1 ± 2.5 vs. 31.3 ± 3.4 vs. 42.8 ± 11.5%, P < 0.001, respectively). This study had similar results, which is consistent with other studies ( 10 , 41 ). And the ECV values of Mayo stage I/II AL CA were significantly higher than those of HCM, and the difference was statistically significant (31.3 ± 3.4 vs. 37.8 ± 5.7%, P < 0.05).…”

Section: Discussionsupporting

confidence: 93%

The diagnostic value of multiparameter cardiovascular magnetic resonance for early detection of light-chain amyloidosis from hypertrophic cardiomyopathy patients

Yue

Yang

Wang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundEarly-stage amyloidosis of the heart is prone to be underdiagnosed or misdiagnosed, increasing the risk of early heart failure and even death of the patient. To ensure timely intervention for cardiac light-chain amyloidosis (AL CA), it is vital to develop an effective tool for early identification of the disease. Recently, multiparameter cardiovascular magnetic resonance (CMR) has been used as a comprehensive tool to assess myocardial tissue characterization. We aimed to investigate the difference in left ventricular (LV) strain, native T1, extracellular volume (ECV), and late gadolinium enhancement (LGE) between AL CA patients, hypertrophic cardiomyopathy patients (HCM), and healthy control subjects (HA). Moreover, we explored the value of multiparameter CMR for differential diagnosis of the early-stage AL CA patients from HCM patients, who shared similar imaging characteristics under LGE imaging.MethodsA total of 38 AL CA patients, 16 HCM patients, and 17 HA people were prospectively recruited. All subjects underwent LGE imaging, Cine images, and T1 mapping on a 3T scanner. The LV LGE pattern was recorded as none, patchy or global. LV strain, native T1, and ECV were measured semi-automatically using dedicated CMR software. According to clinical and biochemical markers, all patients were classified as Mayo stage I/II and Mayo stage IIIa/IIIb. Univariable and multivariable logistic regression models were utilized to identify independent predictors of early-stage AL CA from HCM patients. Receiver operator characteristic (ROC) curve analysis and Youden’s test were done to determine the accuracy of multiparameter CMR in diagnosing Mayo stage I/II AL CA and establish a cut-off value.ResultsFor Mayo stage I/II AL CA patients, the global longitudinal strain (GLS) absolute value (11.9 ± 3.0 vs. 9.5 ± 1.8, P < 0.001) and the global circumferential strain (GCS) absolute value (19.0 ± 3.6 vs. 9.5 ± 1.8, P < 0.001) were significantly higher than in HCM patients. The native T1 (1334.9 ± 49.9 vs. 1318.2 ± 32.4 ms, P < 0.0001) and ECV values (37.8 ± 5.7 vs. 31.3 ± 2.5%, P < 0.0001) were higher than that of HCM patients. In multiparameter CMR models, GCS (2.097, 95% CI: 1.292–3.403, P = 0.003), GLS (1.468, 95% CI: 1.078–1.998, P = 0.015), and ECV (0.727, 95% CI: 0.569–0.929, P = 0.011) were the significant variables for the discrimination of the early-stage AL CA patients from HCM patients. ROC curve analysis and Youden’s test were used on GCS, GLS, ECV, and pairwise parameters for differentiating between Mayo stage I/II AL CA and HCM patients, respectively. The combination of GLS, GCS, and ECV mapping could distinguish Mayo stage I/II AL amyloidosis patients from hypertrophic cardiomyopathy with excellent performance (AUC = 0.969, Youden index = 0.813).ConclusionIn early-stage AL CA patients with atypical LGE, who had similar imaging features as HCM patients, ECV mapping, GCS, and GLS were correlated with the clinical classification of the patients. The combination of GCS, GLS, and ECV could differentiate early-stage AL CA from HCM patients. Multiparameter CMR has the potential to provide an effective and quantitative tool for the early diagnosis of myocardial amyloidosis.

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Section: Discussionsupporting

confidence: 93%

The diagnostic value of multiparameter cardiovascular magnetic resonance for early detection of light-chain amyloidosis from hypertrophic cardiomyopathy patients

Yue

Yang

Wang

et al. 2022

Front. Cardiovasc. Med.

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The value of myocardial contraction fraction and long-axis strain to predict late gadolinium enhancement in multiple myeloma patients with secondary cardiac amyloidosis

Hu,

Song,

Yang

et al. 2024

Sci Rep

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The aim of this study is to assess the effectiveness of conventional and two additional functional markers derived from standard cardiac magnetic resonance (CMR) images in detecting the occurrence of late gadolinium enhancement (LGE) in patients with secondary cardiac amyloidosis (CA) related to multiple myeloma (MM). This study retrospectively included 32 patients with preserved ejection fraction (EF) who had MM-CA diagnosed consecutively. Conventional left ventricular (LV) function markers and two additional functional markers, namely myocardial contraction fraction (MCF) and LV long-axis strain (LAS), were obtained using commercial cardiac post-processing software. Logistic regression analyses and receiver operating characteristic (ROC) analysis were performed to evaluate the predictive performances. (1) There were no notable distinctions in clinical features between the LGE+ and LGE− groups, with the exception of a reduced systolic blood pressure in the former (105.60 ± 18.85 mmHg vs. 124.50 ± 20.95 mmHg, P = 0.022). (2) Patients with MM-CA presented with intractable heart failure with preserved ejection fraction (HFpEF). The LVEF in the LGE+ group exhibited a greater reduction (54.27%, IQR 51.59–58.39%) in comparison to the LGE− group (P < 0.05). And MM-CA patients with LGE+ had significantly higher LVMI (90.15 ± 23.69 g/m 2 ), lower MCF (47.39%, IQR 34.28–54.90%), and the LV LAS were more severely damaged (− 9.94 ± 3.42%) than patients with LGE− (all P values < 0.05). (3) The study found that MCF exhibited a significant independent association with LGE, as indicated by an odds ratio of 0.89 ( P < 0.05). The cut-off value for MCF was determined to be 64.25% with a 95% confidence interval ranging from 0.758 to 0.983. The sensitivity and specificity of this association were calculated to be 95% and 83%, respectively. MCF is a simple reproducible predict marker of LGE in MM-CA patients. It is a potentially CMR-based method that promise to reduce scan times and costs, and boost the accessibility of CMR.

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A predictive model based on non-contrast CMR and texture analysis for the prognostic evaluation of cardiac amyloidosis

She,

Guo,

Sun

et al. 2024

Preprint

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We aimed to develop a predictive model based on texture features with non-contrast cardiac magnetic resonance (CMR) imaging for risk stratification toward adverse events in cardiac amyloidosis (CA) patients. A cohort of 78 CA patients was classified into a training set (n = 54) and a validation set (n = 24) at a ratio of 7:3. A total of 275 texture features were extracted from CMR images. MaZda and the support vector machine (SVM) were utilized for feature selection and model construction. A SVM model incorporating radiological and texture features was built for prediction of endpoint events by evaluating area under curve (AUC). In the whole cohort, 52 patients were major adverse cardiovascular events (MACE) occurred and 26 patients were No MACE occurred. By combining 2 radiological features and 8 texture features extracted from cine and T2-weighted imaging (T2WI) images, the SVM model achieved AUCs of receiver operating characteristic (ROC) and precision-recall (PR) of 0.930 and 0.962 in the training cohort and that of 0.867 and 0.941 in the validated cohort. The Kaplan–Meier curve of this SVM model criteria excellently stratified CA outcomes (Log rank test, P < 0.0001). The SVM model based on radiological and texture features derived from non-contrast CMR images can be a reliable biomarker for adverse events prognostication in CA patients.

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A Risk Score to Diagnose Cardiac Involvement and Provide Prognosis Information in Patients at Risk of Cardiac Light-Chain Amyloidosis

Cited by 3 publications

References 50 publications

The diagnostic value of multiparameter cardiovascular magnetic resonance for early detection of light-chain amyloidosis from hypertrophic cardiomyopathy patients

The diagnostic value of multiparameter cardiovascular magnetic resonance for early detection of light-chain amyloidosis from hypertrophic cardiomyopathy patients

The value of myocardial contraction fraction and long-axis strain to predict late gadolinium enhancement in multiple myeloma patients with secondary cardiac amyloidosis

A predictive model based on non-contrast CMR and texture analysis for the prognostic evaluation of cardiac amyloidosis

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