Cardiac magnetic resonance evaluation of left ventricular remodelling distribution in cardiac amyloidosis

Pozo, Eduardo; Kanwar, Anubhav; Deochand, Rajiv; Castellano, José M.; Naib, Tara; Pazos-López, Pablo; Osman, Keren; Cham, Matthew D.; Narula, Jagat; Fuster, Valentín; Sanz, Javier

doi:10.1136/heartjnl-2014-305710

Cited by 45 publications

(39 citation statements)

References 31 publications

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“…The presence of LVH was defined as increased left ventricular (LV) mass based on age-and sex-indexed reference values. Asymmetric septal hypertrophy was defined as the ratio between the septal and posterior wall >1.5 (19). Asymmetric septal hypertrophy comprised, in turn, 2 different patterns:…”

Section: Cmr Image Analysismentioning

confidence: 99%

“…between the septal and posterior wall >1.5 (19,28), was the most common form of ventricular remodeling in ATTR, being present in 79% of patients with cardiac ATTR. The pattern of asymmetric septal hypertrophy was divided into the morphological subtypes of sigmoid septum (55%) and reverse septal contour (24%).…”

Section: Morphological Phenotypes Asymmetric Septal Hypertrophy Defmentioning

confidence: 99%

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Magnetic Resonance in Transthyretin Cardiac Amyloidosis

Martinez‐Naharro

Treibel

Abdel‐Gadir

et al. 2017

Journal of the American College of Cardiology

332

231

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Section: Cmr Image Analysismentioning

confidence: 99%

Section: Morphological Phenotypes Asymmetric Septal Hypertrophy Defmentioning

confidence: 99%

Magnetic Resonance in Transthyretin Cardiac Amyloidosis

Martinez‐Naharro

Treibel

Abdel‐Gadir

et al. 2017

Journal of the American College of Cardiology

332

231

View full text Add to dashboard Cite

show abstract

“…23 However, some of these echo indices, especially E/E′ ratio, left atrial volume index and myocardial contraction fraction, have high specificity and could, thus, be used to "rule in" potential amyloidosis cases. 27 Among the conventional echocardiographic parameters, myocardial contraction fraction has shown the best accuracy.…”

Section: Conventional Echo Parameters and Diagnosis Of Amyloidosismentioning

confidence: 99%

“…6,7,22 These studies were mostly based either on sole CA populations or made comparisons between patients with possible or no cardiac infiltration. 5,19,23,24 The few studies that have used a "wider" hypertrophic spectrum 8,9,25,26 were restricted to a small number of echo parameters tested.…”

Section: Conventional Echo Parameters and Diagnosis Of Amyloidosismentioning

confidence: 99%

Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis

Pagourelias

Mirea

Duchenne

et al. 2017

Circ: Cardiovascular Imaging

230

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Background— A plethora of echo parameters has been suggested for distinguishing cardiac amyloidosis (CA) from other causes of myocardial thickening with, however, scarce data on their head-to-head comparison. This study aimed at comparing the diagnostic accuracy of various deformation and conventional echo parameters in differentiating CA from other hypertrophic substrates, especially in the gray zone of mild hypertrophy (maximum wall thickness ≤16 mm) or normal ejection fraction (EF). Methods and Results— We included 100 subjects, of which 40 were patients with newly diagnosed, biopsy-proven CA (65.5±10.8 years, 65% male, 62.5% amyloidosis light chain [AL] type), 40 patients with hypertrophic cardiomyopathy matched for demographics and maximum wall thickness (60.1±14.8 years, 85% male), and 20 hypertensives with prominent myocardial remodeling. Quantifiable conventional morphological and functional parameters along with multidimensional strain and strain-derived ratios indices, previously suggested to diagnose CA, were analyzed. EF global longitudinal strain ratio showed the best performance to discriminate CA (area under the curve, 0.95; 95% confidence intervals, 0.89–0.98; P <0.00005). Traditional echo indices showed overall low sensitivities and high specificities (among them myocardial contraction fraction ratio had the highest area under the curve, 0.80; 95% confidence intervals, 0.7–0.87; P <0.0001). In the challenging subgroups (maximum wall thickness ≤16 mm and EF>55%), EF global longitudinal strain ratio remained the best predicting parameter of CA diagnosis (multiple logistic regression models P <0.00005 and P =0.0002, respectively) independent of the CA type. Conclusions— Our study demonstrated that in patients with thickened hearts, EF global longitudinal strain ratio has the best accuracy in detecting CA, even among the most “challenging” patient subgroups as those with mild hypertrophy and normal EF.

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“…3). However, recent work documents concentric left ventricular hypertrophy (LVH) in 59 % of patients with cardiac amyloidosis, eccentric LVH or concentric remodelling in 33 % and normal geometry in the remaining 8 % [6]. Cardiac amyloidosis may present with symmetric or asymmetric, concentric or eccentric hypertrophy (Fig.…”

Section: Morphology Function and Anatomymentioning

confidence: 98%

Cardiovascular magnetic resonance for amyloidosis

et al. 2014

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Cardiac involvement drives the prognosis and treatment in systemic amyloid. Echocardiography, the mainstay of current cardiac imaging, defines cardiac structure and function. Echocardiography, in conjunction with clinical phenotype, electrocardiogram and biomarkers (brain natriuretic peptide and troponin), provides an assessment of the likelihood and extent of cardiac involvement. Two tests are transforming our understanding of cardiac amyloidosis, bone tracer scanning and cardiovascular magnetic resonance (CMR). CMR provides a "second opinion" on the heart's structure and systolic function with better accuracy and more precision than echocardiography but is unable to assess diastolic function and is not as widely available. Where CMR adds unique advantages is in evaluating myocardial tissue characterisation. With administration of contrast, the latest type of late gadolinium enhancement imaging (phase-sensitive inversion recovery sequence) is highly sensitive and specific with images virtually pathognomonic for amyloidosis. CMR is also demonstrating that the range of structural and functional changes in cardiac amyloid is broader than traditionally thought. CMR with T1 mapping, a relatively new CMR technique, can measure the amyloid burden and the myocyte response to infiltration (hypertrophy/cell loss) with advantages for tracking change (e.g. the wall thickness can stay the same but the composition can change) over time or during therapy. Such techniques hold great promise for advancing drug development in this arena and providing new prognostic insights. CMR with tissue characterisation is rewriting our understanding of cardiac amyloidosis and may lead to the development of new classification, therapies and prognostic systems.

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Cardiac magnetic resonance evaluation of left ventricular remodelling distribution in cardiac amyloidosis

Abstract: Asymmetric LVH and remodelling patterns different from concentric LVH are common in CA. Increased LV mass index, increased RWT, and asymmetric LVH are independently associated with the diagnosis. Traditional diagnostic criteria show poor sensitivity.

Cited by 45 publications

References 31 publications

Magnetic Resonance in Transthyretin Cardiac Amyloidosis

Magnetic Resonance in Transthyretin Cardiac Amyloidosis

Echo Parameters for Differential Diagnosis in Cardiac Amyloidosis

Cardiovascular magnetic resonance for amyloidosis

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