Cardiovascular Magnetic Resonance in Clinically Suspected Cardiac Amyloidosis

Abstract

In patients with biopsy-proven cardiac amyloidosis, late gadolinium enhancement frequently occurs in a peculiar pattern. On the basis of the gold standard, EMB, noninvasive CMRI can be used to diagnose or rule out cardiac amyloidosis with good sensitivity and excellent specificity in a clinical routine setting.

Visual Assessment of Relative Apical Sparing Pattern Is More Useful Than Quantitative Assessment for Diagnosing Cardiac Amyloidosis in Borderline or Mildly Increased Left Ventricular Wall Thickness

“…Identification of amyloid deposition on EMB specimen with Congo red or amyloid P stain and/or typical patterns of LGE on CMR was a prerequisite for diagnosis of CA. 10, 11 Because nulling out normal myocardium through optimal inversion time was sometimes technically challenging in CA, it was also considered that CA was highly probable if >50% of LV myocardium went through the nulling time point earlier than LV cavity did. 12 In those patients diagnosed with CA only by LGE on CMR, pathological confirmation of amyloid deposition in at least 1 other organ outside the heart was absolutely necessary.…”

Cardiac Magnetic Resonance Imaging and 2-Dimensional Speckle Tracking Echocardiography in Secondary Cardiac Amyloidosis

“…1 Recently, cardiac magnetic resonance imaging (CMRI) has been proposed to detect transmural tissue involvement of cardiac amyloidosis, which usually occurred from the subendocardium. 2 In contrast, tissue Doppler imaging or 2-dimensional speckle tracking echocardiography (2D-STE) has been applied as a useful tool to augment echocardiographic assessment in the diagnosis of a variety of cardiac diseases including cardiac amyloidosis. 3- 6 Comparison with these images and pathology, however, was not performed directly in these studies.…”

Amyloid cardiomyopathy

“…Late gadolinium enhancement images are typically obtained about 5 minutes after infusion of 0.1 to 0.2 mmol/kg of gadolinium injection; global subendocardial LGE is most often found in amyloid cardiomyopathy. These findings, found in 80% of patients, are typical and pathognomonic for amyloid cardiomyopathy [55][56][57][58][59] . T1 mapping techniques may identify cardiac involvement at an earlier stage compared to LGE images.…”