Identification and Assessment of Cardiac Amyloidosis by Myocardial Strain Analysis of Cardiac Magnetic Resonance Imaging

Abstract

Background:We explored the usefulness of myocardial strain analysis on cardiac magnetic resonance imaging (CMR) scans for the identification of cardiac amyloidosis. Methods and Results:The 61 patients with systemic amyloidosis underwent 3.0-T CMR, including CMR tagging and late-gadolinium enhanced (LGE) imaging. The circumferential strain (CS) of LGE-positive and LGE-negative patients was measured on midventricular short-axis images and compared. Logistic regression modeling of CMR parameters was performed to detect patients with LGE-positive cardiac amyloidosis. Of the 61 patients with systemic amyloidosis 48 were LGE-positive and 13 were LGE-negative. The peak CS was significantly lower in the LGE-positive than in the LGE-negative patients (−9.5±2.3 vs. −13.3±1.4%, P<0.01). The variability in the peak CS time was significantly greater in the LGE-positive than in the LGE-negative patients (46.1±24.5 vs. 21.2±20.1 ms, P<0.01). The peak CS significantly correlated with clinical biomarkers. The sensitivity, specificity, and accuracy of the diagnostic model using CS parameters for the identification of LGE-positive amyloidosis were 93.8%, 76.9%, and 90.2%, respectively. Conclusions:Myocardial strain analysis by CMR helped detect LGE-positive amyloidosis without the need for contrast medium. The peak CS and variability in the peak CS time may correlate with the severity of cardiac amyloid deposition and may be more sensitive than LGE imaging for the detection of early cardiac disease in patients with amyloidosis.

A multi-vendor, multi-center study on reproducibility and comparability of fast strain-encoded cardiovascular magnetic resonance imaging

“…It has been shown that strain, determined using either echocardiography or CMR, is a valuable parameter to determine the impact of coronary artery disease on heart function [12], to detect LV dysfunction, especially in patients with heart failure when EF is still preserved [1,4,12,23] and to reveal diffuse damage to the myocardium due to systemic diseases, such as cardiac amyloidosis [24,25], sarcoidosis [26] or cardiotoxic effects of chemotherapy [5]. Despite these many possible indications, the use of strain in clinical routine is still challenging due to the impact of intra-, interobserver- [7] and inter-vendor reproducibility of the different post-processing platforms [8,9,27] on strain results, which could also explain the lack of inter-technique agreement between echocardiography and CMR [28].…”

Patterns of CMR measured longitudinal strain and its association with late gadolinium enhancement in patients with cardiac amyloidosis and its mimics

“…It is understood that the LGE seen in patients with CA relates to the deposition of amyloid fibrils [ 3 , 13 , 14 ]. A recent study assessing myocardial circumferential strain on CMR has demonstrated a significant reduction in patients with CA with LGE compared with those without LGE, suggesting a potential role for strain analysis for detection of LGE without the need for contrast medium [ 15 ]. A difference in ventricular function has also been demonstrated between the basal and apical segments of the left ventricle by echocardiography measured LS [ 5 ].…”

Cardiac Magnetic Resonance and amyloidosis: Review

“…In addition, the technique may detect longitudinal or circumferential functional changes in individuals with mutations but without a clear phenotype determined by other techniques. 37,38 We understand that one limitation for the use of myocardial tagging in many centers is the lack of specific softwares for analysis, but we believe in the benefits of the implementation of the technology.…”