Left Ventricular Myocardial Deformation on Cine MR Images: Relationship to Severity of Disease and Prognosis in Light-Chain Amyloidosis

Abstract

Purpose To measure left ventricular (LV) myocardial strain with cine magnetic resonance (MR) imaging and a deformable registration algorithm (DRA) and to assess the prognostic value of myocardial strain in patients with light-chain (AL) amyloidosis. Materials and Methods In this prospective study, 78 consecutive patients with AL amyloidosis who underwent contrast material-enhanced cardiac MR imaging were enrolled at West China Hospital. LV myocardial strains and late gadolinium enhancement (LGE) were evaluated. Association between myocardial strain and all-cause mortality was analyzed with the stepwise Cox regression model. Results Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly lower in the no or nonspecific LGE group compared with the subendocardial LGE and transmural LGE groups (mean GLS, -10% ± 3 [standard deviation] vs -7% ± 3 vs -4% ± 1; P < .001) (mean GCS, -13% ± 3 vs -11% ± 3 vs -7% ± 2; P < .001). GLS and GCS were reduced in patients without clinical cardiac amyloidosis (mean GLS, -13% ± 3 vs -16% ± 2; P = .005) (mean GCS, -16% ± 1 vs -19% ± 2; P = .02). Circumferential and radial strains were impaired in basal segments in accordance with the distribution of LGE. Multivariate Cox analysis revealed that GCS (hazard ratio [HR] = 1.16 per 1% absolute decrease; 95% confidence interval [CI]: 1.03, 1.31; P = .02) and the presence of transmural LGE (HR = 1.75; 95% CI: 1.10, 2.80; P = .02) were independent predictors of all-cause mortality after adjustment for LV ejection fraction, right ventricular ejection fraction, LV mass index, GLS, and global radial strain. Conclusion Strain parameters derived with cine MR imaging-based DRA may be a new noninvasive imaging marker with which to evaluate the extent of cardiac amyloid infiltration and may offer independent prognostic information for all-cause mortality in patients with AL amyloidosis.

Prognostic value of novel imaging parameters derived from standard cardiovascular magnetic resonance in high risk patients with systemic light chain amyloidosis

“…Especially, the assessment of LV longitudinal function by strain using tissue Doppler echocardiography has been described to identify early impairments of LV function in AL amyloidosis [36, 37]. In addition, the longitudinal function by strain analysis was associated with poor prognosis and outperformed standard echocardiographic parameters suggesting that strain imaging could serve as a new tool to identify high risk subjects [19, 38, 39]. Our study results are in agreement with previous data.…”

JCS 2020 Guideline on Diagnosis and Treatment of Cardiac Amyloidosis

“…35 LGE mostly occurs in the basal segments. 151 The presence of LGE is considered a powerful prognostic predictor of CA. 152 Recent findings indicate that LGE transitions from subendocardial to transmural as CA progresses, and that CA presents with various atypical LGE patterns (patchy, subepicardial, and diffuse transmural LGE) according to disease stage.…”

The prognostic value of right ventricular deformation derived from cardiac magnetic resonance tissue tracking for all-cause mortality in light-chain amyloidosis patients

“…However, CMR imaging is considered the gold standard technique for RV evaluation (16,17) and could be used to detect subclinical changes in myocardial mechanics early in patients with RV deformation (18) due to the low spatial resolution and difficult acoustic windows (19,20) of echocardiography. To the best of our knowledge, a few studies have evaluated LV dysfunction using CMR tissue tracking or tagging techniques in patients with AL (21,22), and RV deformation assessment with CMR tissue tracking has not yet been reported in the literature. Thus, the aims of this study were (I) to assess and compare RV deformation in AL patients, especially those with preserved RV ejection fraction, and (II) further identify the most potent prognostic index of RV myocardial strain for all-cause mortality in AL patients.…”