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Cardiac magnetic resonance evaluation of left ventricular remodelling distribution in cardiac amyloidosis
  1. Eduardo Pozo1,2,
  2. Anubhav Kanwar1,3,
  3. Rajiv Deochand1,
  4. Jose M Castellano1,
  5. Tara Naib1,
  6. Pablo Pazos-López1,4,5,
  7. Keren Osman6,
  8. Matthew Cham7,
  9. Jagat Narula1,
  10. Valentin Fuster1,5,
  11. Javier Sanz1
  1. 1The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA
  2. 2Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Madrid, Spain
  3. 3Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  4. 4Servizo de Cardioloxía, Complexo Hospitalario Universitario de Vigo, Pontevedra, Spain
  5. 5Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Madrid, Spain
  6. 6Department of Bone Marrow Transplant, The Tisch Cancer Institute, Icahn School of Medicine, New York, New York, USA
  7. 7Department of Radiology, The Mount Sinai Medical Center, New York, New York, USA
  1. Correspondence to Dr Javier Sanz, Mount Sinai Hospital, One Gustave L Levy Place, Box 1030, New York, NY 10029, USA; javier.sanz{at}mountsinai.org

Abstract

Background Cardiac amyloidosis (CA) is associated with typical morphological features on echocardiography, including concentric LV hypertrophy (LVH). Cardiac magnetic resonance (CMR) can accurately depict anatomy in different cardiomyopathies. Our aim was to describe the morphological features and remodelling patterns of CA with CMR, and establish their diagnostic accuracy, as well as the value of traditional diagnostic criteria derived from echocardiography and electrocardiography.

Methods Consecutive patients referred for CMR for possible CA were retrospectively evaluated. The diagnosis of CA was established in the presence of a positive cardiac biopsy and/or a typical pattern of myocardial late gadolinium enhancement. Morphological parameters were obtained from standard cine sequences. The presence and distribution of LVH, relative wall thickness (RWT) and LV remodelling patterns were determined.

Results 130 patients (92 males (70.8%), age 64±13 years) were included. CA was diagnosed in 51 (39.2%). Patients with CA had increased LV wall thickness and LV mass index. An LV remodelling pattern different from concentric LVH was found in 42% of patients with CA, and asymmetric LVH was noted in 68.6%. A model including RWT, asymmetric LVH, and LVMI showed diagnostic accuracy of 88%, sensitivity of 67% and specificity of 86% for CA detection. Traditional diagnostic criteria for CA showed high specificity but poor sensitivity.

Conclusions 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.

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