Abstract

BackgroundCardiac magnetic resonance (CMR) has gained a central role in the diagnosis of cardiac amyloidosis (CA). While the diagnostic role of a typical late gadolinium enhancement (LGE) pattern (global subendocardial enhancement coupled with accelerated contrast washout) has been identified, evidence is still conflicting regarding the prognostic role of such examination.Methods and resultsWe retrospectively analysed all patients referring for CMR at Niguarda Hospital (Milan, Italy) from January 2006 to January 2015 for suspected CA. Primary outcome was all-cause mortality. We identified 42 patients and divided them into 2 groups, according to the presence (Group A) or absence (Group B) of a typical amyloidosis LGE pattern. At the end of the follow-up (median 37 months, interquartile range 10–50 months), 31 patients (74%) had died. The hazard ratio for all-cause death was 3.2 (95% confidence interval [CI] 1.5–6.4, p < 0.01) for Group A versus Group B. Median survival time was 17 months (95% CI 7–42 months) for Group A and 70 months (95% CI 49–94 months) for Group B (p < 0.01). Multivariate analysis did not find any adjunctive predictive role for biventricular volumes and ejection fraction, indexed left ventricular mass, transmitral E/e’ at echocardiography, age at diagnosis or serum creatinine.ConclusionIn our population, a typical LGE pattern was significantly associated with higher mortality. Moreover, patients with a typical LGE pattern showed a globally worse prognosis. Our data suggest that the LGE pattern may play a central role in prognostic stratification of patients with suspected CA, thus prompting further diagnostic and therapeutic measures.

Highlights

  • Cardiac magnetic resonance (CMR) has gained a central role in the diagnosis of cardiac amyloidosis (CA)

  • AL amyloidosis, caused by immunoglobulin light chains produced by a mutated plasma cell clone, is the most common form accounting for about two thirds of cases of CA

  • This study aimed to assess the prognostic value of CMR in a group of consecutive patients routinely referred for a CMR scan in the work-up of suspected CA in a tertiary referral centre

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Summary

Introduction

Cardiac magnetic resonance (CMR) has gained a central role in the diagnosis of cardiac amyloidosis (CA). Amyloidosis, caused by a misfolded, insoluble aggregated protein featuring a characteristic betasheet structure, is the most common aetiology [1]. While different amyloid proteins have been described over the years, only two forms of cardiac amyloidosis (CA) account for the majority of cases. AL amyloidosis, caused by immunoglobulin light chains produced by a mutated plasma cell clone, is the most common form accounting for about two thirds of cases of CA. Over the past few years, cardiac magnetic resonance (CMR) has gained a central role in the diagnostic workup of infiltrative cardiomyopathies. CMR has proven to be a key diagnostic tool when routine cardiac echography and the patient’s history

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