Abstract
Objectives Cardiac amyloidosis (CA) and constrictive pericarditis (CP) are described as the differential diagnoses of restrictive hemodynamic alterations of the heart. We aimed to explain cardiac magnetic resonance (CMR) imaging findings (especially feature tracking (FT)) of CA and CP cases and compare them with healthy controls. Moreover, we evaluated the role of biventricular FT parameters in differentiating CA from CP. Methods Thirty-eight patients who underwent CMR between February 2016 and January 2018 with the ultimate diagnosis of CA (19 patients) or CP (19 patients) were enrolled. We included biopsy-proven light-chain amyloidosis patients. The data of 28 healthy controls were utilized for comparison. The patients were followed up for 8–23 months to register mortality and their surveillance. All CMR morphological and functional data, including FT parameters, were recorded and analyzed. Results Of only 13/19 (68.4%) CA patients who had the follow-up data, 11/13 (84.6%) died. One of The CP patients (5.3%) expired during the follow-up. Significant between-group differences were noted concerning the biventricular ejection fraction as well as global longitudinal, circumferential, and radial strain values (Ps < 0.001). The left ventricular (LV) global longitudinal strain (GLS) ≤10% was detected in 13/19 (68.4%) of the CA and 1/19 (5.3%) of CP cases (P < 0.001). A significant difference between the mean value of the LVGLS and LV global circumferential strain (GCS) of the basal LV level compared to the mid and apical levels was observed (Ps < 0.001) in the CA patients. The differences between the mean LVGLS and the GCS measures of the mid and apical LV levels were not significant (P=1 and P=0.06, respectively). Conclusions In our study, CA and CP severely disrupted ventricular strains. Biventricular GLS was meaningfully lower in the CA subjects. Therefore, strain analysis, especially in the longitudinal direction, could be helpful to differentiate CA from CP.
Highlights
Cardiomyopathies, which are commonly classified based on structural and hemodynamic criteria, are subdivided into dilated, hypertrophic, restrictive (RCM), arrhythmogenic, infiltrative, and ischemic types [1]
Significant differences were found in the mean values of the interatrial septal thickness, the left ventricular (LV) mass index, and the biatrial areas between the cardiac amyloidosis (CA) and the healthy controls
LVGLS ≤10% was detected in 13/19 (68.4%) of the CA group and 1/19 (5.3%) of the constrictive pericarditis (CP) group. e difference between these groups considering LVGLS ≤10% was significant (P < 0.001)
Summary
Cardiomyopathies, which are commonly classified based on structural and hemodynamic criteria, are subdivided into dilated, hypertrophic, restrictive (RCM), arrhythmogenic, infiltrative, and ischemic types [1]. RCM is an uncommon type of cardiomyopathy resulting in myocardial stiffness and impaired ventricular filling [2]. One of the chief causes of RCM is cardiac amyloidosis (CA). Amyloidosis is a multisystem disorder in which an unstable and misfolded protein (amyloid) aggregates in different organs [1]. E 2 main types of amyloidosis that affect the heart are light-chain and transthyretin amyloidosis. Amyloid infiltration of the heart results in the thickening of the myocardium and diastolic dysfunction, which leads to heart failure. E prognosis is largely determined by the occurrence and extent of myocardial involvement [3,4,5,6] Amyloid infiltration of the heart results in the thickening of the myocardium and diastolic dysfunction, which leads to heart failure. e prognosis is largely determined by the occurrence and extent of myocardial involvement [3,4,5,6]
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