Author + information
- Arnt Kristen,
- Rebekka Kammerer,
- Fabian aus dem Siepen,
- Katrin Scherer,
- Sebastian Buss,
- Evangelos Giannitsis,
- Hugo A. Katus and
- Henning Steen
We aimed to use gadolinium contrast-enhanced cardiac magnetic resonance imaging (CE-CMR) to characterize CE-CMR patterns that are related to the different forms of amyloidosis.
In total, 115 patients (70 male, 45 female; mean age 60.7±1.2 years) with different forms of amyloidosis (AL n= 63, TTR n=52) were evaluated by Vector-ECG gated 1.5T whole-body CMR (Achieva Intera® Philips Medical Systems, Best, The Netherlands) and included SSFP and CE-CMR 2-,3-,4-chamber and short-axis planes. EDV, ESV, EF and myocardial mass were analysis. Longitudinal function was assessed by MAPSE and TAPSE. CE-CMR patterns were analyzed qualitatively (subepicardial, subendocardial, patchy, diffuse) and semi-quantitatively (absent=0, weak=1, moderate=2, severe=3) in a modified 16 segment AHA model (maximal sum 48) of the LV.
Patients with TTR were significantly older and had lower TAPSE (14.6±0.9mm vs. 17.3±0.9mm; p<0.05) as compared to AL patients. They did not differ in LV mass, LV ejection fraction, and MAPSE. CE-CMR was observed in 107 (93%) of the patients (AL n=59, 93.7%; TTR n=48, 92.3%). There was no difference between both forms of amyloidosis concerning sum of LGE in the 16 segments by semi-quantitative analysis (AL 25.8±2.2; TTR 28.6±2.2). In TTR patients a more intensive LGE was found in the subepicardial layer of the basal anterolateral (p<0.001), inferolateral (p<0.001) and of the midventricular inferolateral segment (p<0.001) as compared to AL patients. There were 49 fatal events (34.2±2.4 mo, death n=33; HTX n=16). Survival of AL patients was significantly worse as compared to TTR patients (p<0.05; logrank 6.225). In AL patients presence of subepicardial, subendocardial and patchy LGE, LV mass, MAPSE, and TAPSE, but not LV ejection fraction, LGE of LA, RA, RV or interatrial septum were predictors of survival by univariate analysis. By multivariate analysis subendocardial and patchy LGE as well as LV mass were independent predictors of survival.
Prevalence of CE-CMR is high and is associated with severity of cardiac dysfunction. Besides LV mass subendocardial and patchy CE-CMR were independent predictors of survival in patients with AL amyloidosis.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: MRI Ill – CMR in Myocardial Disease and Dysfunction
Abstract Category: 19. Imaging: MRI
Presentation Number: 1184-368
- 2013 American College of Cardiology Foundation