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Cardiac involvement of amyloidosis is an important prognostic factor of survival. While cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) has demonstrated a positive association with other established prognostic indicators, LGE itself has not been shown to predict survival. This study aims to determine the prognostic value of CMR LGE in people with cardiac amyloidosis.
The study sample consists of 69 subjects with a history of amyloidosis and CMR performed in 2006 or 2007; 90 days or less between diagnosis and CMR; and at least stage I disease according to biomarker levels of troponin T and N-terminal pro-brain natriuretic peptide. Subjects were stratified into three categories based on LGE: “None” for no myocardial enhancement, “Type 1” for patchy or focal myocardial enhancement or suboptimal myocardial nulling, and “Type 2” for diffuse transmural or subendocardial enhancement. The primary outcome for prognosis was death.
47 men and 22 women participated in the study. Mean age at diagnosis was 60 years (SD = 9). The median time between diagnosis and CMR was 28 days. There was a statistically significant correlation of stages I (n=13), II (n=24), and III (n=27) with the None (n=21), Type I (n=22) and Type 2 (n=26) LGE groups respectively. Both Type 1 and Type 2 LGE had a statistically significant association with right ventricular (RV) end diastolic volume, RV end systolic volume, pericardial effusion and pleural effusion. Additionally Type 2 LGE was significant for indexed left ventricular (LV) mass, maximum LV thickness, LV ejection fraction, LV end systolic volume, maximum RV thickness and RV ejection fraction. The median follow-up period was 34 months. Analysis with Kaplan-Meyer curves showed that only Type 2 LGE was a statistically significant predictor of survival (p = 0.0012, RR = 4.06, CI = [1.70, 11.19]). The median overall survival for Type 2 LGE was 6 months (p=0.0006, CI = [2, 28]). Median survival was not reached for the None and Type 1 groups; however survival at 72 months was 64% and 52% respectively.
In the setting of cardiac amyloidosis specific patterns of LGE correlate with cardiac stage, and can also serve as predictors for survival.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: MRI V – CMR in Hypertrophic and Infiltrative Cardiomyopathies
Abstract Category: 19. Imaging: MRI
Presentation Number: 1272-364
- 2013 American College of Cardiology Foundation