Oral Abstract Session
SCMR 22nd Annual Scientific Sessions
Background: to evaluate the regional variation of amyloid infiltration in the left ventricle and the prognostic value of T1 mapping parameters in patients with light chain (AL) amyloidosis.
Methods: Between January 2013 and April 2015, we prospectively enrolled 77 patients with AL amyloidosis (66.2% male; mean age, 59 years; range, 26–81years) who underwent 3.0-T cardiac magnetic resonance imaging (MRI). Native T1 and extracellular volume (ECV) were quantitated on the basal, mid, and apical levels of the left ventricle. The patients were classified into three LGE pattern groups: no or nonspecific LGE, sub-endocardial LGE, and transmural LGE. We assessed the relationship between T1 and ECV values and all-cause mortality using Cox uni- and multivariable proportional hazards regression.
Results: Basal ECV (60.6±11.5% vs. 53.0±9.6%; P=.003) was significantly higher than apical ECV in AL patients with transmural LGE, in contrast to healthy controls where basal ECV (26.9±2.8% vs. 31.1±4.9%, P <.001) was lower than apical ECV. Forty-six patients died during follow-up period (median duration, 28 months; 25th–75th percentile, 13.5–38.0 months). Basal ECV had the largest AUC of 0.845 (95% CI, 0.747–0.917) to predict all-cause mortality. Multivariable Cox analysis indicated that basal ECV was an independent prognostic factor and showed incremental prognostic value beyond NYHA class, Mayo stage, and LGE pattern.
Conclusion: We detected amyloid deposition with a decreasing distribution gradient from the base to apex using cardiac MRI T1 mapping techniques. Furthermore, basal myocardial ECV provides incremental prognostic value in patients with AL amyloidosis.