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Prognostic Value of Late Gadolinium Enhancement Cardiovascular Magnetic Resonance in Cardiac Amyloidosis
Open accessAbstract
Background—: The prognosis and treatment of the 2 main types of cardiac amyloidosis, immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis, are substantially influenced by cardiac involvement. Cardiovascular magnetic resonance with late gadolinium enhancement (LGE) is a reference standard for the diagnosis of cardiac amyloidosis, but its potential for stratifying risk is unknown. Methods and Results—: Two hundred fifty prospectively recruited subjects, 122 patients with ATTR amyloid, 9 asymptomatic mutation carriers, and 119 patients with AL amyloidosis, underwent LGE cardiovascular magnetic resonance. Subjects were followed up for a mean of 24±13 months. LGE was performed with phase-sensitive inversion recovery (PSIR) and without (magnitude only). These were compared with extracellular volume measured with T1 mapping. PSIR was superior to magnitude-only inversion recovery LGE because PSIR always nulled the tissue (blood or myocardium) with the longest T1 (least gadolinium). LGE was classified into 3 patterns: none, subendocardial, and transmural, which were associated with increasing amyloid burden as defined by extracellular volume ( P <0.0001), with transitions from none to subendocardial LGE at an extracellular volume of 0.40 to 0.43 (AL) and 0.39 to 0.40 (ATTR) and to transmural at 0.48 to 0.55 (AL) and 0.47 to 0.59 (ATTR). Sixty-seven patients (27%) died. Transmural LGE predicted death (hazard ratio, 5.4; 95% confidence interval, 2.1–13.7; P <0.0001) and remained independent after adjustment for N-terminal pro-brain natriuretic peptide, ejection fraction, stroke volume index, E/E′, and left ventricular mass index (hazard ratio, 4.1; 95% confidence interval, 1.3–13.1; P <0.05). Conclusions—: There is a continuum of cardiac involvement in systemic AL and ATTR amyloidosis. Transmural LGE is determined reliably by PSIR and represents advanced cardiac amyloidosis. The PSIR technique provides incremental information on outcome even after adjustment for known prognostic factors.
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Research works printed but not linked: 27
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Cited by
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001063 · Cited by 4,922
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2021.12.012 · Cited by 2,862
Nonbiopsy Diagnosis of Cardiac Transthyretin Amyloidosis
Gillmore, J. D., Maurer, M. S., Falk, R. H., Merlini, G., Damy, T., Dispenzieri, A., Wechalekar, A. D., Berk, J. L., Quarta, C. C., Grogan, M., et al. (2016) · Circulation · doi:10.1161/circulationaha.116.021612 · Cited by 2,081
Self-citationKusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.044 · Cited by 1,008
AL (Light-Chain) Cardiac Amyloidosis
Falk, R. H., Alexander, K. M., Liao, R., & Dorbala, S. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.06.053 · Cited by 649
Metadata
- Authors
- Fontana, M., Pica, S., Reant, P., Abdel-Gadir, A., Treibel, T. A., Banypersad, S. M., Maestrini, V., Barcella, W., Rosmini, S., Bulluck, H., Sayed, R. H., Patel, K., Mamhood, S., Bucciarelli-Ducci, C., Whelan, C. J., Herrey, A. S., Lachmann, H. J., Wechalekar, A. D., Manisty, C. H., Schelbert, E. B., Kellman, P., Gillmore, J. D., Hawkins, P. N., & Moon, J. C.
- Venue
- Circulation
- Published
- 2015-10-20
- Volume
- 132
- Issue
- 16
- Pages
- 1570-1579
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1769623626
- Cited by
- 626
- References
- 0
- FWCI
- 19.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
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- The paper
- Fontana, M., Pica, S., Reant, P., Abdel-Gadir, A., Treibel, T. A., Banypersad, S. M., Maestrini, V., Barcella, W., Rosmini, S., Bulluck, H., Sayed, R. H., Patel, K., Mamhood, S., Bucciarelli-Ducci, C., Whelan, C. J., Herrey, A. S., Lachmann, H. J., Wechalekar, A. D., Manisty, C. H., . . . Moon, J. C. (2015). Prognostic Value of Late Gadolinium Enhancement Cardiovascular Magnetic Resonance in Cardiac Amyloidosis. Circulation. https://doi.org/10.1161/circulationaha.115.016567
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