T1 mapping and survival in systemic light-chain amyloidosis.
Eur Heart J
; 36(4): 244-51, 2015 Jan 21.
Article
em En
| MEDLINE
| ID: mdl-25411195
ABSTRACT
AIMS:
To assess the prognostic value of myocardial pre-contrast T1 and extracellular volume (ECV) in systemic amyloid light-chain (AL) amyloidosis using cardiovascular magnetic resonance (CMR) T1 mapping. METHODS ANDRESULTS:
One hundred patients underwent CMR and T1 mapping pre- and post-contrast. Myocardial ECV was calculated at contrast equilibrium (ECV(i)) and 15 min post-bolus (ECVb). Fifty-four healthy volunteers served as controls. Patients were followed up for a median duration of 23 months and survival analyses were performed. Mean ECV(i) was raised in amyloid (0.44 ± 0.12) as was ECV(b) (mean 0.44 ± 0.12) compared with healthy volunteers (0.25 ± 0.02), P < 0.001. Native pre-contrast T1 was raised in amyloid (mean 1080 ± 87 ms vs. 954 ± 34 ms, P < 0.001). All three correlated with pre-test probability of cardiac involvement, cardiac biomarkers, and systolic and diastolic dysfunction. During follow-up, 25 deaths occurred. An ECV(i) of >0.45 carried a hazard ratio (HR) for death of 3.84 [95% confidence interval (CI) 1.53-9.61], P = 0.004 and pre-contrast T1 of >1044 ms = HR 5.39 (95% CI 1.24-23.4), P = 0.02. Extracellular volume after primed infusion and ECVb performed similarly. Isolated post-contrast T1 was non-predictive. In Cox regression models, ECV(i) was independently predictive of mortality (HR = 4.41, 95% CI 1.35-14.4) after adjusting for EE', ejection fraction, diastolic dysfunction grade, and NT-proBNP.CONCLUSION:
Myocardial ECV (bolus or infusion technique) and pre-contrast T1 are biomarkers for cardiac AL amyloid and they predict mortality in systemic amyloidosis.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Amiloidose
/
Cardiomiopatias
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article