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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Noncontrast T1 mapping for the diagnosis of cardiac amyloidosis
JACC: Cardiovascular Imaging, Volume 6, No. 4, Year 2013
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Description
Objectives: This study sought to explore the potential role of noncontrast myocardial T1 mapping for detection of cardiac involvement in patients with primary amyloid light-chain (AL) amyloidosis. Background: Cardiac involvement carries a poor prognosis in systemic AL amyloidosis. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is useful for the detection of cardiac amyloid, but characteristic LGE patterns do not always occur or they appear late in the disease. Noncontrast characterization of amyloidotic myocardium with T1 mapping may improve disease detection. Furthermore, quantitative assessment of myocardial amyloid load would be of great value. Methods: Fifty-three AL amyloidosis patients (14 with no cardiac involvement, 11 with possible involvement, and 28 with definite cardiac involvement based on standard biomarker and echocardiographic criteria) underwent CMR (1.5-T) including noncontrast T1 mapping (shortened modified look-locker inversion recovery [ShMOLLI] sequence) and LGE imaging. These were compared with 36 healthy volunteers and 17 patients with aortic stenosis and a comparable degree of left ventricular hypertrophy as the cardiac amyloid patients. Results: Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients (1,140 ± 61 ms) compared to normal subjects (958 ± 20 ms, p < 0.001) and patients with aortic stenosis (979 ± 51 ms, p < 0.001). Myocardial T1 was increased in AL amyloid even when cardiac involvement was uncertain (1,048 ± 48 ms) or thought absent (1,009 ± 31 ms). A noncontrast myocardial T1 cutoff of 1,020 ms yielded 92% accuracy for identifying amyloid patients with possible or definite cardiac involvement. In the AL amyloidosis cohort, there were significant correlations between myocardial T1 time and indices of systolic and diastolic dysfunction. Conclusions: Noncontrast T1 mapping has high diagnostic accuracy for detecting cardiac AL amyloidosis, correlates well with markers of systolic and diastolic dysfunction, and is potentially more sensitive for detecting early disease than LGE imaging. Elevated myocardial T1 may represent a direct marker of cardiac amyloid load. Further studies are needed to assess the prognostic significance of T1 elevation. © 2013 American College of Cardiology Foundation.
Authors & Co-Authors
Karamitsos, Theodoros D.
United Kingdom, Oxford
John Radcliffe Hospital
Piechnik, Stefan Kazimierz
United Kingdom, Oxford
John Radcliffe Hospital
Fontana, Marianna
United Kingdom, London
University College London Hospitals Nhs Foundation Trust
United Kingdom, London
University College London
Ntusi, Ntobeko A.B.
United Kingdom, Oxford
John Radcliffe Hospital
Ferreira, Vanessa M.
United Kingdom, Oxford
John Radcliffe Hospital
Canada, Calgary
Libin Cardiovascular Institute
Myerson, Saul G.
United Kingdom, Oxford
John Radcliffe Hospital
Robson, Matthew D.
United Kingdom, Oxford
John Radcliffe Hospital
Hawkins, Philip Nigel
United Kingdom, London
University College London
Neubauer, Stefan
United Kingdom, Oxford
John Radcliffe Hospital
Statistics
Citations: 476
Authors: 9
Affiliations: 4
Identifiers
Doi:
10.1016/j.jcmg.2012.11.013
ISSN:
18767591
Research Areas
Noncommunicable Diseases
Study Design
Cohort Study
Study Approach
Quantitative