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. 2015 Jan 21;36(4):244-51.
doi: 10.1093/eurheartj/ehu444. Epub 2014 Nov 16.

T1 mapping and survival in systemic light-chain amyloidosis

Sanjay M Banypersad  1 , Marianna Fontana  2 , Viviana Maestrini  3 , Daniel M Sado  3 , Gabriella Captur  2 , Aviva Petrie  4 , Stefan K Piechnik  5 , Carol J Whelan  6 , Anna S Herrey  3 , Julian D Gillmore  6 , Helen J Lachmann  6 , Ashutosh D Wechalekar  6 , Philip N Hawkins  6 , James C Moon  7
Affiliations

T1 mapping and survival in systemic light-chain amyloidosis

Sanjay M Banypersad et al. Eur Heart J. .

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 and results: 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 E:E', 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.

Keywords: Amyloid; CMR; Cardiomyopathy; ECV; Heart failure; T1 mapping.

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Figures

Figure 1
Figure 1
Showing (A) pre-contrast and (B) post-contrast, four-chamber ShMOLLI image with regions of interest drawn in the left atrium for blood T1 measurement and in the basal septum of left ventricle, excluding at least the first two pixels of endocardium on either side of the septum in order to avoid through planing of blood pool.
Figure 2
Figure 2
Dot plot showing correlation between extracellular volume and late-gadolinium enhancement.
Figure 3
Figure 3
Kaplan–Meier survival curves for extracellular volume after primed infusion.
Figure 4
Figure 4
Kaplan–Meier survival curves for (A) pre-contrast myocardial T1 and (B) extracellular volume at bolus (NB: although the median of 0.44 was used, the groups are not equal because more than 1 patient had an extracellular volume of 0.44).
Figure 5
Figure 5
Time-dependent receiver operating characteristic curves for extracellular volume after primed infusion, extracellular volume at bolus and pre-contrast myocardial T1 and survival using nearest neighbour estimator method at time: (top 3) 12 months and (bottom 3) 24 months.
See this image and copyright information in PMC

Comment in

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