Key result
Higher native T1 in cardiac amyloidosis links to reduced LVEF, indicating amyloid overload drives LV dysfunction.
Why the study?
It was unclear whether amyloid overload or microcirculation impairment dominates left ventricular functional remodeling and systolic dysfunction in patients with cardiac amyloidosis.
Does amyloid overload or microcirculation impairment correlate more strongly with left ventricular systolic dysfunction in patients with cardiac amyloidosis?
Observational (n=60)
No
Does amyloid overload or microcirculation impairment correlate more strongly with left ventricular systolic dysfunction in patients with cardiac amyloidosis?
Absolute Event Rate: 1442.2% vs 1407%
p-value: p=0.001
Amyloid overload, rather than microcirculation impairment, appears to be the primary driver of left ventricular systolic dysfunction in patients with cardiac amyloidosis.
Amyloid overload may predominate in LV dysfunction; leaves open T1-guided risk stratification pending prospective validation.
Purpose Amyloid overload and microcirculation impairment are both detrimental to left ventricular (LV) systolic function, while it is not clear which factor dominates LV functional remodeling in patients with cardiac amyloidosis (CA). The purpose of this study was to investigate the major factor of LV systolic dysfunction using cardiac magnetic resonance imaging. Materials and methods Forty CA patients and 20 healthy controls were included in this study. The CA group was divided into two subgroups by the left ventricular ejection fraction (LVEF): patients with reduced LVEF (LVEF < 50%, rLVEF), and patients with preserved LVEF (LVEF ≥ 50%, pLVEF). The scanning sequences included cine, native and post-contrast T1 mapping, rest first-pass perfusion and late gadolinium enhancement. Perfusion and mapping parameters were compared among the three groups. Correlation analysis was performed to evaluate the relationship between LVEF and mapping parameters, as well as the relationship between LVEF and perfusion parameters. Results Remarkably higher native T1 value was observed in the rLVEF patients than the pLVEF patients (1442.2 ± 85.8 ms vs. 1407.0 ± 93.9 ms, adjusted p = 0.001). The pLVEF patients showed significantly lower slope dividing baseline signal intensity (slope%BL; rLVEF vs. pLVEF, 55.1 ± 31.0 vs. 46.2 ± 22.3, adjusted p = 0.001) and a lower maximal signal intensity subtracting baseline signal intensity (MaxSI-BL; rLVEF vs. pLVEF, 43.5 ± 23.9 vs. 37.0 ± 18.6, adjusted p = 0.003) compared to the rLVEF patients. CA patients required more time to reach the maximal signal intensity than the controls did (all adjusted p < 0.01). There was no significant correlation between LVEF and first-pass perfusion parameters, while significant negative correlation was observed between LVEF and native T1 ( r = −0.434, p = 0.005) in CA patients. Conclusion Amyloid overload in the myocardial interstitium may be the major factor of LV systolic dysfunction in CA patients, other than microcirculation impairment.
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Lu et al. (2023) conducted an observational in Cardiac amyloidosis (n=60). Cardiac magnetic resonance imaging vs. Preserved LVEF and healthy controls was evaluated on Native T1 value (ms) (p=0.001). In patients with cardiac amyloidosis, native T1 values were significantly higher in those with reduced LVEF compared to preserved LVEF (1442.2 vs. 1407.0 ms, p=0.001), indicating amyloid overload is the major factor in LV systolic dysfunction.
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