The Diagnostic and Prognostic Value of Multi-Chamber Strain Analysis by Cardiac MRI in Amyloidosis

PURPOSE: To evaluate the diagnostic and prognostic utility of multi-chamber myocardial strain, and its correlation with native T1 mapping and late gadolinium enhancement (LGE) imaging, by cardiac magnetic resonance (CMR) in cardiac amyloidosis. MATERIALS AND METHODS: A total of 47 patients were retrospectively included and the strain of the ventricles and atria were quantified. Native T1 and Query Amyloid Late Enhancement (QALE) values were assessed. Follow-up data on major adverse cardiovascular events (MACE) were retrieved from medical records. Spearman correlations between strain, LGE, and mapping were assessed. The strain parameters were analyzed using receiver operating characteristic curves and Cox regression analysis. RESULTS: LV strain indices, RV GLS, RV GRS, LA reservoir, LA conduit strain, and RA reservoir strain demonstrated diagnostic ability (P<0.05), with the highest diagnostic accuracy for LV GCS (AUC=0.897; cutoff=-12.9). Native T1 and QALE showed moderate correlations with LV and LA strain, reflecting amyloid infiltration and fibrosis-related dysfunction. For prognosis, RV GLS (AUC=0.687; cutoff=-12.5) and RA conduit strain (AUC=0.737; cutoff=+10) independently predicted MACE on univariable Cox analysis (HR=1.05 and 0.96; P<0.05). Importantly, multivariable Cox regression identified LV GLS (HR=5.27; P=0.016) and LA reservoir strain (HR=0.025; P=0.03) as strong independent predictors of MACE. CONCLUSION: Multi-chamber strain, and its integration with T1 and QALE, enhances diagnostic accuracy and prognostic precision in cardiac amyloidosis, enabling earlier recognition of myocardial dysfunction.