Key result
CMR ECV progression at 6 months is linked to ~4-fold higher mortality.
Why the study?
To evaluate the ability of CMR to track response to chemotherapy, correlate haematological response with ECV changes, and assess the prognostic value of ECV changes beyond existing predictors in cardiac AL amyloidosis.
Does progression of extracellular volume on CMR predict death in patients with cardiac AL amyloidosis receiving chemotherapy?
Cohort (n=176)
Blinded image analysis
No
Does progression of extracellular volume on CMR predict death in patients with cardiac AL amyloidosis receiving chemotherapy?
Hazard Ratio: 3.82 (95% CI 1.95–7.49)
p-value: p=<0.001
Changes in extracellular volume measured by CMR can track treatment response and independently predict survival in cardiac AL amyloidosis.
Serial CMR ECV assessment may refine risk stratification beyond haematological response; leaves open whether imaging-guided therapy improves outcomes in cardiac AL amyloidosis.
AIMS: To assess the ability of cardiovascular magnetic resonance (CMR) to (i) measure changes in response to chemotherapy; (ii) assess the correlation between haematological response and changes in extracellular volume (ECV); and (iii) assess the association between changes in ECV and prognosis over and above existing predictors. METHODS AND RESULTS: In total, 176 patients with cardiac AL amyloidosis were assessed using serial N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography, free light chains and CMR with T1 and ECV mapping at diagnosis and subsequently 6, 12, and 24 months after starting chemotherapy. Haematological response was graded as complete response (CR), very good partial response (VGPR), partial response (PR), or no response (NR). CMR response was graded by changes in ECV as progression (≥0.05 increase), stable (<0.05 change), or regression (≥0.05 decrease). At 6 months, CMR regression was observed in 3% (all CR/VGPR) and CMR progression in 32% (61% in PR/NR; 39% CR/VGPR). After 1 year, 22% had regression (all CR/VGPR), and 22% had progression (63% in PR/NR; 37% CR/VGPR). At 2 years, 38% had regression (all CR/VGPR), and 14% had progression (80% in PR/NR; 20% CR/VGPR). Thirty-six (25%) patients died during follow-up (40 ± 15 months); CMR response at 6 months predicted death (progression hazard ratio 3.82; 95% confidence interval 1.95-7.49; P < 0.001) and remained prognostic after adjusting for haematological response, NT-proBNP and longitudinal strain (P < 0.01). CONCLUSIONS: Cardiac amyloid deposits frequently regress following chemotherapy, but only in patients who achieve CR or VGPR. Changes in ECV predict outcome after adjusting for known predictors.
No takes yet. Share an insight, caveat, or question.
Martinez–Naharro et al. (2022) conducted a cohort in Cardiac AL amyloidosis (n=176). Extracellular volume (ECV) progression on CMR vs. Stable or regressed ECV on CMR was evaluated on Death (overall survival) (HR 3.82, 95% CI 1.95-7.49, p=<0.001). Progression of extracellular volume on cardiovascular magnetic resonance at 6 months predicted death with a hazard ratio of 3.82.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: