January 1, 2008Journal of Cardiovascular Magnetic Resonance267 citationsOpen Access

Cardiovascular Magnetic Resonance and prognosis in cardiac amyloidosis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac amyloidosis (n=29). Intervention: Intramyocardial T1 gradient (gadolinium kinetics) vs. Lower intramyocardial T1 gradient (<23 ms). Primary outcome: All-cause mortality (85% accuracy, p=0.005).

AMAlicia M. Maceira SPSanjay Prasad PHPhilip N. Hawkins

Key Result

An intramyocardial T1 gradient of 23 ms at 2 minutes post-gadolinium predicted all-cause mortality with 85% accuracy in patients with cardiac amyloidosis.

Study Design

Type

Cohort (n=29)

Multicenter

PICO

Population

29 patients with proven cardiac amyloidosis followed prospectively for a median of 623 days to assess the prognostic value of cardiovascular magnetic resonance.

Exposure / Comparator

Intramyocardial T1 gradient (gadolinium kinetics) vs Lower intramyocardial T1 gradient (<23 ms)

Primary Outcome

All-cause mortality — 85% accuracy, p=0.005

Main Result

Effect estimate: 85% accuracy

p-value: p=0.005

Limitations

Patient numbers were relatively small.
The diagnosis of cardiac amyloidosis did not routinely include endocardial biopsy.
The measurement technique for T1 includes assumptions about the relaxivity of gadolinium-DTPA being the same in blood and myocardium.
Due to the small sample size, no multivariable analysis was carried out.

Abstract

BACKGROUND: Cardiac involvement is common in amyloidosis and associated with a variably adverse outcome. We have previously shown that cardiovascular magnetic resonance (CMR) can assess deposition of amyloid protein in the myocardial interstitium. In this study we assessed the prognostic value of late gadolinium enhancement (LGE) and gadolinium kinetics in cardiac amyloidosis in a prospective longitudinal study. MATERIALS AND METHODS: The pre-defined study end point was all-cause mortality. We prospectively followed a cohort of 29 patients with proven cardiac amyloidosis. All patients underwent biopsy, 2D-echocardiography and Doppler studies, 123I-SAP scintigraphy, serum NT pro BNP assay, and CMR with a T1 mapping method and late gadolinium enhancement (LGE). RESULTS: Patients with were followed for a median of 623 days (IQ range 221, 1436), during which 17 (58%) patients died. The presence of myocardial LGE by itself was not a significant predictor of mortality. However, death was predicted by gadolinium kinetics, with the 2 minute post-gadolinium intramyocardial T1 difference between subepicardium and subendocardium predicting mortality with 85% accuracy at a threshold value of 23 ms (the lower the difference the worse the prognosis). Intramyocardial T1 gradient was a better predictor of survival than FLC response to chemotherapy (Kaplan Meier analysis P = 0.049) or diastolic function (Kaplan-Meier analysis P = 0.205). CONCLUSION: In cardiac amyloidosis, CMR provides unique information relating to risk of mortality based on gadolinium kinetics which reflects the severity of the cardiac amyloid burden.

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Cite This Study

Maceira et al. (Tue,) conducted a cohort in Cardiac amyloidosis (n=29). Intramyocardial T1 gradient (gadolinium kinetics) vs. Lower intramyocardial T1 gradient (<23 ms) was evaluated on All-cause mortality (85% accuracy, p=0.005). An intramyocardial T1 gradient of 23 ms at 2 minutes post-gadolinium predicted all-cause mortality with 85% accuracy in patients with cardiac amyloidosis.

synapsesocial.com/papers/6a71c5a42163a0a01bc5c56c https://doi.org/https://doi.org/10.1186/1532-429x-10-54

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