Key result
Automated extracellular volume fraction ≥40% increased the risk of cardiovascular death and heart failure hospitalization in AL-CA patients (HR 4.247; 95% CI 1.215-14.851; p=0.024).
Why the study?
T1 mapping on CMR imaging is useful for diagnosis and prognostication in AL-CA, but the performance and prognostic value of AI-automated segmentation-derived T1 mapping parameters needed evaluation.
Does AI-automated extracellular volume fraction measurement on CMR improve the diagnosis of cardiac amyloidosis and prognostication in patients with AL-CA?
Observational (n=300)
Does AI-automated extracellular volume fraction measurement on CMR improve the diagnosis of cardiac amyloidosis and prognostication in patients with AL-CA?
Hazard Ratio: 4.247 (95% CI 1.215–14.851)
p-value: p=0.024
AI-automated ECV measurement on CMR provides high diagnostic accuracy for differentiating cardiac amyloidosis from other causes of LVH and significantly improves prognostic risk stratification in patients with AL-CA.
AIMS: T1 mapping on cardiac magnetic resonance (CMR) imaging is useful for diagnosis and prognostication in patients with light-chain cardiac amyloidosis (AL-CA). We conducted this study to evaluate the performance of T1 mapping parameters, derived from artificial intelligence (AI)-automated segmentation, for detection of cardiac amyloidosis (CA) in patients with left ventricular hypertrophy (LVH) and their prognostic values in patients with AL-CA. METHODS AND RESULTS: A total of 300 consecutive patients who underwent CMR for differential diagnosis of LVH were analyzed. CA was confirmed in 50 patients (39 with AL-CA and 11 with transthyretin amyloidosis), hypertrophic cardiomyopathy in 198, hypertensive heart disease in 47, and Fabry disease in 5. A semi-automated deep learning algorithm (Myomics-Q) was used for the analysis of the CMR images. The optimal cutoff extracellular volume fraction (ECV) for the differentiation of CA from other etiologies was 33.6% (diagnostic accuracy 85.6%). The automated ECV measurement showed a significant prognostic value for a composite of cardiovascular death and heart failure hospitalization in patients with AL-CA (revised Mayo stage III or IV) (adjusted hazard ratio 4.247 for ECV ≥40%, 95% confidence interval 1.215-14.851, p-value = 0.024). Incorporation of automated ECV measurement into the revised Mayo staging system resulted in better risk stratification (integrated discrimination index 27.9%, p = 0.013; categorical net reclassification index 13.8%, p = 0.007). CONCLUSIONS: T1 mapping on CMR imaging, derived from AI-automated segmentation, not only allows for improved diagnosis of CA from other etiologies of LVH, but also provides significant prognostic value in patients with AL-CA.
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Hwang et al. (2025) conducted an observational in Left ventricular hypertrophy and light-chain cardiac amyloidosis (n=300). Automated extracellular volume fraction (ECV) measurement vs. ECV <40% was evaluated on Composite of cardiovascular death and heart failure hospitalization in patients with AL-CA (revised Mayo stage III or IV) (HR 4.247, 95% CI 1.215-14.851, p=0.024). Automated extracellular volume fraction ≥40% increased the risk of cardiovascular death and heart failure hospitalization in AL-CA patients (HR 4.247; 95% CI 1.215-14.851; p=0.024).
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