Key result
Presence of right ventricular late gadolinium enhancement was an independent predictor of all-cause mortality in AL amyloidosis (HR 4.07; 95% CI 1.09-15.24; P=0.037).
Why the study?
Although CMR studies showed prognostic value for LV LGE and strain in AL amyloidosis, RV strain had not yet been studied.
Does the assessment of LV and RV strain and LGE by CMR provide prognostic value for all-cause mortality in patients with AL amyloidosis?
Cohort (n=107)
Does the assessment of LV and RV strain and LGE by CMR provide prognostic value for all-cause mortality in patients with AL amyloidosis?
LV global longitudinal strain and RV late gadolinium enhancement provide incremental prognostic value beyond conventional LV LGE in patients with AL amyloidosis.
Answers are grounded in this paper and cite their sources.
RV LGE may refine mortality risk stratification in AL amyloidosis beyond LV LGE; hypothesis-generating and requires prospective validation.
BACKGROUND: Previous cardiac magnetic resonance (CMR) studies have shown that both late gadolinium enhancement (LGE) and left ventricular (LV) strain have prognostic value in amyloid light-chain (AL) amyloidosis, but the right ventricular (RV) strain has not yet been studied. We aim to determine the incremental prognostic value of LV and RV LGE and strain in AL amyloidosis. METHODS: This prospective study recruited 87 patients (age, 56.9±9.1 years; M/F, 56/31) and 20 healthy subjects (age, 52.7±8.1 years; M/F, 11/9) who underwent CMR. The LV LGE was classified into no, patchy and global groups. The RV LGE was classified into negative and positive groups. Myocardial deformation was measured using a dedicated software. Follow-up was performed for all-cause mortality using Cox proportional hazards regression and Kaplan-Meier curves. RESULTS: During a median follow-up of 21 months, 34 deaths occurred. Presence of LV LGE [HR 2.44, 95% confidence interval (CI), 1.10-5.45, P=0.029] and global longitudinal strain (GLS) (HR 1.13 per 1% absolute decrease, 95% CI, 1.02-1.25, P=0.025) were independent LV predictors. RV LGE (HR 4.07, 95% CI, 1.09-15.24, P=0.037) and GLS (HR 1.10 per 1% absolute decrease, 95% CI, 1.00-1.21, P=0.047) were independent RV predictors. Complementary to LV LGE, LV GLS impairment or RV LGE further reduced survival (both log rank P<0.001). CONCLUSIONS: This study confirms the incremental prognostic value of LV GLS and RV LGE in AL amyloidosis, which refines the conventional risk evaluation based on LV LGE. GLS based on non-contrast-enhanced CMR are promising new predictors.
No takes yet. Share an insight, caveat, or question.
Li et al. (2020) conducted a cohort in AL amyloidosis (n=107). Right ventricular late gadolinium enhancement (RV LGE) vs. Absence of RV LGE was evaluated on All-cause mortality (HR 4.07, 95% CI 1.09-15.24, p=0.037). Presence of right ventricular late gadolinium enhancement was an independent predictor of all-cause mortality in AL amyloidosis (HR 4.07; 95% CI 1.09-15.24; P=0.037).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: