Key result
Low CMR work efficiency is linked to ~2.5-fold higher mortality in cardiac AL amyloidosis.
Why the study?
Left ventricular pressure-volume loop analysis via CMR offers noninvasive assessment of cardiac thermodynamic efficiency, and this study evaluated the clinical relevance and prognostic value of these parameters in patients with cardiac light-chain amyloidosis.
Does noninvasive pressure-volume loop analysis via cardiac magnetic resonance predict all-cause mortality and improve risk stratification in patients with cardiac light-chain amyloidosis?
Cohort (n=297)
No
Does noninvasive pressure-volume loop analysis via cardiac magnetic resonance predict all-cause mortality and improve risk stratification in patients with cardiac light-chain amyloidosis?
Work efficiency derived from non-contrast CMR pressure-volume loop analysis independently predicts all-cause mortality in cardiac AL amyloidosis and enhances prognostic risk stratification when added to the Mayo 2004 staging system.
May support refined prognostication in cardiac AL amyloidosis beyond Mayo staging; leaves open prospective validation before clinical adoption.
Background Left ventricular pressure-volume (PV) loop analysis via cardiovascular magnetic resonance (CMR) offers noninvasive assessment of cardiac thermodynamic efficiency. We aimed to evaluate the clinical relevance and prognostic value of noninvasive PV-loop parameters in patients with cardiac light-chain (AL) amyloidosis. Methods This prospective, single-center study enrolled patients with cardiac AL amyloidosis (AL-CA) who underwent CMR between November 2011 and September 2023. PV-loop parameters were derived from CMR cine images and brachial blood pressure. The primary endpoint was all-cause mortality. Cox regression analysis assessed associations between PV-loop parameters and outcomes, with incremental prognostic value evaluated using C statistics and likelihood ratio tests. Results The single-center, prospective study included 267 consecutive AL-CA patients (mean age 58.8 years±9.8 [SD]; 168 [62.9%] males) and 30 healthy controls with similar age and sex (mean age, 59.9±year 8.2 [SD]; 15 [50%] males). Work efficiency (WE) showed moderate to strong correlations with cardiac function, volumes, decease activity and amyloid burden (all P < 0.01). During a median follow-up of 42 months (IQR: 35-49), 185 patients (69.3%) died. Univariable Cox analysis showed AL-CA patients with WE < 72.2% were at higher mortality risk (hazard ratio 2.45, 95% CI: 1.68-3.57; P < 0.001). After multivariable adjustment, WE < 72.2% remained independent prognostic factor. The integration of WE with Mayo 2004 stage enhanced prognostic discrimination and calibration (C-statistic 0.65, χ² 36.28) relative to Mayo 2004 stage alone (C-statistic 0.58, χ² 25.79), and performed comparably to the combination of extracellular volume fraction (ECV) with Mayo 2004 stage (C-statistic 0.66, χ² 44.49). Conclusion Myocardial work impairment can be detected early, even with preserved LVEF. WE derived from noninvasive and non-enhanced PV-loop analysis via CMR, not only reflects disease severity as quantified by ECV, but also serves as a complementary marker to ECV in risk stratification.
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Liang et al. (2026) conducted a cohort in Cardiac light-chain (AL) amyloidosis (n=297). CMR-derived work efficiency (WE < 72.2%) vs. WE ≥ 72.2% (and 30 healthy controls) was evaluated on All-cause mortality (HR 2.45, 95% CI 1.68-3.57, p=<0.001). CMR-derived work efficiency <72.2% in cardiac AL amyloidosis was associated with higher all-cause mortality (HR 2.45; 95% CI 1.68-3.57; P<0.001) and improved Mayo 2004 stage discrimination.
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