Patients with AL cardiac amyloidosis had significantly reduced first-pass perfusion upslope and max signal intensity, and increased time to maximum signal intensity compared to normal subjects (all P < 0.01).
Cross-Sectional (n=57)
No
Does 3T cardiovascular magnetic resonance first-pass perfusion imaging detect regional myocardial microvascular dysfunction in patients with AL cardiac amyloidosis compared to normal subjects?
3T CMR first-pass perfusion imaging can effectively detect and differentiate regional myocardial microvascular dysfunction in patients with AL cardiac amyloidosis, with more severe impairment seen in those with systolic dysfunction.
p-value: p=<0.01
BACKGROUND: Coronary microvascular dysfunction is highly prevalent in patients with amyloid light-chain (AL) cardiac amyloidosis (AL-CA). The aim of this study was to clarify the feasibility of first-pass perfusion imaging using 3 T cardiovascular magnetic resonance (CMR) for evaluating the difference in left ventricular (LV) regional myocardial microvascular function among normal subjects and in patients with AL-CA. The amyloidosis patients were classified into those with impaired systolic function LV ejection fraction (LVEF) < 50 % and those with preserved systolic function. METHODS: In total, 32 patients with biopsy-proven AL-CA, including 11 AL-CA patients with systolic dysfunction, 21 AL-CA patients with preserved systolic function, and 25 healthy subjects, underwent CMR examination. LV regional myocardial perfusion parameters included upslope, time to maximum signal intensity (TTM) and max signal intensity (MaxSI) were compared among the three patient groups. Receiver operating characteristic analysis was performed to determine whether perfusion parameters could be used in discriminating regional myocardial microvascularity between AL-CA patients and normal subjects. RESULTS: The patients with AL-CA had significantly reduced first-pass perfusion upslope and MaxSI, and increased TTM compared with the normal subjects (all P < 0.01). Compared with the patients with AL-CA and preserved LVEF, the patients with AL-CA and impaired systolic function had a longer TTM in the basal (47.05 ± 16.59 vs. 39.68 ± 19.11; P = 0.002) and mid-ventricular (44.61 ± 16.34 vs. 37.74 ± 18.25; P = 0.002) segments; lower upslope in the basal (2.41 ± 1.32 vs. 3.60 ± 1.68; P < 0.0001), mid-ventricular (2.82 ± 1.34 vs. 4.15 ± 2.02; P < 0.0001), and apical (3.71 ± 1.38 vs. 4.97 ± 2.55; P = 0.004) segments; and lower MaxSI (31.67 ± 15.23 vs. 37.96 ± 11.15; P < 0.0001) in the basal segment. The ROC curve analysis revealed that the first-pass upslope, TTM, and MaxSI may be used as indicators for differentiating microcirculation between AL-CA patients with preserved or impaired systolic function and normal subjects. CONCLUSIONS: The differences in LV regional myocardial microvascular function among normal subjects, AL-CA patients with systolic dysfunction, and AL-CA patients with preserved systolic function can be monitored using first-pass perfusion CMR.
Li et al. (Fri,) conducted a cross-sectional in Amyloid light-chain (AL) cardiac amyloidosis (n=57). 3T cardiovascular magnetic resonance (CMR) first-pass perfusion imaging vs. Normal healthy subjects was evaluated on First-pass perfusion parameters (upslope, time to maximum signal intensity, and max signal intensity) (p=<0.01). Patients with AL cardiac amyloidosis had significantly reduced first-pass perfusion upslope and max signal intensity, and increased time to maximum signal intensity compared to normal subjects (all P < 0.01).