Abstract 4040: Severity of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Imaging Does Not Predict Increased Mortality in Cardiac Amyloidosis
Background: Patients (Pts) with cardiac amyloidosis (CA) are at increased risk for sudden cardiac death (SCD) but risk determinants are not well defined. Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) may predict risk SCD in Pts with cardiomyopathy. Whether the presence or severity of LGE on CMR also predicts risk of SCD in Pts with CA is unclear.
Methods: Between October 2001 and September 2008, consecutive Pts at Mayo Clinic with biopsy proven CA who underwent CMR to determine presence and severity of LGE. An LGE ratio (signal intensity post- signal intensity pre/signal intensity pre) was calculated to quantify the severity of LGE.
Results: A total of 44 patients (28 AL, 9 senile, 6 familial) with CA were included. Mean age was 61±12 years, with 34 (79%) males. Ejection fraction was preserved (54±12%) and mean septal thickness was 16.09 mm±3.11 mm. LGE was present in all but one patient, with mean LGE ratio 3.43±2.99. One year survival of the study group was 65%. LGE ratio was similar amongst patients who died (3.54±2.60) and those who survived (3.36±3.28, p=0.88). There was no difference in left (176.53±42.68g vs. 200.12±65.52g, p=0.16) and right (44.38±13.80g vs. 44.46±16.68g, p=0.99) ventricular mass. Troponin T levels were higher in Pts who died (0.11±0.11 ng/dL) compared with survivors (0.04±0.06 ng/dL, p=0.04). Amongst Pts with AL type CA, one year survival was 51%. LGE ratio, left and right ventricular mass were also similar amongst survivors and those who died.
Conclusions: In Pts with CA presence or severity of LGE by CMR imaging does not predict SCD risk and therefore does not provide early or incremental prognostic information beyond currently used risk factors such as Troponin T level.