Abstract 14759: Prognostic Significance of Late Gadolinium Enhancement Pattern by Cardiac Magnetic Resonance Imaging in Cardiac Amyloidosis
Background: Late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (CMR) may identify early cardiac amyloidosis (CA) in patients (Pts) with minimal or normal echocardiographic findings. However, whether severity of LGE predicts worse survival in CA is unclear.
Methods: To determine this, we reviewed all consecutive Pts with amyloidosis who underwent CMR due to suspicion of CA between October 2001 and September 2008. Pts without echo or LGE criteria for CA were excluded. Global severity of LGE in the left and right ventricles (LV and RV) was graded visually (LGE grade 1= minimal focal LV; 2= mild focal LV; 3= mild diffuse LV; 4= moderate diffuse LV and RV, 5= severe LV and RV), and septal LGE ratio (septal LGE signal intensity post- pre/ pre) was calculated.
Results: Amongst 154 Pts who underwent CMR, 39 had no echo or CMR findings of CA and were excluded. Of the 115 (91 AL, 11 senile,13 familial) remaining Pts, CA was confirmed by RV biopsy in 44. Demographics, echo and CMR data are shown (Table). Ejection fraction was preserved and similar across groups. Septal thickness was increased in all Pts but was most prominent in senile form. LV hypertrophy was present in 82% of Pts and RV hypertrophy in 52%. LGE grade 4 or 5 was associated with shorter deceleration times (160.65 ± 35.77 vs. 191.13 ± 49.58, p <0.01) and higher E/E' ratio (23.59 ± 10.77 vs. 17.85 ± 23.59, p<0.01). Survival at one year (from CMR) of all Pts with LGE grade 4 and 5 was 57% compared with 73% in those with LGE grade 3 or less (p= 0.02), and was similar when limited to AL type (57% vs. 71% at 1 year, p= 0.02). Mean LGE ratio was 3.45 ± 2.97 and in univariate risk modeling was not associated with increased mortality (RR 1.06, p=0.30).
Conclusions: In Pts with CA, increased global LGE severity grade by CMR imaging is associated with more advanced diastolic dysfunction and higher mortality, but severity of septal LGE quantified by LGE ratio does not impact prognosis.
- © 2010 by American Heart Association, Inc.