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• Clinical Article •
Value of CMR feature-tracking imaging in discriminating subtypes of cardiac amyloidosis
ZHUANG Baiyan  LI Shuang  WANG Hui  ZHANG Hongkai  XU Lei 

Cite this article as: ZHUANG B Y, LI S, WANG H, et al. Value of CMR feature-tracking imaging in discriminating subtypes of cardiac amyloidosis[J]. Chin J Magn Reson Imaging, 2024, 15(2): 23-29, 62. DOI:10.12015/issn.1674-8034.2024.02.004.


[Abstract] Objective To obtain the myocardial strain values of the left ventricle at the global and regional level in patients with different subtypes of cardiac amyloidosis (CA) through cardiovascular magnetic resonance feature tracking (CMR-FT).Materials and Methods This study included patients with CA who had undergone endocardial biopsy, and 20 cases of immunoglobulin light chain cardiac amyloidosis (AL-CA) and 22 cases of transthyretin cardiac amyloidosi (ATTR-CA) were retrospectively included according to immunohistochemistry, serum immunofixation electrophoresis, and Tcm/HMDP/PYP scintillation imaging. The type and range of late gadolinium enhancement in the two groups were evaluated to reflect the differences in histological characteristics. The radial, circumferential and longitudinal strains (2D and 3D) of the whole left ventricle and myocardium layers (subepicardial and subendocardial) were obtained by CMR-FT technique, and the differences of each parameter between groups were analyzed. Receiver operator characteristic curve analysis was used to analyze the accuracy of strain parameters in distinguishing the two CA types.Results Compared with the ATTR-CA group, the left ventricular ejection fraction was slightly lower in the AL-CA group, and the left ventricular end-diastolic volume was relatively smaller, but didn't reach statistically significant. After body surface area correction, left ventricular mass in ATTR-CA group was slightly higher than that in AL-CA group [left ventricular mass index: (106.38±29.79) mL/m2 vs. (100.04±36.73) mL/m2]. The distribution of late gadolinium enhancement was more diffuse in patients with ATTR-CA type (60%) and more subendocardial in patients with AL-CA type. The absolute values of left ventricular global radial strain (3D) (12.96%±5.21% vs. 16.58%±4.39%),global longitudinal strain (2D) (-6.70%±1.94% vs. -7.87%±1.70%), global circumferential strain-epicardial (GCSepi) (-8.41%±2.78% vs. -10.51%±3.10%) and global longitudinal strain-epicardial (GLSepi) (-6.49%±2.03% vs. -8.15%±1.86%) in ATTR-CA group were lower than that in AL-CA group (all P<0.05). The accuracy of GPSepi and GLSepi were the highest, and the AUC values were both reached 0.705. Logistic regression analysis showed that GLSepi was an independent factor in distinguishing different subtypes (OR=1.60, P=0.021).Conclusions CMR-FT imaging can provide valuable information about myocardial function and strain in patients with CA. Moreover, it is capable of distinguishing between the two common subtypes, ATTR-CA and AL-CA. The left ventricular myocardial strains in ATTR-CA are lower than those in AL-CA.
[Keywords] cardiac amyloidosis；immunoglobulin light chain cardiac amyloidosis；transthyretin cardiac amyloidosi；typing；myocardial strain；cardiac magnetic resonance-feature tracking；magnetic resonance imaging

ZHUANG Baiyan   LI Shuang   WANG Hui   ZHANG Hongkai   XU Lei*  

Department of Radiology, Beijing Anzhen Hospital; Beijing Institute of Heart, Lung and Blood Vessel Diseases; Department of Medical Imaging, Capital Medical University, Beijing 100029, China

Corresponding author: XU L, E-mail: leixu2001@hotmail.com

Conflicts of interest   None.

Received  2023-07-24
Accepted  2024-01-21
DOI: 10.12015/issn.1674-8034.2024.02.004
Cite this article as: ZHUANG B Y, LI S, WANG H, et al. Value of CMR feature-tracking imaging in discriminating subtypes of cardiac amyloidosis[J]. Chin J Magn Reson Imaging, 2024, 15(2): 23-29, 62. DOI:10.12015/issn.1674-8034.2024.02.004.

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