title: Cardiac magnetic resonance evaluation of left ventricular remodelling distribution in cardiac amyloidosis.
abstract: BACKGROUND
  Cardiac amyloidosis (CA) is associated with typical morphological features on echocardiography, including concentric LV hypertrophy (LVH). Cardiac magnetic resonance (CMR) can accurately depict anatomy in different cardiomyopathies. Our aim was to describe the morphological features and remodelling patterns of CA with CMR, and establish their diagnostic accuracy, as well as the value of traditional diagnostic criteria derived from echocardiography and electrocardiography.
  
  
  METHODS
  Consecutive patients referred for CMR for possible CA were retrospectively evaluated. The diagnosis of CA was established in the presence of a positive cardiac biopsy and/or a typical pattern of myocardial late gadolinium enhancement. Morphological parameters were obtained from standard cine sequences. The presence and distribution of LVH, relative wall thickness (RWT) and LV remodelling patterns were determined.
  
  
  RESULTS
  130 patients (92 males (70.8%), age 64±13 years) were included. CA was diagnosed in 51 (39.2%). Patients with CA had increased LV wall thickness and LV mass index. An LV remodelling pattern different from concentric LVH was found in 42% of patients with CA, and asymmetric LVH was noted in 68.6%. A model including RWT, asymmetric LVH, and LVMI showed diagnostic accuracy of 88%, sensitivity of 67% and specificity of 86% for CA detection. Traditional diagnostic criteria for CA showed high specificity but poor sensitivity.
  
  
  CONCLUSIONS
  Asymmetric LVH and remodelling patterns different from concentric LVH are common in CA. Increased LV mass index, increased RWT, and asymmetric LVH are independently associated with the diagnosis. Traditional diagnostic criteria show poor sensitivity.
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pozo
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Kanwar
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Deochand
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Castellano
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Naib
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA Servizo de Cardioloxía, Complexo Hospitalario Universitario de Vigo, Pontevedra, Spain Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Pazos-López
authors.affiliation: Department of Bone Marrow Transplant, The Tisch Cancer Institute, Icahn School of Medicine, New York, New York, USA.
authors.forename: Keren
authors.initials: K
authors.lastname: Osman
authors.affiliation: Department of Radiology, The Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cham
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Madrid, Spain.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.affiliation: The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine, New York, New York, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000175:diagnosis* / Q000503:physiopathology; D001706:Biopsy; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020257:Ventricular Remodeling