The diagnostic performance of cardiac magnetic resonance in detection of myocardial involvement in AL amyloidosis.
BACKGROUND
The non-invasive assessment of amyloid heart disease may be challenging. Cardiac magnetic resonance (CMR) represents a method of choice for assessment of left ventricular (LV) morphology and function, and it also provides a unique possibility to evaluate the presence of amyloid deposition by the late gadolinium enhancement (LGE) technique. However, so far, published studies have not been consistent in terms of described LGE patterns associated with amyloid cardiomyopathy.


OBJECTIVE
To compare echocardiographic and CMR assessment of LV morphology and function and to evaluate the presence and pattern of LGE in a population of patients with AL amyloid cardiomyopathy.


METHODS
Twenty-two consecutive patients with newly diagnosed AL amyloid cardiomyopathy and without contraindications to CMR were comprehensively examined by echocardiography and CMR.


RESULTS
Echocardiography and CMR did not differ in the evaluation of interventricular septal thickness, LV end-diastolic diameter and ejection fraction. Significant differences were found between echocardiographic and CMR estimates of LV end-diastolic volume (P<0·01) and LV mass (P<0·001). Various global LGE patterns (transmural homogenous or heterogeneous, subendocardial) were present in 17 patients (77%), patchy LGE was observed in one case (4·5%) and suboptimal nulling of the myocardium was reported in two subjects (9%).


CONCLUSIONS
Echocardiography significantly overestimates LV mass and underestimates LV volumes in patients with AL amyloid cardiomyopathy as compared to CMR. As it is present in more than three quarters of individuals with AL amyloid cardiomyopathy, any type of global LGE pattern may be considered as pathogenomic for amyloid heart disease.
2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Michal
M
Fikrle
2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
Tomas
T
Palecek
Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Martin
M
Masek
2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
Petr
P
Kuchynka
1st Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Jan
J
Straub
1st Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Ivan
I
Spicka
Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Romana
R
Rysava
2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Ales
A
Linhart
D000368:Aged; D000686:Amyloidosis / Q000150:complications / Q000000981:diagnostic imaging*; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
AL amyloidosis; cardiac magnetic resonance; cardiomyopathy; echocardiography; late gadolinium enhancement