title: Clinical and prognostic utility of cardiovascular magnetic resonance imaging in myeloma patients with suspected cardiac amyloidosis.
abstract: OBJECTIVE
  AL amyloidosis affects up to 30% of patients with multiple myeloma (MM), and cardiac involvement is associated with worse outcomes. Traditional screening modalities including EKG, echocardiography and biomarkers have limited value. The aim of this study was to evaluate the clinical and prognostic value of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR) imaging in patients with plasma cell dyscrasias and suspected cardiac amyloidosis (CA).
  
  
  METHODS
  A total of 251 consecutive patients with plasma cell dyscrasias who underwent CMR were enrolled in this study. Primary endpoint was all cause mortality. Clinical, ECG, echocardiographic, biomarker and CMR predictors of mortality were analyzed.
  
  
  RESULTS
  Mean age of population was 63 ± 10 years, 36% females and 19% African Americans. During a median follow-up duration of 28 months (IQR 5-56), there were 97 deaths (39%). Patients who died were more likely to have diabetes (28% vs. 14%; P = 0.03), CAD (28% vs. 16%; P = 0.04) and CKD (33% vs. 21%; P = 0.04). With endomyocardial biopsy as the gold standard (42 (17%) patients), amyloid pattern on CMR (LGE+) had sensitivity and negative predictive values of 100%; specificity and positive predictive values of 80 and 81% with an AUC 0.9 for CA. History of CAD (HR 1.64, 95% CI 1.01-2.6; P = 0.04), brain natriuretic peptide (HR 1.0003 95% CI 1.0001-1.0006; P = 0.004) and LGE + (HR 1.72, 95% CI 1.05-2.8; P = 0.02) were independent predictors of mortality. LGE+ possessed incremental prognostic value over clinical, laboratory and echocardiographic variables for mortality prediction.
  
  
  CONCLUSIONS
  CMR is a clinically useful tool for diagnosis and prognostication in myeloma patients with suspected CA.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA Department of Radiology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA sabhabhatti@hotmail.com.
authors.forename: Sabha
authors.initials: S
authors.lastname: Bhatti
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Evan
authors.initials: E
authors.lastname: Watts
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Fahd
authors.initials: F
authors.lastname: Syed
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Vallurupalli
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Pandey
authors.affiliation: Department of Radiology, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Kedar
authors.initials: K
authors.lastname: Jambekar
authors.affiliation: The Christ Hospital, Cincinnati, OH, USA.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Mazur
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D001707:Biopsy, Needle; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D019786:Gadolinium DTPA
keywords: cardiac amyloidosis; cardiovascular magnetic resonance; late gadolinium enhancement; prognosis