Quantitative assessment of systolic and diastolic function in patients with LGE negative systemic amyloidosis using CMR.
OBJECTIVE
In clinical routine myocardial affection in amyloidosis is assessed by qualitative late gadolinium enhancement (LGE). Recent studies suggest that early cardiac involvement in amyloidosis may be overlooked by qualitative LGE assessment. The aim of this study was to assess possible early cardiac involvement in LGE negative AL patients by means of systolic and diastolic strain assessment and quantitative enhancement.


METHODS
51 individuals (17 Patients with LGE positive light-chain amyloidosis (AL) (Group A), 17 Patients with LGE negative systemic AL (Group B), and 17 healthy controls (Group C)) were investigated. SSFP-Cine sequences were acquired in short axis slices as well as horizontal long axis views. Standard CMR parameters as well as Feature Tracking (FT) derived systolic and diastolic circumferential and longitudinal strain parameters were calculated. Additionally, contrast enhanced MRI images were analyzed to quantitatively determine the extent of enhancement.


RESULTS
AL patients with and without LGE both had significantly lower early diastolic strain rate (EDSR) values and peak systolic longitudinal strain (PSLS) values than healthy controls (EDSR: Group A 63.1±17.6; Group B: 74.46±11.8; Group C: 86.82±12.7; F(2.48)=10.7 p<0.001); (PSLS: Group A: -13.44±1.9%; Group B: -20.31±1.2%; Group C: -23.11±1.4%; F(2.48)=167.6; p<0.001). Analysis of quantitative LGE enhancement revealed increased enhancement in qualitative LGE negative AL patients compared to healthy controls (Group A: 19.6±8.9%; Group B: 8.2±3.9%; Group C: 2.4±1.3% F(2.48)=52.2; p<0.001).


CONCLUSIONS
CMR strain analysis detects early systolic and diastolic strain impairment in AL patients lacking qualitative LGE enhancement.
Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany. Electronic address: daniel.kuetting@ukb.uni-bonn.de.
Daniel L R
DL
Kuetting
Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany. Electronic address: rami.homsi@ukb.uni-bonn.de.
Rami
R
Homsi
Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany. Electronic address: Alois_.sprinkart@ukb.uni-bonn.de.
Alois M
AM
Sprinkart
Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany. Electronic address: julian.luetkens@ukb.uni-bonn.de.
Julian
J
Luetkens
Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany. Electronic address: daniel.thomas@ukb.uni-bonn.de.
Daniel K
DK
Thomas
Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany. Electronic address: hans.schild@ukb.uni-bonn.de.
Hans H
HH
Schild
Department of Radiology, University of Bonn, Sigmund-Freud-Str.25, 53127 Bonn, Germany. Electronic address: darius.dabir@ukb.uni-bonn.de.
Darius
D
Dabir
D000368:Aged; D000465:Algorithms; D000686:Amyloidosis / Q000150:complications / Q000175:diagnosis*; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003287:Contrast Media / Q000494:pharmacology; D003971:Diastole; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds / Q000494:pharmacology*; D015203:Reproducibility of Results; D013599:Systole; D016277:Ventricular Function, Left / Q000502:physiology*
D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
Amyloidosis; CMR; Quantitative enhancement; Strain analysis