Is the Cardiac Magnetic Resonance Cine Images Capable of Differentiating Between LVEF-preserved Light-chain Amyloidosis and Hypertrophic Cardiomyopathy? －the Value of Left Atrial Parameters

Abstract

Purpose: Due to the limited application of late gadolinium enhancement (LGE) in patients with renal insufficiency and the lack of advanced mapping technique, non-invasively discriminating left ventricular ejection fraction (LVEF)-preserved light-chain amyloidosis (AL) from hypertrophic cardiomyopathy (HCM) with similar left ventricular (LV) hypertrophy was challenging. The aims of this study were to evaluate left atrial (LA) morphology and function in LVEF-preserved AL patients using CMR cine images and to investigate the ability of CMR-derived LA parameters in discriminating LVEF-preserved AL from HCM.Methods and results: Thirty-eight confirmed LVEF-preserved AL patients and 38 HCM patients as well as 20 healthy controls were enrolled in this retrospective study. Morphological and functional parameters of LA and LV were measured in multi-plane cine images. Receiver operator characteristics curves were generated to estimate the discriminative ability of parameters. The LA active contractile function of AL and HCM patients were both significantly impaired compared to the control, and the impairment of AL patients was severer than that of HCM (all P < 0.05). In morphological aspect, thickened maximum atrial septal thickness (ASHmax) was found in AL group with regard to HCM and control. Combining ASHmax and LA functional parameters had excellent discriminative ability between AL and HCM (area under the curve [AUC] > 0.9).Conclusions: The combination of ASHmax and LA function was able to perform accurately non-invasive differentiating diagnosis between AL and HCM patients in limited clinical condition, and it could helpfully complemented and extended the current AL diagnostic strategies.