Myocardial Deformation in Cardiac Amyloid Light-chain Amyloidosis: Assessed with 3T Cardiovascular Magnetic Resonance Feature Tracking

Abstract

Clinically, assessment of myocardial function is essential in patients with amyloid light-chain cardiac amyloidosis (AL-CA) to predict outcome and determine therapeutic approach. The aim of this study was to investigate the feasibility of cardiovascular magnetic resonance (CMR)-derived feature tracking algorithm for assessing left ventricular (LV) myocardial deformation in AL-CA, and to determine if these abnormal myocardial deformation parameters are correlated to impaired LV myocardial microvascular dysfunction. A total of 42 AL-CA patients, including 26 with preserved systolic function and 16 with impaired LVEF, and 35 healthy controls were enrolled and underwent CMR examination. Our result indicated that AL-CA patients had significantly reduced global peak strain (PS) (longitudinal, circumferential, and radial) (all P < 0.05). AL-CA patients with normal LVEF showed preserved longitudinal PS at apical and significantly reduced longitudinal PS at mid and basal segments. By Spearman's rank correlation analysis, the LV regional radial, circumferential, and longitudinal myocardial deformation values were correlated to myocardial upslope and MaxSI in CA, regardless of LVEF. This study indicated that the abnormal LV myocardial deformation of AL-CA patients can be monitored using feature tracking CMR, even in those with preserved LVEF; and the myocardial deformation was associated with coronary microvascular dysfunction.Cardiac amyloidosis (CA), characterized by extracellular deposition of pathologically insoluble proteins in heart tissue, is seen in more than one-half of the patients with systemic light-chain (AL) amyloidosis, and the major cause of death in these patients 1, 2 . Assessment of myocardial function is essential in patients with amyloidosis, as the extent and severity of cardiac involvement is the most significant indicator to determine patient prognosis 2-4 .Clinically, the left ventricular ejection fraction (LVEF), reflecting global LV systolic function, has remained the reference standard for the evaluation of ventricular function. Reduced LVEF has been considered an independent predictor of cardiac mortality in AL amyloidosis 2 . However, subclinical dysfunction of the left ventricle can be observed by speckle tracking echocardiography in CA patients with preserved LVEF 5,6 . Thus, LVEF is limited by its inability to assess regional function and less sensitive for the evaluation of early contractile impairment 7,8 .Cardiovascular magnetic resonance (CMR) tagging-derived myocardial strain values, which could measure cardiac muscle motion and deformation, have emerged as more sensitive indicators than EF for measurement of systolic function 9 . However, this established method is limited by time consuming and requiring additional sequence acquisition. As cine CMR imaging has relative high signal to noise, contrast to noise ratios and ability of unrestricted access to large fields of view, it could provide more accurate and reproducible assessment of changing

Assessment of left ventricular deformation in patients with type 2 diabetes mellitus by cardiac magnetic resonance tissue tracking

“…The trend of change in segmental strain parameters was consistent with that of global LV strain parameters. These results are similar to the findings in the study by Li et al on cardiac strain in myocardial amyloidosis 35 .…”

Progression of myocardial fibrosis in hypertrophic cardiomyopathy: mechanisms and clinical implications

“…Commercially available software (Circle Cardiovascular Imaging Inc., Calgary, Canada) was used to analyse left ventricular (LV) volumes, mass, ejection fraction, peak systolic 2D global longitudinal, circumferential and radial strain as previously reported 21 . The assessment of LV indices and LGE mass were undertaken by two observers blinded to the clinical information (M.S.…”

Left Ventricular Deformation in Patients with Connective Tissue Disease: Evaluated by 3.0T Cardiac Magnetic Resonance Tissue Tracking

“…The LV wall is composed of cardiomyocytes, of which the orientation continuously rotates from epicardium to endocardium 16 . Recently, CMR tissue tracking has been gradually used to quantitatively measure LV function via different strain parameters from the radial, circumferential, and longitudinal directions 8,17,18 with high sensitivity and reproducibility 19,20 . One of the findings of the present study was that, compared with healthy controls, the magnitude of global and regional PS in the three directions was decreased in CTD patients with preserved LVEF, which is consistent with STE results 12,13 .…”

“…Cardiac magnetic resonance imaging (MRI) tissue tracking has recently been developed for the assessment of myocardial deformation and subclinical cardiac dysfunction prior to a reduction in the LV ejection fraction (LVEF) 7,8 . However, to the best of our knowledge, few studies have evaluated myocardial dysfunction in patients with CTD using cardiac MRI tissue tracking 9,10 .…”