Nonenhanced Chemical Exchange Saturation Transfer Cardiac Magnetic Resonance Imaging in Patients With Amyloid Light‐Chain Amyloidosis

Li, Xiao; Huang, Sisi; Han, Pei; Zhou, Zhengwei; Azab, Linda; Lu, Meng Yao; Li, Jian; An, Jing; Cao, Yihan; Jin, Zhengyu; Li, Debiao

doi:10.1002/jmri.27859

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…2 ) [ 13 ]. Local normal ranges were determined as 1295.0 ± 36.2 ms for T1 and 40.3 ± 2.3 ms for T2 [ 14 ]. ECV values were obtained from pre- and post-contrast T1 map indexes of hematocrit.…”

Section: Methodsmentioning

confidence: 99%

Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy

Guo,

Li,

Gao

et al. 2024

Korean J Radiol

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Objective Cardiac magnetic resonance (CMR) is a diagnostic tool that provides precise and reproducible information about cardiac structure, function, and tissue characterization, aiding in the monitoring of chemotherapy response in patients with light-chain cardiac amyloidosis (AL-CA). This study aimed to evaluate the feasibility of CMR in monitoring responses to chemotherapy in patients with AL-CA. Materials and Methods In this prospective study, we enrolled 111 patients with AL-CA (50.5% male; median age, 54 [interquartile range, 49–63] years). Patients underwent longitudinal monitoring using biomarkers and CMR imaging. At follow-up after chemotherapy, patients were categorized into superior and inferior response groups based on their hematological and cardiac laboratory responses to chemotherapy. Changes in CMR findings across therapies and differences between response groups were analyzed. Results Following chemotherapy (before vs. after), there were significant increases in myocardial T2 (43.6 ± 3.5 ms vs. 44.6 ± 4.1 ms; P = 0.008), recovery in right ventricular (RV) longitudinal strain (median of -9.6% vs. -11.7%; P = 0.031), and decrease in RV extracellular volume fraction (ECV) (median of 53.9% vs. 51.6%; P = 0.048). These changes were more pronounced in the superior-response group. Patients with superior cardiac laboratory response showed significantly greater reductions in RV ECV (-2.9% [interquartile range, -8.7%–1.1%] vs. 1.7% [-5.5%–7.1%]; P = 0.017) and left ventricular ECV (-2.0% [-6.0%–1.3%] vs. 2.0% [-3.0%–5.0%]; P = 0.01) compared with those with inferior response. Conclusion Cardiac amyloid deposition can regress following chemotherapy in patients with AL-CA, particularly showing more prominent regression, possibly earlier, in the RV. CMR emerges as an effective tool for monitoring associated tissue characteristics and ventricular functional recovery in patients with AL-CA undergoing chemotherapy, thereby supporting its utility in treatment response assessment.

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Section: Methodsmentioning

confidence: 99%

Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy

Guo,

Li,

Gao

et al. 2024

Korean J Radiol

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“…Compared to MRS, CEST yields better spatial resolution and higher sensitivity under indirect detection through water protons 87 . The CEST signal decreases in patients with CA and significantly correlates with clinical staging, LGE patterns, and ECV, thereby approving its feasibility to identify cardiac involvement and assess amyloid burden 88 . The intrinsic disadvantage of the long scan time of the technique hinders its clinical application.…”

Section: Metabolic Cardiac Mri Techniquementioning

confidence: 99%

State of the Art: Quantitative Cardiac MRI in Cardiac Amyloidosis

Guo

2022

Magnetic Resonance Imaging

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Cardiac amyloidosis (CA) is characterized by amyloid infiltration in the myocardial extracellular space, causing heart failure. Patients with CA are currently underdiagnosed. Cardiac involvement is significantly associated with the prognosis and treatment decision‐making for CA. Early identification and accurate stratification are the crucial first step in patient management. Comprehensive cardiac MRI‐based evaluation of the cardiac structure, function, and myocardial tissue characterization assesses cardiac involvement by tracing disease processes. Emerging quantitative tissue characterization techniques have introduced new measures that can identify early staged CA and monitor disease progression or response after treatment. Quantitative cardiac MRI is becoming an instrumental tool in understanding CA, which leads to changes in individualized patient care. This review aimed to discuss the quantitative cardiac MRI‐based assessment of CA using established and emerging techniques. Evidence Level 5 Technical Efficacy Stage 3

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“…6 Their results showed that the optimized Cr CEST protocol was able to discern the metabolic activity difference among infarct, border zone, and remote myocardium with good repeatability. Recently, the technique has shown potential in identifying cardiac involvement and assessing disease burden in light-chain amyloidosis patients, 7 indicating the technique to be promising in heart disease characterization.…”

Section: Introductionmentioning

confidence: 99%

Dynamic alteration in myocardium creatine during acute infarction using MR CEST imaging

et al. 2022

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Creatine (Cr) is an essential metabolite in the creatine kinase reaction, which plays a critical role in maintaining normal cardiac function. Chemical exchange saturation transfer (CEST) MRI offers a novel way to map myocardium Cr. This study aims to investigate the dynamic alteration in myocardium Cr during acute infarction using CEST MRI, which may facilitate understanding of the heart remodeling mechanism at the molecular level. Seven adult Bama pigs underwent cardiac cine, Cr CEST, and late gadolinium‐enhanced (LGE) T1‐weighted (T1w) imaging three and 14 days after myocardial infarction induction on a 3 T scanner. Cardiac structural and functional indices, including myocardium mass (MM), end‐diastolic volume (EDV), end‐systolic volume (ESV), stroke volume (SV), and ejection fraction (EF), were measured from cines. Infarct angle was determined from LGE T1w images, based on which myocardium was classified into infarct, adjacent, and remote regions. Cr‐weighted CEST signal was quantified from a three‐pool Lorentzian fitting model and measured within each region and the entire myocardium. Student's t‐test was conducted to evaluate any significant differences in measurements between the two time points. Correlation was assessed with Pearson correlation. P values less than 0.05 were considered statistically significant. Over the studied period, MM, EDV, and ESV did not alter significantly (P > 0.05), whereas significant increases of SV and EF and decrease of infarct angle were observed (P < 0.05). Meanwhile, the Cr‐weighted CEST signal elevated significantly on Day 14 compared with Day 3 in the infarct (10.00 ± 1.28% versus 6.91 ± 1.54%, P < 0.01), adjacent (11.17 ± 2.00% versus 8.01 ± 1.58%, P = 0.01), and entire myocardium (11.03 ± 1.36% versus 8.19 ± 1.28%, P < 0.01). Moderate negative correlations were shown between the infarct angle and Cr‐weighted CEST signals in the infarct (r = −0.80, P < 0.001), adjacent (r = −0.58, P = 0.03), and entire myocardium (r = −0.76, P < 0.01). In conclusion, the dynamic increase of myocardium Cr during acute infarction may interact with cardiac structural and functional recovery. The study provides supplementary insights into the heart remodeling process from the metabolic viewpoint.

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Nonenhanced Chemical Exchange Saturation Transfer Cardiac Magnetic Resonance Imaging in Patients With Amyloid Light‐Chain Amyloidosis

Cited by 6 publications

References 26 publications

Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy

Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy

State of the Art: Quantitative Cardiac MRI in Cardiac Amyloidosis

Dynamic alteration in myocardium creatine during acute infarction using MR CEST imaging

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