The Auxiliary Role of Cardiac Magnetic Resonance Feature-Tracking Parameters in the Differentiation between Cardiac Amyloidosis and Constrictive Pericarditis

Abstract

Objectives. Cardiac amyloidosis (CA) and constrictive pericarditis (CP) are described as the differential diagnoses of restrictive hemodynamic alterations of the heart. We aimed to explain cardiac magnetic resonance (CMR) imaging findings (especially feature tracking (FT)) of CA and CP cases and compare them with healthy controls. Moreover, we evaluated the role of biventricular FT parameters in differentiating CA from CP. Methods. Thirty-eight patients who underwent CMR between February 2016 and January 2018 with the ultimate diagnosis of CA (19 patients) or CP (19 patients) were enrolled. We included biopsy-proven light-chain amyloidosis patients. The data of 28 healthy controls were utilized for comparison. The patients were followed up for 8–23 months to register mortality and their surveillance. All CMR morphological and functional data, including FT parameters, were recorded and analyzed. Results. Of only 13/19 (68.4%) CA patients who had the follow-up data, 11/13 (84.6%) died. One of The CP patients (5.3%) expired during the follow-up. Significant between-group differences were noted concerning the biventricular ejection fraction as well as global longitudinal, circumferential, and radial strain values ( P s < 0.001 ). The left ventricular (LV) global longitudinal strain (GLS) ≤10% was detected in 13/19 (68.4%) of the CA and 1/19 (5.3%) of CP cases ( P < 0.001 ). A significant difference between the mean value of the LVGLS and LV global circumferential strain (GCS) of the basal LV level compared to the mid and apical levels was observed ( P s < 0.001 ) in the CA patients. The differences between the mean LVGLS and the GCS measures of the mid and apical LV levels were not significant ( P = 1 and P = 0.06 , respectively). Conclusions. In our study, CA and CP severely disrupted ventricular strains. Biventricular GLS was meaningfully lower in the CA subjects. Therefore, strain analysis, especially in the longitudinal direction, could be helpful to differentiate CA from CP.

Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts

“…This approach can help to identify inflammation, and therefore anti-inflammatory therapy can be considered [ 24 ]. Myocardial tissue tracking with CMR has also been utilized and has been found helpful in differentiating cases of CP from RCM, but its use has not been widely adopted due to limited availability [ 4 , 60 , 61 ].…”

Cardiac Magnetic Resonance Imaging Techniques and Applications for Pericardial Diseases

“…2 Similar to echocardiography, strain can also be measured on MRI cine sequence using feature tracking software, and has been shown in recent studies to help distinguish between constrictive pericarditis and restrictive cardiomyopathy such as significantly higher magnitude of global strain and significantly lower left ventricular lateral/septal wall strain ratios for constriction. 11,12 Free-Breathing Sequences Free-breathing cine sequences are performed to assess for pericardial constriction, as evidenced by pronounced respirophasic septal shift. The sequence is taken over at least 2 complete respiratory cycles, with patient instructed to fully inspire and expire, and temporal resolution optimized to preferably below 60 ms. 9 During inspiration, the accentuated venous return to the heart constrained within a noncompliant pericardium leads to septal deviation towards the left ventricle, and vice versa during expiration.…”

“…2 Similar to echocardiography, strain can also be measured on MRI cine sequence using feature tracking software, and has been shown in recent studies to help distinguish between constrictive pericarditis and restrictive cardiomyopathy such as significantly higher magnitude of global strain and significantly lower left ventricular lateral/septal wall strain ratios for constriction. 11,12…”

The relationship of myocardial and liver T2* values with cardiac function and laboratory findings in transfusion-dependent thalassemia major patients: A retrospective cardiac MRI study

“…[12][13][14][15][16][17][18][19] As in some other cardiac diseases, MRI of the heart in thalassemia may eliminate the need for a biopsy. 20 Early detection of cardiac iron accumulation is essential to avoid irreversible cardiac damages such as restrictive cardiomyopathy. 21 If initiated early, some cardiac complications are often reversible with aggressive intravenous iron chelation therapy.…”

“… 12 - 19 As in some other cardiac diseases, MRI of the heart in thalassemia may eliminate the need for a biopsy. 20 …”