Diagnostic and Prognostic Utility of Cardiovascular Magnetic Resonance Imaging in Light-Chain Cardiac Amyloidosis
Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. The aim of this study was to assess the diagnostic and progno...
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| Published in | The American journal of cardiology Vol. 103; no. 4; pp. 544 - 549 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
Elsevier Inc
15.02.2009
Elsevier Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0002-9149 1879-1913 1879-1913 |
| DOI | 10.1016/j.amjcard.2008.09.105 |
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| Abstract | Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. The aim of this study was to assess the diagnostic and prognostic significance of cardiovascular magnetic resonance imaging in patients with amyloid light-chain amyloidosis but unknown cardiac involvement. Cardiovascular magnetic resonance imaging with LGE was performed in 28 patients with systemic amyloidosis. The presence of cardiac amyloidosis was determined by separate clinical evaluation. The performance of LGE for the prediction of cardiac amyloidosis and prognostic implications of LGE were determined. LGE was observed in 19 patients (68%). The sensitivity, specificity, positive predictive value, and negative predictive value of LGE for the identification of clinical cardiac involvement were 86%, 86%, 95%, and 67%, respectively. During a median follow-up period of 29 months, there were 5 deaths (82% survival). LGE itself did not predict survival (p = 0.62). LGE volume was positively correlated with serum level of B-type natriuretic peptide (BNP; R = 0.64, p ≤0.001), and in multivariate analysis, LGE volume proved the strongest independent predictor of BNP. BNP was correlated with New York Heart Association class (p = 0.03). Reduced right ventricular end-diastolic volume (p <0.01) and stroke volume (p = 0.02) were associated with mortality. In conclusion, in patients with systemic amyloidosis, LGE is highly sensitive and specific for the identification of cardiac involvement but does not predict survival. LGE is strongly correlated with heart failure severity as assessed by BNP. |
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| AbstractList | While the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. We sought to assess the diagnostic and prognostic significance of cardiovascular magnetic resonance (CMR) imaging in patients with light chain (AL) amyloidosis but unknown cardiac involvement. CMR with LGE was performed in 28 patients with systemic amyloidosis. The presence of cardiac amyloidosis was determined by a separate clinical evaluation. The performance of LGE for the prediction of cardiac amyloidosis and prognostic implications of LGE were determined. LGE was observed in 19 (68%) patients. The sensitivity, specificity, positive predictive value and negative predictive value of LGE for the identification of clinical cardiac involvement was 86%, 86%, 95%, and 67% respectively. During a median follow-up of 29 months, there were 5 deaths (82% survival). LGE itself did not predict survival (p=0.62). LGE volume positively correlated to serum level of B-type natriuretic peptide (BNP) (R=0.64, p≤0.001) and in multivariable analysis, LGE volume proved the strongest independent predictor of BNP. BNP was correlated to New York Heart Association class (p=0.03). Reduced right ventricular end-diastolic volume (p < 0.01) and stroke volume (p = 0.02) were associated with mortality. In conclusion, in patients with systemic amyloidosis, LGE is highly sensitive and specific for the identification of cardiac involvement, but does not predict survival. LGE does correlate strongly to heart failure severity as assessed by BNP. Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. The aim of this study was to assess the diagnostic and prognostic significance of cardiovascular magnetic resonance imaging in patients with amyloid light-chain amyloidosis but unknown cardiac involvement. Cardiovascular magnetic resonance imaging with LGE was performed in 28 patients with systemic amyloidosis. The presence of cardiac amyloidosis was determined by separate clinical evaluation. The performance of LGE for the prediction of cardiac amyloidosis and prognostic implications of LGE were determined. LGE was observed in 19 patients (68%). The sensitivity, specificity, positive predictive value, and negative predictive value of LGE for the identification of clinical cardiac involvement were 86%, 86%, 95%, and 67%, respectively. During a median follow-up period of 29 months, there were 5 deaths (82% survival). LGE itself did not predict survival (p = 0.62). LGE volume was positively correlated with serum level of B-type natriuretic peptide (BNP; R = 0.64, p < or =0.001), and in multivariate analysis, LGE volume proved the strongest independent predictor of BNP. BNP was correlated with New York Heart Association class (p = 0.03). Reduced right ventricular end-diastolic volume (p <0.01) and stroke volume (p = 0.02) were associated with mortality. In conclusion, in patients with systemic amyloidosis, LGE is highly sensitive and specific for the identification of cardiac involvement but does not predict survival. LGE is strongly correlated with heart failure severity as assessed by BNP. Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. The aim of this study was to assess the diagnostic and prognostic significance of cardiovascular magnetic resonance imaging in patients with amyloid light-chain amyloidosis but unknown cardiac involvement. Cardiovascular magnetic resonance imaging with LGE was performed in 28 patients with systemic amyloidosis. The presence of cardiac amyloidosis was determined by separate clinical evaluation. The performance of LGE for the prediction of cardiac amyloidosis and prognostic implications of LGE were determined. LGE was observed in 19 patients (68%). The sensitivity, specificity, positive predictive value, and negative predictive value of LGE for the identification of clinical cardiac involvement were 86%, 86%, 95%, and 67%, respectively. During a median follow-up period of 29 months, there were 5 deaths (82% survival). LGE itself did not predict survival (p = 0.62). LGE volume was positively correlated with serum level of B-type natriuretic peptide (BNP; R = 0.64, p < or =0.001), and in multivariate analysis, LGE volume proved the strongest independent predictor of BNP. BNP was correlated with New York Heart Association class (p = 0.03). Reduced right ventricular end-diastolic volume (p <0.01) and stroke volume (p = 0.02) were associated with mortality. In conclusion, in patients with systemic amyloidosis, LGE is highly sensitive and specific for the identification of cardiac involvement but does not predict survival. LGE is strongly correlated with heart failure severity as assessed by BNP.Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. The aim of this study was to assess the diagnostic and prognostic significance of cardiovascular magnetic resonance imaging in patients with amyloid light-chain amyloidosis but unknown cardiac involvement. Cardiovascular magnetic resonance imaging with LGE was performed in 28 patients with systemic amyloidosis. The presence of cardiac amyloidosis was determined by separate clinical evaluation. The performance of LGE for the prediction of cardiac amyloidosis and prognostic implications of LGE were determined. LGE was observed in 19 patients (68%). The sensitivity, specificity, positive predictive value, and negative predictive value of LGE for the identification of clinical cardiac involvement were 86%, 86%, 95%, and 67%, respectively. During a median follow-up period of 29 months, there were 5 deaths (82% survival). LGE itself did not predict survival (p = 0.62). LGE volume was positively correlated with serum level of B-type natriuretic peptide (BNP; R = 0.64, p < or =0.001), and in multivariate analysis, LGE volume proved the strongest independent predictor of BNP. BNP was correlated with New York Heart Association class (p = 0.03). Reduced right ventricular end-diastolic volume (p <0.01) and stroke volume (p = 0.02) were associated with mortality. In conclusion, in patients with systemic amyloidosis, LGE is highly sensitive and specific for the identification of cardiac involvement but does not predict survival. LGE is strongly correlated with heart failure severity as assessed by BNP. Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. The aim of this study was to assess the diagnostic and prognostic significance of cardiovascular magnetic resonance imaging in patients with amyloid light-chain amyloidosis but unknown cardiac involvement. Cardiovascular magnetic resonance imaging with LGE was performed in 28 patients with systemic amyloidosis. The presence of cardiac amyloidosis was determined by separate clinical evaluation. The performance of LGE for the prediction of cardiac amyloidosis and prognostic implications of LGE were determined. LGE was observed in 19 patients (68%). The sensitivity, specificity, positive predictive value, and negative predictive value of LGE for the identification of clinical cardiac involvement were 86%, 86%, 95%, and 67%, respectively. During a median follow-up period of 29 months, there were 5 deaths (82% survival). LGE itself did not predict survival (p = 0.62). LGE volume was positively correlated with serum level of B-type natriuretic peptide (BNP; R = 0.64, p ≤0.001), and in multivariate analysis, LGE volume proved the strongest independent predictor of BNP. BNP was correlated with New York Heart Association class (p = 0.03). Reduced right ventricular end-diastolic volume (p <0.01) and stroke volume (p = 0.02) were associated with mortality. In conclusion, in patients with systemic amyloidosis, LGE is highly sensitive and specific for the identification of cardiac involvement but does not predict survival. LGE is strongly correlated with heart failure severity as assessed by BNP. Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to identify cardiac involvement in patients with systemic amyloidosis is unknown. The aim of this study was to assess the diagnostic and prognostic significance of cardiovascular magnetic resonance imaging in patients with amyloid light-chain amyloidosis but unknown cardiac involvement. Cardiovascular magnetic resonance imaging with LGE was performed in 28 patients with systemic amyloidosis. The presence of cardiac amyloidosis was determined by separate clinical evaluation. The performance of LGE for the prediction of cardiac amyloidosis and prognostic implications of LGE were determined. LGE was observed in 19 patients (68%). The sensitivity, specificity, positive predictive value, and negative predictive value of LGE for the identification of clinical cardiac involvement were 86%, 86%, 95%, and 67%, respectively. During a median follow-up period of 29 months, there were 5 deaths (82% survival). LGE itself did not predict survival (p = 0.62). LGE volume was positively correlated with serum level of B-type natriuretic peptide (BNP; R = 0.64, p ≤0.001), and in multivariate analysis, LGE volume proved the strongest independent predictor of BNP. BNP was correlated with New York Heart Association class (p = 0.03). Reduced right ventricular end-diastolic volume (p <0.01) and stroke volume (p = 0.02) were associated with mortality. In conclusion, in patients with systemic amyloidosis, LGE is highly sensitive and specific for the identification of cardiac involvement but does not predict survival. LGE is strongly correlated with heart failure severity as assessed by BNP. [PUBLICATION ABSTRACT] |
| Author | Ozonoff, Al Harrigan, Caitlin Davidoff, Ravin Ruberg, Frederick L. Appelbaum, Evan Kissinger, Kraig V. Manning, Warren J. Skinner, Martha |
| AuthorAffiliation | b Department of Radiology, Boston University School of Medicine, Boston, MA a Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA e Amyloid Treatment and Research Program, Boston University School of Medicine, Boston, MA d Department of Biostatistics, Boston University School of Public Health, Boston, MA c Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, MA f Department of Radiology, Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, MA |
| AuthorAffiliation_xml | – name: b Department of Radiology, Boston University School of Medicine, Boston, MA – name: d Department of Biostatistics, Boston University School of Public Health, Boston, MA – name: c Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, MA – name: e Amyloid Treatment and Research Program, Boston University School of Medicine, Boston, MA – name: f Department of Radiology, Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, MA – name: a Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA |
| Author_xml | – sequence: 1 givenname: Frederick L. surname: Ruberg fullname: Ruberg, Frederick L. email: frruberg@bu.edu organization: Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts – sequence: 2 givenname: Evan surname: Appelbaum fullname: Appelbaum, Evan organization: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, Massachusetts – sequence: 3 givenname: Ravin surname: Davidoff fullname: Davidoff, Ravin organization: Section of Cardiology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts – sequence: 4 givenname: Al surname: Ozonoff fullname: Ozonoff, Al organization: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts – sequence: 5 givenname: Kraig V. surname: Kissinger fullname: Kissinger, Kraig V. organization: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, Massachusetts – sequence: 6 givenname: Caitlin surname: Harrigan fullname: Harrigan, Caitlin organization: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, Massachusetts – sequence: 7 givenname: Martha surname: Skinner fullname: Skinner, Martha organization: Amyloid Treatment and Research Program, Boston University School of Medicine, Boston, Massachusetts – sequence: 8 givenname: Warren J. surname: Manning fullname: Manning, Warren J. organization: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medicine Center, Harvard Medical School, Boston, Massachusetts |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21139730$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/19195518$$D View this record in MEDLINE/PubMed |
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| Keywords | Heart Prognosis Medical imagery Metabolic diseases Amyloidosis Circulatory system Diagnosis Cardiology Light peptide chain Enzymopathy Nuclear magnetic resonance imaging Protein |
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| Snippet | Although the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to... While the presence of abnormal late gadolinium enhancement (LGE) in cardiac amyloidosis has been well established, its prognostic implication and utility to... |
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| SubjectTerms | Aged Amyloidosis Amyloidosis - diagnosis Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Female Gadolinium Heart Heart Diseases - diagnosis Humans Magnetic Resonance Imaging Male Medical diagnosis Medical prognosis Medical sciences Metabolic diseases Middle Aged NMR Nuclear magnetic resonance Other metabolic disorders Predictive Value of Tests Prognosis Severity of Illness Index |
| Title | Diagnostic and Prognostic Utility of Cardiovascular Magnetic Resonance Imaging in Light-Chain Cardiac Amyloidosis |
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