Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping

• DOI: 10.1001/jamacardio.2023.2010
• Publication Date: 2023-07-19T15:17:18Z
• Authors: Adam Ioannou; Rishi K. Patel; Ana Martinez-Naharro; Yousuf Razvi; Aldostefano Porcari; Muhammad U. Rauf; Roos E. Bolhuis; Jacob Fernando-Sa...; Ruta Virsinskaite; Francesco Bandera; Tushar Kotecha; Lucia Venneri; Daniel Knight; Charlotte Manisty; James Moon; Helen Lachmann; Carol Whelan; Peter Kellman; Philip N. Hawkins; Julian D. Gillmore; Ashutosh Wechalekar; Marianna Fontana
• Keywords: Cardiac Amyloidosis; AL amyloidosis; Cardiac magnetic resonance

Cardiac magnetic resonance (CMR) imaging-derived extracellular volume (ECV) mapping, generated from precontrast and postcontrast T1, accurately determines treatment response in cardiac light-chain amyloidosis. Native T1 which can be derived without the need for contrast, has demonstrated accuracy diagnosis prognostication, but it is unclear whether serial native measurements could also track response.To assess mapping measure association between changes prognosis.This single-center cohort study evaluated patients diagnosed with amyloidosis (January 2016 to December 2020) who underwent CMR scans at a repeat scan following chemotherapy. Analysis took place January October 2022.Comparison of biomarkers imaging parameters reduced, stable, or increased mortality.The comprised 221 (mean [SD] age, 64.7 [10.6] years; 130 male [59%]). At 6 months, 183 64.8 [10.5] 110 [60%]) imaging. Reduced 50 milliseconds more occurred 8 (4%), all whom had good hematological response; by an 42 (23%), most poor (27 [68%]). 12 160 63.8 [11.1] 94 [59%]) scan. A reduced 24 (15%), response, was associated reduction N-terminal pro-brain natriuretic peptide (median [IQR], 2638 [913-5767] vs 423 [128-1777] ng/L; P < .001), maximal wall thickness [SD], 14.8 [3.6] 13.6 [3.9] mm; = .009), E/e' 14.9 [6.8] 12.0 [4.0]; .007), improved longitudinal strain -14.8% [4.0%] -16.7% [4.0%]; .004), both myocardial T2 52.3 [2.9] 49.4 [2.0] milliseconds; .001) ECV 0.47 [0.07] 0.42 [0.08]; .001). (17 [71%]), 1622 [554-5487] 3150 [1161-8745] left ventricular ejection fraction 65.8% [11.4%] 61.5% [12.4%]; increase 52.5 [2.7] 55.3 [4.2] 0.48 [0.09] 0.56 [0.09]; Change months independently mortality (hazard ratio, 2.41 [95% CI, 1.36-4.27]; .003).Changes treatment, reflecting composite ECV, are traditional markers mortality. However, as study, these results require external validation larger cohort.