Characterization of Cardiac Amyloidosis by Atrial Late Gadolinium Enhancement Using Contrast-Enhanced Cardiac Magnetic Resonance Imaging and Correlation With Left Atrial Conduit and Contractile Function.
Characterization of Cardiac Amyloidosis by Atrial Late Gadolinium Enhancement Using Contrast-Enhanced Cardiac Magnetic Resonance Imaging and Correlation With Left Atrial Conduit and Contractile Function.
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DOI：
10.1016/j.amjcard.2015.05.021
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发表时间：
2015-08-15
期刊：
影响因子：
--
通讯作者：
Falk RH
中科院分区：
文献类型：
--
作者：
Kwong RY;Heydari B;Abbasi S;Steel K;Al-Mallah M;Wu H;Falk RH
The diagnosis of cardiac amyloidosis (CA) often necessitates invasive myocardial biopsy. We sought to evaluate whether LGE of the atrial myocardium by CMR was associated with impaired left atrial function, and whether the extent of left atrial LGE may enhance diagnostic differentiation of CA from other cardiomyopathies. Twenty-two patients with biopsy-proven CA, 37 with systemic hypertension (SH) and 22 with non-ischemic dilated cardiomyopathy (NIDC) underwent CMR and echocardiographic evaluation. CA patients had greater minimal left atrial volume (57 ± 53 vs. 24 ± 18 in SH and 19 ± 25% in NIDC, P=0.003), and significantly lower total left atrial emptying function (19 ± 14 vs. 40 ± 14 in SH and 33 ± 20% in NIDC, P=0.0006). The mean proportion of atrial enhancement (LGELA%) was significantly greater in CA patients compared to SH and NIDC (59 ± 36% vs. 7.4 ± 2.1 and 2.9 ± 9.0%, p<0.0001, respectively). There was also a strong inverse correlation between both active and total atrial emptying (r = −0.69 P=0.001, r=−0.67 P=0.01, respectively) with LGELA% for CA patients. In multivariable regression analysis, LGELA% was the strongest adjusted predictor for CA diagnosis. Using ROC analysis, LGELA% > or = 33% produced the highest diagnostic utility for CA (sensitivity 76%, specificity 94%). Patients with CA may have extensive LGE of the left atrial myocardium, which is associated with marked reduction in left atrial emptying function. The extent of left atrial LGE was highly predictive for the diagnosis of CA.
