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Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy

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Abstract

Aim

To evaluate the ability of fast strain-encoded (SENC) cardiac magnetic resonance (CMR) derived myocardial strain and native T1 mapping to discriminate between hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis.

Methods

Ninety nine patients (57 with hypertrophic cardiomyopathy and 42 with cardiac amyloidosis) were systematically analysed. LV-ejection fraction, LV-mass index, septal wall thickness and native T1 mapping values were assessed. In addition, global circumferential and longitudinal strain and segmental circumferential and longitudinal strain in basal, mid-ventricular, and apical segments were calculated. A ratio was built by dividing native T1 values by basal segmental strain (T1-to-basal segmental strain ratio).

Results

Myocardial strain was equally distributed in apical and basal segments in HCM patients, whereas an apical sparing with less impaired apical strain was noticed in cardiac amyloidosis (apical-to-basal-ratio of 1.01 ± 0.23 versus 1.20 ± 0.28, p < 0.001). T1 values were significantly higher in amyloidosis compared to HCM patients (1170.7 ± 66.4 ms versus 1078.3 ± 57.4ms, p < 0.001). The T1-to-basal segmental strain ratio exhibited high accuracy for the differentiation between the two clinical entities (Sensitivity = 85%, Specificity = 77%, AUC = 0.90, 95% CI = 0.81–0.95, p < 0.001). Multivariable analysis showed that age and the T1-to-basal-strain-ratio were the most robust factors for the differentiation between HCM and cardiac amyloidosis.

Conclusion

The T1-to-basal-segmental strain ratio, combining information from segmental circumferential and longitudinal strain and native T1 mapping aids the differentiation between HCM and cardiac amyloidosis with high accuracy and within a fast CMR protocol, obviating the need for contrast agent administration.

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Data availability

The dataset used and/or analysed is available from the corresponding author upon reasonable request.

Abbreviations

LVH:

Left-ventricular-hypertrophy

HCM:

Hypertrophic cardiomyopathy

LV:

Left ventricle

CMR:

Cardiovascular magnetic resonance

Fast-SENC:

Fast strain-encoded sequence

GLS:

Global longitudinal strain

GCS:

Global circumferential strain

AUC:

Area under the curve

BSA:

Body surface area

BMI:

Body-mass-index

LVEDV:

Left-ventricular end-diastolic volume

LVESV:

Left-ventricular end-systolic volume

IVS:

Interventricular septum

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Acknowledgements

We thank Birgit Hoerig, Kirsten Falk, Ute Pfeiffer and Silke Morgenstern for their excellent technical assistance with the acquisitions of all CMR scans.

Funding

The work had no external or internal funding.

Author information

Authors and Affiliations

  1. Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany

    Henning Steen, Florian André & Norbert Frey

  2. DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany

    Henning Steen, Florian André & Norbert Frey

  3. Department of Cardiology, Marien Hospital Hamburg, Hamburg, Germany

    Moritz Montenbruck

  4. Department of Radiology, Saint Luke Hospital, Thessaloniki, Greece

    Alexandros Kallifatidis

  5. Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité Berlin, Berlin, Germany

    Sebastian Kelle

  6. DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany

    Sebastian Kelle

  7. Departments of Cardiology, Vascular Medicine and Pneumology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany

    Grigorios Korosoglou

  8. Weinheim Imaging Center, GRN Hospital Weinheim, Hector Foundation, Weinheim, Germany

    Grigorios Korosoglou

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  1. Henning Steen
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Contributions

HS and GK designed the study, performed the analysis, and wrote the manuscript. All other authors performed the acquisitions and data analysis, reviewed the manuscript, and provided important intellectual input.

Corresponding author

Correspondence to Grigorios Korosoglou.

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Conflict of interests

HS, GK and SK received research grants from Myocardial Solutions. SK and HS own stock options of Myocardial Solutions. All other authors declare that they have no competing interests regarding this manuscript.

Ethics approval and consent to participate

The study was approved by Ethics Committee of the University of Hamburg (PV7193). All patients gave written informed consent.

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Not applicable.

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Steen, H., Montenbruck, M., Kallifatidis, A. et al. Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy. Clin Res Cardiol 113, 469–480 (2024). https://doi.org/10.1007/s00392-023-02348-4

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  • DOI: https://doi.org/10.1007/s00392-023-02348-4

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