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Prognostic impact of T2-weighted CMR imaging for cardiac amyloidosis

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Abstract

Objectives

Using cardiac magnetic resonance imaging (MRI) we tested the diagnostic value of various markers for amyloid infiltration.

Methods

We performed MRI at 1.5 T in 36 consecutive patients with cardiac amyloidosis and 48 healthy volunteers. The protocol included cine imaging, T2-weighted spin echo, T1-weighted spin echo before and early after contrast and late gadolinium enhancement. We compared the frequency of abnormalities and their relation to mortality.

Results

Median follow-up was 31 months. Twenty-three patients died. Mean left ventricular (LV) mass was 205 ± 70 g. LV ejection fraction (EF) was 55 ± 12%. T2 ratio was 1.5 ± 0.4. 33/36 patients had pericardial and 22/36 had pleural effusions. All but two had heterogeneous late enhancement. Surviving patients did not differ from those who had died with regard to gender, LV mass or volume. Surviving patients had a significantly higher LVEF (60.4 ± 9.9% vs. 51.6 ± 11.5%; p = 0.03). The deceased patients had a lower T2 ratio than those who survived (1.38 ± 0.42 vs. 1.76 ± 0.17; p = 0.005). Low T2 was associated with shorter survival (Chi-squared 11.3; p < 0.001). Cox regression analysis confirmed T2 ratio < 1.5 as the only independent predictors for survival.

Conclusion

Cardiac amyloidosis is associated with hypointense signal on T2-weighted images. A lower T2 ratio was independently associated with shortened survival.

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Acknowledgement

We gratefully acknowledge the support of Carsten Schwenke (SCOSSiS Statistical Consulting). We sincerely thank Wilko Weichert MD, Pathology Institute, Charite, University Medicine Berlin, for providing Fig. 1. We are indebted to our technicians Denise Kleindienst, Kerstin Kretschel and Evi Polzin.

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Authors and Affiliations

  1. HELIOS Klinikum Berlin Buch & Charite Campus Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Ralf Wassmuth, Hassan Abdel-Aty, Steffen Bohl & Jeanette Schulz-Menger

  2. Cardio Imaging Center Berlin, Berlin, Germany

    Hassan Abdel-Aty

  3. Unfallkrankenhaus Berlin, Berlin, Germany

    Steffen Bohl

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  1. Ralf Wassmuth
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  2. Hassan Abdel-Aty
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  3. Steffen Bohl
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  4. Jeanette Schulz-Menger
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Correspondence to Ralf Wassmuth.

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Wassmuth, R., Abdel-Aty, H., Bohl, S. et al. Prognostic impact of T2-weighted CMR imaging for cardiac amyloidosis. Eur Radiol 21, 1643–1650 (2011). https://doi.org/10.1007/s00330-011-2109-3

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