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Myocardial signal intensity decay after gadolinium injection: a fast and effective method for the diagnosis of cardiac amyloidosis

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Abstract

Late Gadolinium Enhancement (LGE) pattern of cardiac amyloidosis (CA) at cardiac magnetic resonance (CMR) examination is absent in approximately 30 % of patients. We tested whether the evaluation of myocardial gadolinium signal intensity (SI) decay (SID) has a higher diagnostic accuracy for CA. CMR was performed in 59 patients with systemic AL amyloidosis (36 males, 69 ± 10 years, mean ± SD), and 20 age/sex-matched healthy controls. LGE images were acquired every minute up to 8 min after gadolinium injection (time of inversion 250 ms). SI regions of interest were plotted in SI/time curves for endocardial (Endo) and epicardial layer of interventricular septum, cavity, and skeletal muscle as reference. SID (a negative exponential function described by the parameter TSID) was expressed as number of heart beats (HB) from each ROI. The typical LGE pattern for CA was detected in 42 patients (Ty-LGE), while 17 showed either absent LGE or an atypical pattern (ATy-LGE). A definite CA diagnosis was confirmed in all Ty-LGE patients and in 10/17 ATy-LGE patients. At ROC analysis Endo-TSID was the most accurate parameter to distinguish Ty-LGE and ATy-LGE patients from controls. A 269 HB threshold (mean + 2 SD Endo-TSID measured in controls) identified 51/52 patients with definite CA diagnosis, with 98 % sensitivity, 93 % specificity, and 96 % diagnostic accuracy. A direct relation was found between the extracellular volume and Endo-TSID in CA patients (r 0.72, 95 % CI 0.37–089, p < 0.001). the analysis of myocardial SID after gadolinium injection improves the accuracy of CMR for CA diagnosis.

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Abbreviations

AL:

Amyloid light chain

ARB:

Angiotensin receptor blocker

BMI:

Body mass index

CA:

Cardiac amyloidosis

CKD:

Chronic kidney disease

CMR:

Cardiac magnetic resonance

COPD:

Chronic obstructive pulmonary disease

EGFR:

Estimated glomerular filtration rate

LGE:

Late gadolinium enhancement

MGUS:

Monoclonal gammopathy of undetermined significance

NYHA:

New York Heart Association

ROI:

Region of interest

SD:

Standard deviation

SID:

Signal intensity decay

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Conflict of interest

No conflict of interest declared.

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Authors and Affiliations

  1. Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy

    Giovanni Donato Aquaro, Pier Giorgio Masci & Michele Emdin

  2. Regional Amyloid Center, AOU Careggi Firenze, Florence, Italy

    Federico Perfetto & Francesco Cappelli

  3. Cardio-Thoracic and Vascular Department, Pisa, Italy

    Nicola Riccardo Pugliese, Andrea Barison, Claudio Passino & Michele Emdin

Authors
  1. Giovanni Donato Aquaro
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  2. Nicola Riccardo Pugliese
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  3. Federico Perfetto
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  4. Francesco Cappelli
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  5. Andrea Barison
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  6. Pier Giorgio Masci
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  7. Claudio Passino
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  8. Michele Emdin
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Correspondence to Giovanni Donato Aquaro.

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Aquaro, G.D., Pugliese, N.R., Perfetto, F. et al. Myocardial signal intensity decay after gadolinium injection: a fast and effective method for the diagnosis of cardiac amyloidosis. Int J Cardiovasc Imaging 30, 1105–1115 (2014). https://doi.org/10.1007/s10554-014-0436-6

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  • DOI: https://doi.org/10.1007/s10554-014-0436-6

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