Document Detail


Cardiovascular magnetic resonance in cardiac amyloidosis.
MedLine Citation:
PMID:  15630027     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac amyloidosis can be diagnostically challenging. Cardiovascular magnetic resonance (CMR) can assess abnormal myocardial interstitium. METHODS AND RESULTS: Late gadolinium enhancement CMR was performed in 30 patients with cardiac amyloidosis. In 22 of these, myocardial gadolinium kinetics with T1 mapping was compared with that in 16 hypertensive controls. One patient had CMR and autopsy only. Subendocardial T1 in amyloid patients was shorter than in controls (at 4 minutes: 427+/-73 versus 579+/-75 ms; P<0.01), was shorter than subepicardium T1 for the first 8 minutes (P< or =0.01), and was correlated with markers of increased myocardial amyloid load, as follows: left ventricular (LV) mass (r=-0.51, P=0.013); wall thickness (r=-0.54 to -0.63, P<0.04); interatrial septal thickness (r=-0.52, P=0.001); and diastolic function (r=-0.42, P=0.025). Global subendocardial late gadolinium enhancement was found in 20 amyloid patients (69%); these patients had greater LV mass (126+/-30 versus 93+/-25 g/m2; P=0.009) than unenhanced patients. Histological quantification showed substantial interstitial expansion with amyloid (30.5%) but only minor fibrosis (1.3%). Amyloid was dominantly subendocardial (42%) compared with midwall (29%) and subepicardium (18%). There was 97% concordance in diagnosis of cardiac amyloid by combining the presence of late gadolinium enhancement and an optimized T1 threshold (191 ms at 4 minutes) between myocardium and blood. CONCLUSIONS: In cardiac amyloidosis, CMR shows a characteristic pattern of global subendocardial late enhancement coupled with abnormal myocardial and blood-pool gadolinium kinetics. The findings agree with the transmural histological distribution of amyloid protein and the cardiac amyloid load and may prove to have value in diagnosis and treatment follow-up.
Authors:
Alicia Maria Maceira; Jayshree Joshi; Sanjay Kumar Prasad; James Charles Moon; Enrica Perugini; Idris Harding; Mary Noelle Sheppard; Philip Alexander Poole-Wilson; Philip Nigel Hawkins; Dudley John Pennell
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-01-03
Journal Detail:
Title:  Circulation     Volume:  111     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2005 Jan 
Date Detail:
Created Date:  2005-01-19     Completed Date:  2005-07-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  186-93     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Aged
Amyloidosis / diagnosis,  pathology*,  radionuclide imaging,  ultrasonography
Biopsy
Cardiomyopathies / diagnosis,  pathology*,  radionuclide imaging,  ultrasonography
Contrast Media / pharmacokinetics
Female
Gadolinium DTPA / blood,  diagnostic use,  pharmacokinetics
Humans
Hypertension / pathology
Hypertrophy, Left Ventricular / etiology,  pathology,  ultrasonography
Iodine Radioisotopes / diagnostic use,  pharmacokinetics
Magnetic Resonance Imaging*
Male
Middle Aged
Organ Size
Prospective Studies
Serum Amyloid P-Component / diagnostic use,  pharmacokinetics
Stroke Volume
Ventricular Dysfunction, Left / etiology,  physiopathology
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Iodine Radioisotopes; 0/Serum Amyloid P-Component; 80529-93-7/Gadolinium DTPA
Comments/Corrections
Comment In:
Circulation. 2005 Jan 18;111(2):122-4   [PMID:  15657385 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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