Volume 14 Supplement 1

Abstracts of the 15th Annual SCMR Scientific Sessions: 2012

Open Access

Cardiac involvement in cardiac AL amyloidosis as measured by equilibrium contrast cardiovascular magnetic resonance

  • Sanjay M Banypersad1, 2,
  • Daniel Sado1,
  • Andrew Flett1,
  • Simon D Gibbs2,
  • Jennifer H Pinney2,
  • Viviana Maestrini1,
  • Steven K White1,
  • Jason Dungu2,
  • Philip N Hawkins2 and
  • James Moon1
Journal of Cardiovascular Magnetic Resonance201214(Suppl 1):P174

DOI: 10.1186/1532-429X-14-S1-P174

Published: 1 February 2012

Background

Involvement of the heart drives prognosis in Systemic AL Amyloidosis, predicting outcome and influencing therapeutic options. Current methods of cardiac assessment do not allow formal quantification of the amyloid load. We used Equilibrium Contrast Cardiovascular Magnetic Resonance (EQ-CMR) to measure the interstitial compartment of the heart by measuring the myocardial contrast volume of distribution, VDm.

Methods

Patients with systemic AL amyloidosis undergoing routine work up at the National Amyloidosis Centre were recruited (n=54, 35 males, 19 females, mean age 64) and underwent EQ-CMR and conventional CMR including late enhancement to measure VDm and standard cardiac work-up including ECG, echocardiography, biomarkers (BNP, troponin) and functional assessment (6 minute walk test, 6MWT, where permitted by autonomic neuropathy). Results were compared to normal controls. Conventional assessment ranked cardiac involvement as definite, probable and none.

Results

VDm was significantly higher in patients than normal controls (0.25 vs 0.40, P < 0.001). This tracked conventional cardiac assessment (none, probable, definite corresponded with a VDm of 0.276 vs 0.342 vs 0.488, P<0.005), respectively. VDm correlated with cardiac parameters by echo (e.g. TDI S-wave R2 0.24, P=0.001) and conventional CMR (e.g. indexed LV mass R2 0.31, P<0.001). Significant correlations were also seen with BNP (R2 0.2, P<0.005) and Trop T (R2 0.26, P<0.01). VDm was associated with ECG abnormalities and tracked small QRS voltages (R2 0.43, P<0.001). A higher VDm trended towards a lower 6-minute walk test outcome (R2 0.1, P=0.09)

Conclusions

The measurement of the myocardial interstitial compartment (VDm) using EQ-CMR in systemic AL amyloidosis has the potential to be the first quantitative test for cardiac amyloid deposition.

Funding

GSK
Figure 1

showing the mean myocardial volume of distributions (and 95% confidence intervals) for normals and patients with systemic AL amyloidosis (P<0.001).

Figure 2

compares the mean VDm between normals (group 1) and Systemic AL Amyloidosis patients with : No suspected cardiac involvement (group 2, P=0.44), possible cardiac involvement (group 3, P<0.001) and definite cardiac involvement (group 4, P<0.001).

Authors’ Affiliations

(1)
CMR, Heart Hospital
(2)
National Amyloidosis Centre, Royal Free Hospital

Copyright

© Banypersad et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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