Diagnostic performance and relationships of structural parameters and strain components for the diagnosis of cardiac amyloidosis with MRI - 04/09/24

Doi : 10.1016/j.diii.2024.08.002

Youssef Zaarour ^a,^⁎ , Islem Sifaoui ^a, Haifa Remili ^a, Mounira Kharoubi ^b, Amira Zaroui ^b, Thibaud Damy ^b, Jean-François Deux ^c
^a Department of Radiology, Henri Mondor University Hospital, Assistance Publique-Hopitaux de Paris, 94000 Creteil, France
^b Referral Center for Cardiac Amyloidosis, Department of Cardiology, Mondor Amyloidosis Network, GRC Amyloid Research Institute, CHU Henri Mondor, 94000 Creteil and Université Paris Est Creteil, INSERM Unit U955, Team 8, Paris-Est Creteil University, Créteil, France
^c Department of Radiology, Geneva University Hospitals, 1205, Geneva, Switzerland

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 04 September 2024

Highlights

•	Extracellular volume outperforms feature-tracking myocardial strain components for the diagnosis of cardiac amyloidosis with cardiac MRI.
•	Feature-tracking global radial strain compares favorably with native myocardial T1 for the diagnosis of cardiac amyloidosis using cardiac MRI.
•	With the exception of extracellular volume, the combination of feature tracking with global radial strain and basal native myocardial T1 provides best performances (AUC = 0.905) for the diagnosis of cardiac amyloidosis with 82% sensitivity and 90% specificity using cardiac MRI.

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Abstract

Purpose

The purpose of this study was to evaluate the diagnostic performance and relationships of cardiac MRI structural parameters and strain components in patients with cardiac amyloidosis (CA) and to estimate the capabilities of these variables to discriminate between CA and non-amyloid cardiac hypertrophy (NACH).

Materials and methods

Seventy patients with CA (56 men; mean age, 76 ± 10 [standard deviation] years) and 32 patients (19 men; mean age, 63 ± 10 [standard deviation] years) with NACH underwent cardiac MRI. Feature tracking (FT) global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS), strain AB ratio (apical strain divided by basal strain), myocardial T1, myocardial T2 and extracellular volume (ECV) were calculated. Comparisons between patients with CA and those with NACH were made using Mann-Whitney rank sum test. The ability of each variable to discriminate between CA and NACH was estimated using area under the receiver operating characteristic curve (AUC).

Results

Patients with CA had higher median GLS (-7.0% [Q1, -9.0; Q3, -5.0]), higher median GCS (-12.0% [Q1, -15.0; Q3, -9.0]), and lower median GRS (16.5% [Q1, 13.0; Q3, 23.0]) than those with NACH (-9.0% [Q1, -11.0; Q3, -8.0]; -17.0% [Q1, -20.0; Q3, -14.0]; and 25.5% [Q1, 16.0; Q3, 31.5], respectively) (P < 0.001 for all). Median myocardial T1 and ECV were significantly higher in patients with CA (1112 ms [Q1, 1074; Q3, 1146] and 47% [Q1, 41; Q3, 55], respectively) than in those with NACH (1056 ms [Q1, 1011; Q3, 1071] and 28% [Q1, 26; Q3, 30], respectively) (P < 0.001). Basal ECV showed the best performance for the diagnosis of CA (AUC = 0.975; 95% confidence interval [CI]: 0.947–1). No differences in AUC were found between AB ratio of GRS (0.843; 95% CI: 0.768–0.918) and basal myocardial T1 (0.834; 95% CI: 0.741–0.928) for the diagnosis of CA (P = 0.81). The combination of the AB ratio of FT-GRS and basal myocardial T1 had a diagnostic performance not different from that of basal ECV (P = 0.06).

Conclusion

ECV outperforms FT-strain for the diagnosis of CA with cardiac MRI. The AB ratio of FT-GRS associated with myocardial T1 provides diagnostic performance similar to that achieved by ECV.

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Keywords : Cardiac amyloidosis, Cardiac MRI, Extracellular volume, Feature-tracking strain, Hypertrophic cardiomyopathy

Abbreviations : AB, AL, AUC, ATTR, CA, CI, ECV, FT, GCS, GLS, GRS, ICC, MRI, NACH, SD