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Clinical Research in Cardiology
Published in: Clinical Research in Cardiology 3/2024

14-12-2023 | Cardiac Amyloidosis | Original Paper

Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy

Authors: Henning Steen, Moritz Montenbruck, Alexandros Kallifatidis, Florian André, Norbert Frey, Sebastian Kelle, Grigorios Korosoglou

Published in: Clinical Research in Cardiology | Issue 3/2024

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Abstract

Aim

To evaluate the ability of fast strain-encoded (SENC) cardiac magnetic resonance (CMR) derived myocardial strain and native T1 mapping to discriminate between hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis.

Methods

Ninety nine patients (57 with hypertrophic cardiomyopathy and 42 with cardiac amyloidosis) were systematically analysed. LV-ejection fraction, LV-mass index, septal wall thickness and native T1 mapping values were assessed. In addition, global circumferential and longitudinal strain and segmental circumferential and longitudinal strain in basal, mid-ventricular, and apical segments were calculated. A ratio was built by dividing native T1 values by basal segmental strain (T1-to-basal segmental strain ratio).

Results

Myocardial strain was equally distributed in apical and basal segments in HCM patients, whereas an apical sparing with less impaired apical strain was noticed in cardiac amyloidosis (apical-to-basal-ratio of 1.01 ± 0.23 versus 1.20 ± 0.28, p < 0.001). T1 values were significantly higher in amyloidosis compared to HCM patients (1170.7 ± 66.4 ms versus 1078.3 ± 57.4ms, p < 0.001). The T1-to-basal segmental strain ratio exhibited high accuracy for the differentiation between the two clinical entities (Sensitivity = 85%, Specificity = 77%, AUC = 0.90, 95% CI = 0.81–0.95, p < 0.001). Multivariable analysis showed that age and the T1-to-basal-strain-ratio were the most robust factors for the differentiation between HCM and cardiac amyloidosis.

Conclusion

The T1-to-basal-segmental strain ratio, combining information from segmental circumferential and longitudinal strain and native T1 mapping aids the differentiation between HCM and cardiac amyloidosis with high accuracy and within a fast CMR protocol, obviating the need for contrast agent administration.

Graphical abstract

Appendix
Available only for authorised users
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Metadata
Title
Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy
Authors
Henning Steen
Moritz Montenbruck
Alexandros Kallifatidis
Florian André
Norbert Frey
Sebastian Kelle
Grigorios Korosoglou
Publication date
14-12-2023
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology / Issue 3/2024
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-023-02348-4

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