Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2017 | Research

Patterns of CMR measured longitudinal strain and its association with late gadolinium enhancement in patients with cardiac amyloidosis and its mimics

Authors: Lynne K. Williams, Julian F. Forero, Zoran B. Popovic, Dermot Phelan, Diego Delgado, Harry Rakowski, Bernd J. Wintersperger, Paaladinesh Thavendiranathan

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Abstract

Background

Regional variability of longitudinal strain (LS) has been previously described with echocardiography in patients with cardiac amyloidosis (CA), however, the reason for this variability is not completely evident. We sought to describe regional patterns in LS using feature-tracking software applied to cardiovascular magnetic resonance (CMR) cine images in patients with CA, hypertrophic cardiomyopathy (HCM), and Anderson-Fabry’s disease (AFD) and to relate these patterns to the distribution of late gadolinium enhancement (LGE).

Methods

Patients with CA (n = 45) were compared to LV mass indexed matched patients with HCM (n = 19) and AFD (n = 19). Peak systolic LS measurements were obtained using Velocity Vector Imaging (VVI) software on CMR cine images. A relative regional LS ratio (RRSR) was calculated as the ratio of the average of the apical segmental LS divided by the sum of the average basal and mid-ventricular segmental LS. LGE was quantified for the basal, mid, and apical segments using a threshold of 5SD above remote myocardium. A regional LGE ratio was calculated similar to RRSR.

Results

Patients with CA had significantly had worse global LS (−15.7 ± 4.6%) than those with HCM (−18.0 ± 4.6%, p = 0.046) and AFD (−21.9 ± 5.1%, p < 0.001). The RRSR was higher in patients with CA (1.00 ± 0.31) than in AFD (0.79 ± 0.24; p = 0.018) but not HCM (0.84 ± 0.32; p = 0.114). In CA, a regional difference in LGE burden was noted, with lower LGE in the apex (31.5 ± 19.1%) compared to the mid (38.2 ± 19.0%) and basal (53.7 ± 22.7%; p < 0.001 for both) segments. The regional LGE ratio was not significantly different between patients with CA (0.33 ± 0.15) and AFD (0.47 ± 0.58; p = 0.14) but lower compared to those with HCM (0.72 ± 0.43; p < 0.0001). LGE percentage showed a significant impact on LS (p < 0.0001), with a 0.9% decrease in absolute LS for every 10% increase in LGE percentage.

Conclusion

The presence of marked “relative apical sparing” of LS along with a significant reduction in global LS seen in patients with CA on CMR cine analysis may provide an additional tool to differentiate CA from other cause of LVH. The concomitant presence of a base to apex gradient in quantitative LGE burden suggests that the regional strain gradient may be at least partially explained by the burden of amyloid deposition and fibrosis.

Cacoub P, Axler O, De Zuttere D, Hausfater P, Amoura Z, Walter S, Wechsler B, Godeau P, Piette JC. Amyloidosis and cardiac involvement. Ann Med Interne (Paris). 2000;151:611–7.

Bennani Smires Y, Victor G, Ribes D, Berry M, Cognet T, Mejean S, Huart A, Roussel M, Petermann A, Roncalli J, Carrie D, Rousseau H, Berry I, Chauveau D, Galinier M, Lairez O. Pilot study for left ventricular imaging phenotype of patients over 65 years old with heart failure and preserved ejection fraction: the high prevalence of amyloid cardiomyopathy. Int J Cardiovasc Imaging. 2016;32:1403–13.CrossRefPubMed

Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I, Sheppard MN, Poole-Wilson PA, Hawkins PN, Pennell DJ. Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation. 2005;111:186–93.CrossRefPubMed

Bergesio F, Ciciani AM, Santostefano M, Brugnano R, Manganaro M, Palladini G, Di Palma AM, Gallo M, Tosi PL, Salvadori M. Immunopathology group ISoN. Renal involvement in systemic amyloidosis--an italian retrospective study on epidemiological and clinical data at diagnosis. Nephrol Dial Transplant. 2007;22:1608–18.CrossRefPubMed

Phelan D, Collier P, Thavendiranathan P, Popovic ZB, Hanna M, Plana JC, Marwick TH, Thomas JD. Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis. Heart. 2012;98:1442–8.CrossRefPubMed

Phelan D, Thavendiranathan P, Popovic Z, Collier P, Griffin B, Thomas JD, Marwick TH. Application of a parametric display of two-dimensional speckle-tracking longitudinal strain to improve the etiologic diagnosis of mild to moderate left ventricular hypertrophy. J Am Soc Echocardiogr. 2014;27:888–95.CrossRefPubMed

Senapati A, Sperry BW, Grodin JL, Kusunose K, Thavendiranathan P, Jaber W, Collier P, Hanna M, Popovic ZB, Phelan D. Prognostic implication of relative regional strain ratio in cardiac amyloidosis. Heart. 2016;102:748–54.CrossRefPubMed

Williams LK, Urbano-Moral JA, Rowin EJ, Jamorski M, Bruchal-Garbicz B, Carasso S, Pandian NG, Maron MS, Rakowski H. Velocity vector imaging in the measurement of left ventricular myocardial mechanics on cardiac magnetic resonance imaging: correlations with echocardiographically derived strain values. J Am Soc Echocardiogr. 2013;26:1153–62.CrossRefPubMed

Gertz MA, Comenzo R, Falk RH, Fermand JP, Hazenberg BP, Hawkins PN, Merlini G, Moreau P, Ronco P, Sanchorawala V, Sezer O, Solomon A, Grateau G. Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (al): a consensus opinion from the 10th international symposium on amyloid and amyloidosis, tours, france, 18-22 april 2004. Am J Hematol. 2005;79:319–28.CrossRefPubMed

10.

Austin BA, Tang WH, Rodriguez ER, Tan C, Flamm SD, Taylor DO, Starling RC, Desai MY. Delayed hyper-enhancement magnetic resonance imaging provides incremental diagnostic and prognostic utility in suspected cardiac amyloidosis. JACC Cardiovasc Imaging. 2009;2:1369–77.CrossRefPubMed

11.

Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW, American College of Cardiology Foundation/American Heart Association Task Force on Practice G. 2011 accf/aha guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the american college of cardiology foundation/american heart association task force on practice guidelines. Developed in collaboration with the american association for thoracic surgery, american society of echocardiography, american society of nuclear cardiology, heart failure society of america, heart rhythm society, society for cardiovascular angiography and interventions, and society of thoracic surgeons. J Am Coll Cardiol. 2011;58:e212–e260.

12.

Fontana M, Pica S, Reant P, Abdel-Gadir A, Treibel TA, Banypersad SM, Maestrini V, Barcella W, Rosmini S, Bulluck H, Sayed RH, Patel K, Mamhood S, Bucciarelli-Ducci C, Whelan CJ, Herrey AS, Lachmann HJ, Wechalekar AD, Manisty CH, Schelbert EB, Kellman P, Gillmore JD, Hawkins PN, Moon JC. Prognostic value of late gadolinium enhancement cardiovascular magnetic resonance in cardiac amyloidosis. Circulation. 2015;132:1570–9.CrossRefPubMedPubMedCentral

13.

Perugini E, Rapezzi C, Piva T, Leone O, Bacchi-Reggiani L, Riva L, Salvi F, Lovato L, Branzi A, Fattori R. Non-invasive evaluation of the myocardial substrate of cardiac amyloidosis by gadolinium cardiac magnetic resonance. Heart. 2006;92:343–9.CrossRefPubMed

14.

Vogelsberg H, Mahrholdt H, Deluigi CC, Yilmaz A, Kispert EM, Greulich S, Klingel K, Kandolf R, Sechtem U. Cardiovascular magnetic resonance in clinically suspected cardiac amyloidosis: noninvasive imaging compared to endomyocardial biopsy. J Am Coll Cardiol. 2008;51:1022–30.CrossRefPubMed

15.

Oda S, Utsunomiya D, Nakaura T, Yuki H, Kidoh M, Morita K, Takashio S, Yamamuro M, Izumiya Y, Hirakawa K, Ishida T, Tsujita K, Ueda M, Yamashita T, Ando Y, Hata H, Yamashita Y. Identification and assessment of cardiac amyloidosis by myocardial strain analysis of cardiac magnetic resonance imaging. Circ J. 2017;81:1014–21.CrossRefPubMed

16.

Ternacle J, Bodez D, Guellich A, Audureau E, Rappeneau S, Lim P, Radu C, Guendouz S, Couetil JP, Benhaiem N, Hittinger L, Dubois-Rande JL, Plante-Bordeneuve V, Mohty D, Deux JF, Damy T. Causes and consequences of longitudinal lv dysfunction assessed by 2d strain echocardiography in cardiac amyloidosis. JACC Cardiovasc Imaging. 2016;9:126–38.CrossRefPubMed

17.

Brenner DA, Jain M, Pimentel DR, Wang B, Connors LH, Skinner M, Apstein CS, Liao R. Human amyloidogenic light chains directly impair cardiomyocyte function through an increase in cellular oxidant stress. Circ Res. 2004;94:1008–10.CrossRefPubMed

18.

Liao R, Jain M, Teller P, Connors LH, Ngoy S, Skinner M, Falk RH, Apstein CS. Infusion of light chains from patients with cardiac amyloidosis causes diastolic dysfunction in isolated mouse hearts. Circulation. 2001;104:1594–7.PubMed

19.

Shi J, Guan J, Jiang B, Brenner DA, Del Monte F, Ward JE, Connors LH, Sawyer DB, Semigran MJ, Macgillivray TE, Seldin DC, Falk R, Liao R. Amyloidogenic light chains induce cardiomyocyte contractile dysfunction and apoptosis via a non-canonical p38alpha mapk pathway. Proc Natl Acad Sci U S A. 2010;107:4188–93.CrossRefPubMedPubMedCentral

20.

Maret E, Todt T, Brudin L, Nylander E, Swahn E, Ohlsson JL, Engvall JE. Functional measurements based on feature tracking of cine magnetic resonance images identify left ventricular segments with myocardial scar. Cardiovasc Ultrasound. 2009;7:53.CrossRefPubMedPubMedCentral

21.

Schuster A, Morton G, Hussain ST, Jogiya R, Kutty S, Asrress KN, Makowski MR, Bigalke B, Perera D, Beerbaum P, Nagel E. The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol. 2013;82:296–301.CrossRefPubMed

22.

Singh A, Steadman CD, Khan JN, Horsfield MA, Bekele S, Nazir SA, Kanagala P, Masca NG, Clarysse P, McCann GP. Intertechnique agreement and interstudy reproducibility of strain and diastolic strain rate at 1.5 and 3 tesla: a comparison of feature-tracking and tagging in patients with aortic stenosis. J Magn Reson Imaging. 2015;41:1129–37.CrossRefPubMed

Title: Patterns of CMR measured longitudinal strain and its association with late gadolinium enhancement in patients with cardiac amyloidosis and its mimics
Authors: Lynne K. Williams
Julian F. Forero
Zoran B. Popovic
Dermot Phelan
Diego Delgado
Harry Rakowski
Bernd J. Wintersperger
Paaladinesh Thavendiranathan
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-017-0376-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Patterns of CMR measured longitudinal strain and its association with late gadolinium enhancement in patients with cardiac amyloidosis and its mimics

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

Sources of variability in quantification of cardiovascular magnetic resonance infarct size - reproducibility among three core laboratories

Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification

Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

Native T1 mapping: inter-study, inter-observer and inter-center reproducibility in hemodialysis patients

Reference ranges for cardiac structure and function using cardiovascular magnetic resonance (CMR) in Caucasians from the UK Biobank population cohort

CMR-based blood oximetry via multi-parametric estimation using multiple T2 measurements