Left and right ventricular myocardial deformation and late gadolinium enhancement: Incremental prognostic value in amyloid light-chain amyloidosis

Xiao Li; Jian Li; Lu Lin; Kaini Shen; Zhuang Tian; Jian Sun; Congli Zhang; Jing An; Zhengyu Jin; Rozemarijn Vliegenthart; Joseph B. Selvanayagam; Yining Wang

doi:10.21037/cdt-20-181

Left and right ventricular myocardial deformation and late gadolinium enhancement: Incremental prognostic value in amyloid light-chain amyloidosis

Xiao Li, Jian Li, Lu Lin, Kaini Shen, Zhuang Tian, Jian Sun, Congli Zhang, Jing An, Zhengyu Jin, Rozemarijn Vliegenthart, Joseph B. Selvanayagam, Yining Wang

Flinders University

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Abstract

Background: Previous cardiac magnetic resonance (CMR) studies have shown that both late gadolinium enhancement (LGE) and left ventricular (LV) strain have prognostic value in amyloid light-chain (AL) amyloidosis, but the right ventricular (RV) strain has not yet been studied. We aim to determine the incremental prognostic value of LV and RV LGE and strain in AL amyloidosis. Methods: This prospective study recruited 87 patients (age, 56.9±9.1 years; M/F, 56/31) and 20 healthy subjects (age, 52.7±8.1 years; M/F, 11/9) who underwent CMR. The LV LGE was classified into no, patchy and global groups. The RV LGE was classified into negative and positive groups. Myocardial deformation was measured using a dedicated software. Follow-up was performed for all-cause mortality using Cox proportional hazards regression and Kaplan-Meier curves. Results: During a median follow-up of 21 months, 34 deaths occurred. Presence of LV LGE [HR 2.44, 95% confidence interval (CI), 1.10–5.45, P=0.029] and global longitudinal strain (GLS) (HR 1.13 per 1% absolute decrease, 95% CI, 1.02–1.25, P=0.025) were independent LV predictors. RV LGE (HR 4.07, 95% CI, 1.09–15.24, P=0.037) and GLS (HR 1.10 per 1% absolute decrease, 95% CI, 1.00–1.21, P=0.047) were independent RV predictors. Complementary to LV LGE, LV GLS impairment or RV LGE further reduced survival (both log rank P<0.001). Conclusions: This study confirms the incremental prognostic value of LV GLS and RV LGE in AL amyloidosis, which refines the conventional risk evaluation based on LV LGE. GLS based on non-contrast-enhanced CMR are promising new predictors.

Original language	English
Pages (from-to)	470-480
Number of pages	11
Journal	Cardiovascular Diagnosis and Therapy
Volume	10
Issue number	3
DOIs	https://doi.org/10.21037/cdt-20-181
Publication status	Published - Jun 2020

Bibliographical note

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Keywords

Amyloidosis
Cardiomyopathies
Magnetic resonance imaging

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10.21037/cdt-20-181Licence: CC BY-NC-ND

Xiao_Left_P2020Final published version, 1.03 MBLicence: CC BY-NC-ND

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Li, X., Li, J., Lin, L., Shen, K., Tian, Z., Sun, J., Zhang, C., An, J., Jin, Z., Vliegenthart, R., Selvanayagam, J. B., & Wang, Y. (2020). Left and right ventricular myocardial deformation and late gadolinium enhancement: Incremental prognostic value in amyloid light-chain amyloidosis. Cardiovascular Diagnosis and Therapy, 10(3), 470-480. https://doi.org/10.21037/cdt-20-181

@article{f49bcfee1b884e11be4314a804fabcb8,

title = "Left and right ventricular myocardial deformation and late gadolinium enhancement: Incremental prognostic value in amyloid light-chain amyloidosis",

abstract = "Background: Previous cardiac magnetic resonance (CMR) studies have shown that both late gadolinium enhancement (LGE) and left ventricular (LV) strain have prognostic value in amyloid light-chain (AL) amyloidosis, but the right ventricular (RV) strain has not yet been studied. We aim to determine the incremental prognostic value of LV and RV LGE and strain in AL amyloidosis. Methods: This prospective study recruited 87 patients (age, 56.9±9.1 years; M/F, 56/31) and 20 healthy subjects (age, 52.7±8.1 years; M/F, 11/9) who underwent CMR. The LV LGE was classified into no, patchy and global groups. The RV LGE was classified into negative and positive groups. Myocardial deformation was measured using a dedicated software. Follow-up was performed for all-cause mortality using Cox proportional hazards regression and Kaplan-Meier curves. Results: During a median follow-up of 21 months, 34 deaths occurred. Presence of LV LGE [HR 2.44, 95% confidence interval (CI), 1.10–5.45, P=0.029] and global longitudinal strain (GLS) (HR 1.13 per 1% absolute decrease, 95% CI, 1.02–1.25, P=0.025) were independent LV predictors. RV LGE (HR 4.07, 95% CI, 1.09–15.24, P=0.037) and GLS (HR 1.10 per 1% absolute decrease, 95% CI, 1.00–1.21, P=0.047) were independent RV predictors. Complementary to LV LGE, LV GLS impairment or RV LGE further reduced survival (both log rank P<0.001). Conclusions: This study confirms the incremental prognostic value of LV GLS and RV LGE in AL amyloidosis, which refines the conventional risk evaluation based on LV LGE. GLS based on non-contrast-enhanced CMR are promising new predictors.",

keywords = "Amyloidosis, Cardiomyopathies, Magnetic resonance imaging",

author = "Xiao Li and Jian Li and Lu Lin and Kaini Shen and Zhuang Tian and Jian Sun and Congli Zhang and Jing An and Zhengyu Jin and Rozemarijn Vliegenthart and Selvanayagam, {Joseph B.} and Yining Wang",

note = "Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.",

year = "2020",

month = jun,

doi = "10.21037/cdt-20-181",

language = "English",

volume = "10",

pages = "470--480",

journal = "Cardiovascular Diagnosis and Therapy",

issn = "2223-3652",

publisher = "AME Publishing Company",

number = "3",

}

Li, X, Li, J, Lin, L, Shen, K, Tian, Z, Sun, J, Zhang, C, An, J, Jin, Z, Vliegenthart, R, Selvanayagam, JB & Wang, Y 2020, 'Left and right ventricular myocardial deformation and late gadolinium enhancement: Incremental prognostic value in amyloid light-chain amyloidosis', Cardiovascular Diagnosis and Therapy, vol. 10, no. 3, pp. 470-480. https://doi.org/10.21037/cdt-20-181

TY - JOUR

T1 - Left and right ventricular myocardial deformation and late gadolinium enhancement

T2 - Incremental prognostic value in amyloid light-chain amyloidosis

AU - Li, Xiao

AU - Li, Jian

AU - Lin, Lu

AU - Shen, Kaini

AU - Tian, Zhuang

AU - Sun, Jian

AU - Zhang, Congli

AU - An, Jing

AU - Jin, Zhengyu

AU - Vliegenthart, Rozemarijn

AU - Selvanayagam, Joseph B.

AU - Wang, Yining

N1 - Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

PY - 2020/6

Y1 - 2020/6

N2 - Background: Previous cardiac magnetic resonance (CMR) studies have shown that both late gadolinium enhancement (LGE) and left ventricular (LV) strain have prognostic value in amyloid light-chain (AL) amyloidosis, but the right ventricular (RV) strain has not yet been studied. We aim to determine the incremental prognostic value of LV and RV LGE and strain in AL amyloidosis. Methods: This prospective study recruited 87 patients (age, 56.9±9.1 years; M/F, 56/31) and 20 healthy subjects (age, 52.7±8.1 years; M/F, 11/9) who underwent CMR. The LV LGE was classified into no, patchy and global groups. The RV LGE was classified into negative and positive groups. Myocardial deformation was measured using a dedicated software. Follow-up was performed for all-cause mortality using Cox proportional hazards regression and Kaplan-Meier curves. Results: During a median follow-up of 21 months, 34 deaths occurred. Presence of LV LGE [HR 2.44, 95% confidence interval (CI), 1.10–5.45, P=0.029] and global longitudinal strain (GLS) (HR 1.13 per 1% absolute decrease, 95% CI, 1.02–1.25, P=0.025) were independent LV predictors. RV LGE (HR 4.07, 95% CI, 1.09–15.24, P=0.037) and GLS (HR 1.10 per 1% absolute decrease, 95% CI, 1.00–1.21, P=0.047) were independent RV predictors. Complementary to LV LGE, LV GLS impairment or RV LGE further reduced survival (both log rank P<0.001). Conclusions: This study confirms the incremental prognostic value of LV GLS and RV LGE in AL amyloidosis, which refines the conventional risk evaluation based on LV LGE. GLS based on non-contrast-enhanced CMR are promising new predictors.

AB - Background: Previous cardiac magnetic resonance (CMR) studies have shown that both late gadolinium enhancement (LGE) and left ventricular (LV) strain have prognostic value in amyloid light-chain (AL) amyloidosis, but the right ventricular (RV) strain has not yet been studied. We aim to determine the incremental prognostic value of LV and RV LGE and strain in AL amyloidosis. Methods: This prospective study recruited 87 patients (age, 56.9±9.1 years; M/F, 56/31) and 20 healthy subjects (age, 52.7±8.1 years; M/F, 11/9) who underwent CMR. The LV LGE was classified into no, patchy and global groups. The RV LGE was classified into negative and positive groups. Myocardial deformation was measured using a dedicated software. Follow-up was performed for all-cause mortality using Cox proportional hazards regression and Kaplan-Meier curves. Results: During a median follow-up of 21 months, 34 deaths occurred. Presence of LV LGE [HR 2.44, 95% confidence interval (CI), 1.10–5.45, P=0.029] and global longitudinal strain (GLS) (HR 1.13 per 1% absolute decrease, 95% CI, 1.02–1.25, P=0.025) were independent LV predictors. RV LGE (HR 4.07, 95% CI, 1.09–15.24, P=0.037) and GLS (HR 1.10 per 1% absolute decrease, 95% CI, 1.00–1.21, P=0.047) were independent RV predictors. Complementary to LV LGE, LV GLS impairment or RV LGE further reduced survival (both log rank P<0.001). Conclusions: This study confirms the incremental prognostic value of LV GLS and RV LGE in AL amyloidosis, which refines the conventional risk evaluation based on LV LGE. GLS based on non-contrast-enhanced CMR are promising new predictors.

KW - Amyloidosis

KW - Cardiomyopathies

KW - Magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=85088495358&partnerID=8YFLogxK

U2 - 10.21037/cdt-20-181

DO - 10.21037/cdt-20-181

M3 - Article

AN - SCOPUS:85088495358

SN - 2223-3652

VL - 10

SP - 470

EP - 480

JO - Cardiovascular Diagnosis and Therapy

JF - Cardiovascular Diagnosis and Therapy

IS - 3

ER -

Left and right ventricular myocardial deformation and late gadolinium enhancement: Incremental prognostic value in amyloid light-chain amyloidosis

Abstract

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