Kim Jin Young, Hong Yoo Jin, Han Kyunghwa, Lee Hye Jeong, Hur Jin, Kim Young Jin, Choi Byoung Wook
Department of Radiology, Keimyung University School of Medicine, Daegu, Korea.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University Medical Center, Seoul, Korea.
Korean J Radiol. 2021 Jun;22(6):880-889. doi: 10.3348/kjr.2020.0579. Epub 2021 Feb 24.
This study aimed to investigate the regional amyloid burden and myocardial deformation using T1 mapping and strain values in patients with cardiac amyloidosis (CA) according to late gadolinium enhancement (LGE) patterns.
Forty patients with CA were divided into 2 groups per LGE pattern, and 15 healthy subjects were enrolled. Global and regional native T1 and T2 mapping, extracellular volume (ECV), and cardiac magnetic resonance (CMR)-feature tracking strain values were compared in an intergroup and interregional manner.
Of the patients with CA, 32 had diffuse global LGE (group 2), and 8 had focal patchy or no LGE (group 1). Global native T1, T2, and ECV were significantly higher in groups 1 and 2 than in the control group (native T1: 1384.4 ms vs. 1466.8 ms vs. 1230.5 ms; T2: 53.8 ms vs. 54.2 ms vs. 48.9 ms; and ECV: 36.9% vs. 51.4% vs. 26.0%, respectively; all, < 0.001). Basal ECV (53.7%) was significantly higher than the mid and apical ECVs (50.1% and 50.0%, respectively; < 0.001) in group 2. Basal and mid peak radial strains (PRSs) and peak circumferential strains (PCSs) were significantly lower than the apical PRS and PCS, respectively (PRS, 15.6% vs. 16.7% vs. 26.9%; and PCS, -9.7% vs. -10.9% vs. -15.0%; all, < 0.001). Basal ECV and basal strain (2-dimensional PRS) in group 2 showed a significant negative correlation ( = -0.623, < 0.001). Group 1 showed no regional ECV differences (basal, 37.0%; mid, 35.9%; and apical, 38.3%; = 0.184).
Quantitative T1 mapping parameters such as native T1 and ECV may help diagnose early CA. ECV, in particular, can reflect regional differences in the amyloid deposition in patients with advanced CA, and increased basal ECV is related to decreased basal strain. Therefore, quantitative CMR parameters may help diagnose CA and determine its severity in patients with or without LGE.
本研究旨在根据延迟钆增强（LGE）模式，利用T1映射和应变值来研究心脏淀粉样变性（CA）患者的局部淀粉样蛋白负荷和心肌变形情况。
40例CA患者根据LGE模式分为2组，并纳入15名健康受试者。以组间和区域间的方式比较整体和局部的固有T1、T2映射、细胞外容积（ECV）以及心脏磁共振（CMR）特征追踪应变值。
在CA患者中，32例有弥漫性整体LGE（第2组），8例有局灶性斑片状或无LGE（第1组）。第1组和第2组的整体固有T1、T2和ECV显著高于对照组（固有T1：1384.4毫秒对1466.8毫秒对1230.5毫秒；T2：53.8毫秒对54.2毫秒对48.9毫秒；ECV：分别为36.9%对51.4%对26.0%；均P<0.001）。第2组的基底ECV（53.7%）显著高于中部和心尖部的ECV（分别为50.1%和50.0%；P<0.001）。第2组的基底和中部的峰值径向应变（PRS）和峰值圆周应变（PCS）分别显著低于心尖部的PRS和PCS（PRS，15.6%对16.7%对26.9%；PCS，-9.7%对-10.9%对-15.0%；均P<0.001）。第2组的基底ECV和基底应变（二维PRS）呈显著负相关（r=-0.623，P<0.001）。第1组未显示出区域ECV差异（基底，37.0%；中部，35.9%；心尖部，38.3%；P=0.184）。
固有T1和ECV等定量T1映射参数可能有助于早期CA的诊断。特别是ECV可以反映晚期CA患者淀粉样蛋白沉积的区域差异，基底ECV增加与基底应变降低有关。因此，定量CMR参数可能有助于CA的诊断并确定其在有或无LGE患者中的严重程度。
