Grazzini Giulia, Pradella Silvia, Bani Rossella, Fornaciari Chiara, Cappelli Francesco, Perfetto Federico, Cozzi Diletta, Giovannelli Simona, Sica Giacomo, Miele Vittorio
Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy.
Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Largo Piero Palagi 1, 50134 Florence, Italy.
Diagnostics (Basel). 2024 May 18;14(10):1048. doi: 10.3390/diagnostics14101048.
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy divided into two types: light-chain (LA) and transthyretin (ATTR) CA. Cardiac magnetic resonance (CMR) has emerged as an important diagnostic tool in CA. While late gadolinium enhancement (LGE), T1 mapping and extracellular volume (ECV) have a consolidate role in the assessment of CA, T2 mapping has been less often evaluated. We aimed to test the value of T2 mapping in the evaluation of CA. This study recruited 70 patients with CA (51 ATTR, 19 AL). All the subjects underwent 1.5 T CMR with T1 and T2 mapping and cine and LGE imaging. Their QALE scores were evaluated. The myocardial T2 values were significantly ( < 0.001) increased in both types of CA compared to the controls. In the AL-CA group, increased T2 values were associated with a higher QALE score. The myocardial native T1 values and ECV were significantly ( < 0.001) higher in the CA patients than in the healthy subjects. Left ventricular (LV) mass, QALE score and ECV were higher in ATTR amyloidosis compared with AL amyloidosis, while the LV ejection fraction was lower ( < 0.001). These results support the concept of the presence of myocardial edema in CA. Therefore, a CMR evaluation including not only myocardial T1 imaging but also myocardial T2 imaging allows for more comprehensive tissue characterization in CA.
心脏淀粉样变性（CA）是一种浸润性心肌病，分为两种类型：轻链（LA）型和转甲状腺素蛋白（ATTR）型CA。心脏磁共振成像（CMR）已成为CA的一种重要诊断工具。虽然钆延迟强化（LGE）、T1 mapping和细胞外容积（ECV）在CA评估中具有重要作用，但T2 mapping的评估较少。我们旨在测试T2 mapping在CA评估中的价值。本研究招募了70例CA患者（51例ATTR型，19例AL型）。所有受试者均接受了1.5T的CMR检查，包括T1和T2 mapping以及电影成像和LGE成像。评估了他们的QALE评分。与对照组相比，两种类型的CA患者心肌T2值均显著升高（<0.001）。在AL-CA组中，T2值升高与更高的QALE评分相关。CA患者的心肌固有T1值和ECV显著高于健康受试者（<0.001）。与AL淀粉样变性相比，ATTR淀粉样变性患者的左心室（LV）质量、QALE评分和ECV更高，而LV射血分数更低（<0.001）。这些结果支持CA存在心肌水肿的概念。因此，CMR评估不仅包括心肌T1成像，还包括心肌T2成像，能够对CA进行更全面的组织特征分析。
