Azuma Mai, Kato Shingo, Sawamura Shungo, Fukui Kazuki, Takizawa Ryouya, Nakayama Naoki, Ito Masanori, Hibi Kiyoshi, Utsunomiya Daisuke
Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Heart Vessels. 2025 Feb;40(2):131-139. doi: 10.1007/s00380-024-02447-w. Epub 2024 Jul 29.
The frequency of cardiac amyloidosis potentially present in patients with atrial fibrillation (AF) remains unclear. The purpose of this study is to determine the frequency and clinical characteristics of cardiac amyloidosis latent in AF by performing cardiac magnetic resonance imaging (MRI) in patients scheduled for AF ablation. We retrospectively analyzed 193 consecutive patients who underwent CA and cardiac MRI for atrial fibrillation. The primary endpoint of the study was the frequency of histologically confirmed cardiac amyloidosis or suspected cardiac amyloidosis [positive imaging findings on cardiac MRI strongly suspecting cardiac amyloidosis (diffuse subendocardial late gadolinium enhancement or MRI-derived extracellular volume of > 0.40)]. Among the 193 patients, 8 were confirmed or suspected cases of cardiac amyloidosis, representing a frequency of 4% (8/193 patients). Multivariate analysis identified interventricular septal thickness at end-diastole (LVSd) as an independent and significant predictor of cardiac amyloidosis (OR: 1.72, 95% CI 1.12-2.87, p = 0.020).The optimal cut-off value for IVSd was determined to be > 12.9 mm based on the Youden index. At this cut-off, the sensitivity was 75.0% (95% CI 34.9-96.8%) and the specificity was 92.3% (95% CI 87.4-95.7%), allowing for the identification of patients with definite or suspected cardiac amyloidosis. The frequency of confirmed and suspected cases of cardiac amyloidosis among patients with an IVSd > 12.9 mm was 30% (6/20 patients). In addition, prevalence of biopsy-proven cardiac amyloidosis was 10% (2/20). The prevalence of cardiac amyloidosis in atrial fibrillation patients scheduled for ablation with cardiac hypertrophy is not negligible.
心房颤动（AF）患者中潜在存在的心脏淀粉样变性的发生率仍不清楚。本研究的目的是通过对计划进行房颤消融的患者进行心脏磁共振成像（MRI），来确定隐匿于房颤中的心脏淀粉样变性的发生率和临床特征。我们回顾性分析了193例连续接受房颤导管消融（CA）及心脏MRI检查的患者。本研究的主要终点是组织学确诊的心脏淀粉样变性或疑似心脏淀粉样变性的发生率[心脏MRI上的阳性影像学表现高度怀疑心脏淀粉样变性（弥漫性心内膜下晚期钆增强或MRI衍生的细胞外容积>0.40）]。在这193例患者中，8例为确诊或疑似心脏淀粉样变性病例，发生率为4%（8/193例患者）。多因素分析确定舒张末期室间隔厚度（LVSd）是心脏淀粉样变性的独立且显著的预测因素（OR：1.72，95%CI 1.12-2.87，p = 0.020）。根据约登指数，IVSd的最佳截断值确定为>12.9 mm。在此截断值时，敏感性为75.0%（95%CI 34.9-96.8%），特异性为92.3%（95%CI 87.4-95.7%），从而能够识别出确诊或疑似心脏淀粉样变性的患者。IVSd>12.9 mm的患者中确诊和疑似心脏淀粉样变性病例的发生率为30%（6/20例患者）。此外，经活检证实的心脏淀粉样变性的患病率为10%（2/20）。计划进行消融且有心脏肥厚的房颤患者中，心脏淀粉样变性的患病率不可忽视。
