https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Leipzig Klinik und Poliklinik für Kardiologie Leipzig, Deutschland; 2Universitätsklinikum Leipzig Klinik und Poliklinik für Nuklearmedizin Leipzig, Deutschland; 3Universitätskliniku Leipzig Poliklinik für Diagnostische und Interventionelle Radiologie Leipzig, Deutschland
Background and aims: Cardiac amyloidosis (CA) is a frequent cause of heart failure with hypertrophic phenotype in elderly patients. Cardiac magnetic resonance (CMR) imaging with T1 mapping may differentiate underlying causes of left ventricular (LV) hypertrophy, particularly CA. Previous CMR studies focused on patients referred for suspected CA to an amyloidosis center. The aim of this study was to investigate the role of CMR with T1 imaging for the diagnosis of CA in elderly patients with symptomatic heart failure and additional risk factors for CA.
Methods: We prospectively enrolled patients aged ≥ 60 years with symptomatic heart failure (NYHA II-IV), LV ejection fraction 40%, increased LV wall thickness (≥ 12mm end-diastolic), and elevated cardiac biomarkers (NT-proBNP ≥1,000 ng/L and high-sensitivity cardiac troponin T ≥ 14 ng/L). All patients underwent standardized quantitative CMR (3T scanner), 99mTc-DPD bone scintigraphy, screening for monoclonal protein, and, if indicated, endomyocardial biopsy. The primary outcome was diagnostic accuracy of T1 mapping for the diagnosis of CA. The study is registered at clinicaltrials.gov (NCT04862273).
Results: 112 consecutive patients with a median age of 81 years (interquartile range, 74–85) and 45% females were recruited. CA was diagnosed in 38 patients. The diagnostic accuracy was 0.836 for native T1 measurement and 0.904 for the extracellular volume fraction (ECV), measured from native and post-contrast T1 mapping. A diagnostic algorithm including both native T1 (≥ 1,341ms, z-score 3.0) and ECV (≥ 37%) diagnosed CA with a sensitivity of 92.9% and a specificity of 95.8% (Figure). Contrast application could be avoided in 51% of patients. A definite diagnosis based on CMR alone was provided in 80%.
Conclusion: CMR with T1 imaging provides high accuracy for the diagnosis of CA in patients with heart failure at risk for CA. CMR may be a useful tool to identify the underlying causes in heart failure which require specific and timely treatment to improve outcome.