PMID- 31202744 OWN - NLM STAT- MEDLINE DCOM- 20200720 LR - 20210109 IS - 1876-7591 (Electronic) IS - 1876-7591 (Linking) VI - 13 IP - 1 Pt 1 DP - 2020 Jan TI - Noncontrast Magnetic Resonance for the Diagnosis of Cardiac Amyloidosis. PG - 69-80 LID - S1936-878X(19)30433-4 [pii] LID - 10.1016/j.jcmg.2019.03.026 [doi] AB - OBJECTIVES: This study aimed to assess the diagnostic use of native T1 to detect cardiac amyloidosis (CA) in a large prospective cohort of patients referred for suspected systemic amyloidosis. BACKGROUND: CA is a progressive and fatal underdiagnosed cause of heart failure. Cardiovascular magnetic resonance (CMR) has emerged as an extremely useful test for the non-invasive diagnosis of CA, but administration of contrast is still required to make a diagnosis. METHODS: In this study, 868 patients with suspected CA referred between 2015 and 2017 underwent CMR with late gadolinium enhancement (LGE), T1 mapping, and an array of clinical investigations. RESULTS: The final diagnosis was cardiac light-chain (AL) amyloidosis in 222, cardiac transthyretin (ATTR) amyloidosis in 214, and no cardiac involvement in 427 cases. T1 was significantly elevated in both types of CA and this was associated with high diagnostic accuracy in the overall population (area under the curve, 0.93). A native T1 <1,036 ms was associated with 98% negative predictive value for CA whereas a native T1 >1,164 ms was associated with 98% positive predictive value for CA. We propose the use of these cut-offs to exclude or confirm CA and to restrict the administration of contrast only to patients with intermediate probability (native T1 between 1,036 and 1,164 ms), 58% of patients in this population. CONCLUSIONS: Native myocardial T1 enables diagnosis of CA to be made without need for gadolinium contrast in a large proportion of patients with suspected systemic amyloidosis. We propose a diagnostic algorithm for non-contrast CMR applicable to patients with suspected amyloidosis. CI - Copyright (c) 2020 American College of Cardiology Foundation. All rights reserved. FAU - Baggiano, Andrea AU - Baggiano A AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Centro Cardiologico Monzino, IRCCS, Milan, Italy. FAU - Boldrini, Michele AU - Boldrini M AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Emergency Department, Amyloid Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy. FAU - Martinez-Naharro, Ana AU - Martinez-Naharro A AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Kotecha, Tushar AU - Kotecha T AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Department of Cardiology, Royal Free Hospital, London, United Kingdom. FAU - Petrie, Aviva AU - Petrie A AD - University College London Eastman Dental Institute, London, United Kingdom. FAU - Rezk, Tamer AU - Rezk T AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Gritti, Maurizio AU - Gritti M AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Quarta, Cristina AU - Quarta C AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Knight, Daniel S AU - Knight DS AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Department of Cardiology, Royal Free Hospital, London, United Kingdom. FAU - Wechalekar, Ashutosh D AU - Wechalekar AD AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Lachmann, Helen J AU - Lachmann HJ AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Perlini, Stefano AU - Perlini S AD - Emergency Department, Amyloid Research and Treatment Center, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy. FAU - Pontone, Gianluca AU - Pontone G AD - Centro Cardiologico Monzino, IRCCS, Milan, Italy. FAU - Moon, James C AU - Moon JC AD - Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom. FAU - Kellman, Peter AU - Kellman P AD - National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland. FAU - Gillmore, Julian D AU - Gillmore JD AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Hawkins, Philip N AU - Hawkins PN AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. FAU - Fontana, Marianna AU - Fontana M AD - National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom. Electronic address: m.fontana@ucl.ac.uk. LA - eng GR - FS/18/21/33447/BHF_/British Heart Foundation/United Kingdom PT - Journal Article DEP - 20190612 PL - United States TA - JACC Cardiovasc Imaging JT - JACC. Cardiovascular imaging JID - 101467978 RN - 0 (Contrast Media) RN - 0 (Organometallic Compounds) RN - 6HG8UB2MUY (Meglumine) RN - L0ND3981AG (gadoterate meglumine) RN - Amyloidosis, Hereditary, Transthyretin-Related SB - IM CIN - JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 1):81-82. PMID: 31202771 CIN - JACC Cardiovasc Imaging. 2020 May;13(5):1293-1294. PMID: 32381248 CIN - JACC Cardiovasc Imaging. 2020 May;13(5):1294-1295. PMID: 32381249 MH - Adult MH - Aged MH - Aged, 80 and over MH - Amyloid Neuropathies, Familial/*diagnostic imaging/pathology/physiopathology MH - Cardiomyopathies/*diagnostic imaging/pathology/physiopathology MH - Contrast Media/administration & dosage MH - Female MH - Humans MH - Immunoglobulin Light-chain Amyloidosis/*diagnostic imaging/pathology/physiopathology MH - *Magnetic Resonance Imaging MH - Male MH - Meglumine/administration & dosage MH - Middle Aged MH - Myocardium/*pathology MH - Organometallic Compounds/administration & dosage MH - Predictive Value of Tests MH - Prospective Studies MH - Reproducibility of Results MH - *Ventricular Function, Left MH - *Ventricular Remodeling OTO - NOTNLM OT - accuracy OT - amyloidosis OT - cardiovascular magnetic resonance OT - native T1 mapping OT - renal failure EDAT- 2019/06/17 06:00 MHDA- 2020/07/21 06:00 CRDT- 2019/06/17 06:00 PHST- 2019/03/13 00:00 [received] PHST- 2019/03/16 00:00 [accepted] PHST- 2019/06/17 06:00 [pubmed] PHST- 2020/07/21 06:00 [medline] PHST- 2019/06/17 06:00 [entrez] AID - S1936-878X(19)30433-4 [pii] AID - 10.1016/j.jcmg.2019.03.026 [doi] PST - ppublish SO - JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 1):69-80. doi: 10.1016/j.jcmg.2019.03.026. Epub 2019 Jun 12.