PMID- 32417333
OWN - NLM
STAT- MEDLINE
DCOM- 20210113
LR  - 20210624
IS  - 1876-7591 (Electronic)
IS  - 1936-878X (Print)
IS  - 1876-7591 (Linking)
VI  - 13
IP  - 6
DP  - 2020 Jun
TI  - Improved Quantification of Cardiac Amyloid Burden in Systemic Light 
      Chain Amyloidosis: Redefining Early Disease?
PG  - 1325-1336
LID - S1936-878X(20)30251-5 [pii]
LID - 10.1016/j.jcmg.2020.02.025 [doi]
AB  - OBJECTIVES: The purpose of this study was to determine phenotypes characterizing 
      cardiac involvement in AL amyloidosis by using direct (fluorine-18-labeled 
      florbetapir [(18)F]florbetapir positron emission tomography [PET]/computed 
      tomography) and indirect (echocardiography and cardiac magnetic resonance [CMR]) 
      imaging biomarkers of AL amyloidosis. BACKGROUND: Cardiac involvement in systemic 
      light chain amyloidosis (AL) is the main determinant of prognosis and, therefore, 
      guides management. The hypothesis of this study was that myocardial AL deposits 
      and expansion of extracellular volume (ECV) could be identified before increases 
      in N-terminal pro-B-type natriuretic peptide or wall thickness. METHODS: A total 
      of 45 subjects were prospectively enrolled in 3 groups: 25 with active AL 
      amyloidosis with cardiac involvement (active-CA), 10 with active AL amyloidosis 
      without cardiac involvement by conventional criteria (active-non-CA), and 10 with 
      AL amyloidosis with cardiac involvement in remission for at least 1 year 
      (remission-CA). All subjects underwent echocardiography, CMR, and 
      [(18)F]florbetapir PET/CT to evaluate cardiac amyloid burden. RESULTS: The 
      active-CA group demonstrated the largest myocardial AL amyloid burden, quantified 
      by [(18)F]florbetapir retention index (RI) 0.110 (interquartile range [IQR]: 
      0.078 to 0.139) min(-1), and the lowest cardiac function by global longitudinal 
      strain (GLS), median GLS -11% (IQR: -8% to -13%). The remission-CA group had 
      expanded extracellular volume (ECV) and [(18)F]florbetapir RI of 0.097 (IQR: 
      0.070 to 0.124 min(-1)), and abnormal GLS despite hematologic remission for >1 
      year. The active-non-CA cohort had evidence of cardiac amyloid deposition by 
      advanced imaging metrics in 50% of the subjects; cardiac involvement was 
      identified by late gadolinium enhancement in 20%, elevated ECV in 20%, and 
      elevated [(18)F]florbetapir RI in 50%. CONCLUSIONS: Evidence of cardiac amyloid 
      infiltration was found based on direct and indirect imaging biomarkers in 
      subjects without CA by conventional criteria. The findings from 
      [(18)F]florbetapir PET imaging provided insight into the preclinical disease 
      process and on the basis of interpretation of expanded ECV on CMR and have 
      important implications for future research and clinical management of AL 
      amyloidosis. (Molecular Imaging of Primary Amyloid Cardiomyopathy [MICA]; 
      NCT02641145).
CI  - Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Cuddy, Sarah A M
AU  - Cuddy SAM
AD  - Department of Medicine, Division of Cardiology, Cardiac Amyloidosis Program, 
      Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; 
      Department of Radiology, Division of Nuclear Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts; Department of 
      Medicine and Radiology, CV Imaging Program, Cardiovascular Division, Brigham and 
      Women's Hospital and Harvard Medical School, Boston, Massachusetts.
FAU - Bravo, Paco E
AU  - Bravo PE
AD  - Department of Radiology, Division of Nuclear Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts; Departments of 
      Radiology and Medicine, Divisions of Nuclear Medicine and Cardiology, Hospital of 
      the University of Pennsylvania, Philadelphia, Pennsylvania.
FAU - Falk, Rodney H
AU  - Falk RH
AD  - Department of Medicine, Division of Cardiology, Cardiac Amyloidosis Program, 
      Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
FAU - El-Sady, Samir
AU  - El-Sady S
AD  - Department of Radiology, Division of Nuclear Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts.
FAU - Kijewski, Marie Foley
AU  - Kijewski MF
AD  - Department of Radiology, Division of Nuclear Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts.
FAU - Park, Mi-Ae
AU  - Park MA
AD  - Department of Radiology, Division of Nuclear Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts.
FAU - Ruberg, Frederick L
AU  - Ruberg FL
AD  - Section of Cardiovascular Medicine, Amyloidosis Center, Boston Medical Center, 
      Boston University School of Medicine, Boston, Massachusetts.
FAU - Sanchorawala, Vaishali
AU  - Sanchorawala V
AD  - Section of Cardiovascular Medicine, Amyloidosis Center, Boston Medical Center, 
      Boston University School of Medicine, Boston, Massachusetts.
FAU - Landau, Heather
AU  - Landau H
AD  - Division of Medical Oncology, Memorial Sloan Kettering Medical Center, New York 
      City, New York.
FAU - Yee, Andrew J
AU  - Yee AJ
AD  - Department of Medicine, Division of Hematology and Oncology, Massachusetts 
      General Hospital, Boston, Massachusetts.
FAU - Bianchi, Giada
AU  - Bianchi G
AD  - Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, 
      Massachusetts.
FAU - Di Carli, Marcelo F
AU  - Di Carli MF
AD  - Department of Radiology, Division of Nuclear Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts; Department of 
      Medicine and Radiology, CV Imaging Program, Cardiovascular Division, Brigham and 
      Women's Hospital and Harvard Medical School, Boston, Massachusetts.
FAU - Cheng, Su-Chun
AU  - Cheng SC
AD  - Department of Data Sciences, Division of Biostatistics, Dana-Farber Cancer 
      Institute, Boston, Massachusetts.
FAU - Jerosch-Herold, Michael
AU  - Jerosch-Herold M
AD  - Department of Medicine and Radiology, CV Imaging Program, Cardiovascular 
      Division, Brigham and Women's Hospital and Harvard Medical School, Boston, 
      Massachusetts.
FAU - Kwong, Raymond Y
AU  - Kwong RY
AD  - Department of Medicine and Radiology, CV Imaging Program, Cardiovascular 
      Division, Brigham and Women's Hospital and Harvard Medical School, Boston, 
      Massachusetts.
FAU - Liao, Ronglih
AU  - Liao R
AD  - Amyloidosis Program, Stanford University, Stanford, California.
FAU - Dorbala, Sharmila
AU  - Dorbala S
AD  - Department of Medicine, Division of Cardiology, Cardiac Amyloidosis Program, 
      Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; 
      Department of Radiology, Division of Nuclear Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, Massachusetts; Department of 
      Medicine and Radiology, CV Imaging Program, Cardiovascular Division, Brigham and 
      Women's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic 
      address: sdorbala@bwh.harvard.edu.
LA  - eng
SI  - ClinicalTrials.gov/NCT02641145
GR  - T32 HL094301/HL/NHLBI NIH HHS/United States
GR  - R01 HL093148/HL/NHLBI NIH HHS/United States
GR  - R01 HL099073/HL/NHLBI NIH HHS/United States
GR  - R01 HL139671/HL/NHLBI NIH HHS/United States
GR  - R01 HL128135/HL/NHLBI NIH HHS/United States
GR  - P30 CA008748/CA/NCI NIH HHS/United States
GR  - R01 HL130563/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20200513
PL  - United States
TA  - JACC Cardiovasc Imaging
JT  - JACC. Cardiovascular imaging
JID - 101467978
RN  - 0 (Aniline Compounds)
RN  - 0 (Ethylene Glycols)
RN  - 0 (Fluorine Radioisotopes)
RN  - 0 (Radiopharmaceuticals)
RN  - 6867Q6IKOD (florbetapir)
SB  - IM
CIN - JACC Cardiovasc Imaging. 2020 Jun;13(6):1348-1352. PMID: 32417331
MH  - Aged
MH  - Aniline Compounds/*administration & dosage
MH  - Cardiomyopathies/*diagnostic imaging/pathology
MH  - Early Diagnosis
MH  - *Echocardiography, Doppler
MH  - Ethylene Glycols/*administration & dosage
MH  - Female
MH  - Fluorine Radioisotopes/*administration & dosage
MH  - Humans
MH  - Immunoglobulin Light-chain Amyloidosis/*diagnostic imaging/pathology
MH  - *Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Multimodal Imaging
MH  - Myocardium/*pathology
MH  - *Positron Emission Tomography Computed Tomography
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Radiopharmaceuticals/*administration & dosage
MH  - Severity of Illness Index
MH  - United States
PMC - PMC8218539
MID - NIHMS1710397
OTO - NOTNLM
OT  - [(18)F]florbetapir
OT  - cardiac amyloidosis
OT  - cardiac magnetic resonance
OT  - echocardiography
OT  - light chain amyloidosis
OT  - longitudinal strain imaging
OT  - positron emission tomography
EDAT- 2020/05/18 06:00
MHDA- 2021/01/14 06:00
PMCR- 2021/06/22
CRDT- 2020/05/18 06:00
PHST- 2019/10/01 00:00 [received]
PHST- 2020/01/13 00:00 [revised]
PHST- 2020/02/05 00:00 [accepted]
PHST- 2020/05/18 06:00 [pubmed]
PHST- 2021/01/14 06:00 [medline]
PHST- 2020/05/18 06:00 [entrez]
PHST- 2021/06/22 00:00 [pmc-release]
AID - S1936-878X(20)30251-5 [pii]
AID - 10.1016/j.jcmg.2020.02.025 [doi]
PST - ppublish
SO  - JACC Cardiovasc Imaging. 2020 Jun;13(6):1325-1336. doi: 
      10.1016/j.jcmg.2020.02.025. Epub 2020 May 13.