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Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping

IMPORTANCE: Cardiac magnetic resonance (CMR) imaging–derived extracellular volume (ECV) mapping, generated from precontrast and postcontrast T1, accurately determines treatment response in cardiac light-chain amyloidosis. Native T1 mapping, which can be derived without the need for contrast, has dem...

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Autores principales: Ioannou, Adam, Patel, Rishi K., Martinez-Naharro, Ana, Razvi, Yousuf, Porcari, Aldostefano, Rauf, Muhammad U., Bolhuis, Roos E., Fernando-Sayers, Jacob, Virsinskaite, Ruta, Bandera, Francesco, Kotecha, Tushar, Venneri, Lucia, Knight, Daniel, Manisty, Charlotte, Moon, James, Lachmann, Helen, Whelan, Carol, Kellman, Peter, Hawkins, Philip N., Gillmore, Julian D., Wechalekar, Ashutosh, Fontana, Marianna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357357/
https://www.ncbi.nlm.nih.gov/pubmed/37466990
http://dx.doi.org/10.1001/jamacardio.2023.2010
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author Ioannou, Adam
Patel, Rishi K.
Martinez-Naharro, Ana
Razvi, Yousuf
Porcari, Aldostefano
Rauf, Muhammad U.
Bolhuis, Roos E.
Fernando-Sayers, Jacob
Virsinskaite, Ruta
Bandera, Francesco
Kotecha, Tushar
Venneri, Lucia
Knight, Daniel
Manisty, Charlotte
Moon, James
Lachmann, Helen
Whelan, Carol
Kellman, Peter
Hawkins, Philip N.
Gillmore, Julian D.
Wechalekar, Ashutosh
Fontana, Marianna
author_facet Ioannou, Adam
Patel, Rishi K.
Martinez-Naharro, Ana
Razvi, Yousuf
Porcari, Aldostefano
Rauf, Muhammad U.
Bolhuis, Roos E.
Fernando-Sayers, Jacob
Virsinskaite, Ruta
Bandera, Francesco
Kotecha, Tushar
Venneri, Lucia
Knight, Daniel
Manisty, Charlotte
Moon, James
Lachmann, Helen
Whelan, Carol
Kellman, Peter
Hawkins, Philip N.
Gillmore, Julian D.
Wechalekar, Ashutosh
Fontana, Marianna
author_sort Ioannou, Adam
collection PubMed
description IMPORTANCE: Cardiac magnetic resonance (CMR) imaging–derived extracellular volume (ECV) mapping, generated from precontrast and postcontrast T1, accurately determines treatment response in cardiac light-chain amyloidosis. Native T1 mapping, which can be derived without the need for contrast, has demonstrated accuracy in diagnosis and prognostication, but it is unclear whether serial native T1 measurements could also track the cardiac treatment response. OBJECTIVE: To assess whether native T1 mapping can measure the cardiac treatment response and the association between changes in native T1 and prognosis. DESIGN, SETTING, AND PARTICIPANTS: This single-center cohort study evaluated patients diagnosed with cardiac light-chain amyloidosis (January 2016 to December 2020) who underwent CMR scans at diagnosis and a repeat scan following chemotherapy. Analysis took place between January 2016 and October 2022. MAIN OUTCOMES AND MEASURES: Comparison of biomarkers and cardiac imaging parameters between patients with a reduced, stable, or increased native T1 and association between changes in native T1 and mortality. RESULTS: The study comprised 221 patients (mean [SD] age, 64.7 [10.6] years; 130 male [59%]). At 6 months, 183 patients (mean [SD] age, 64.8 [10.5] years; 110 male [60%]) underwent repeat CMR imaging. Reduced native T1 of 50 milliseconds or more occurred in 8 patients (4%), all of whom had a good hematological response; by contrast, an increased native T1 of 50 milliseconds or more occurred in 42 patients (23%), most of whom had a poor hematological response (27 [68%]). At 12 months, 160 patients (mean [SD] age, 63.8 [11.1] years; 94 male [59%]) had a repeat CMR scan. A reduced native T1 occurred in 24 patients (15%), all of whom had a good hematological response, and was associated with a reduction in N-terminal pro-brain natriuretic peptide (median [IQR], 2638 [913-5767] vs 423 [128-1777] ng/L; P < .001), maximal wall thickness (mean [SD], 14.8 [3.6] vs 13.6 [3.9] mm; P = .009), and E/e' (mean [SD], 14.9 [6.8] vs 12.0 [4.0]; P = .007), improved longitudinal strain (mean [SD], −14.8% [4.0%] vs −16.7% [4.0%]; P = .004), and reduction in both myocardial T2 (mean [SD], 52.3 [2.9] vs 49.4 [2.0] milliseconds; P < .001) and ECV (mean [SD], 0.47 [0.07] vs 0.42 [0.08]; P < .001). At 12 months, an increased native T1 occurred in 24 patients (15%), most of whom had a poor hematological response (17 [71%]), and was associated with an increased N-terminal pro-brain natriuretic peptide (median [IQR], 1622 [554-5487] vs 3150 [1161-8745] ng/L; P = .007), reduced left ventricular ejection fraction (mean [SD], 65.8% [11.4%] vs 61.5% [12.4%]; P = .009), and an increase in both myocardial T2 (mean [SD], 52.5 [2.7] vs 55.3 [4.2] milliseconds; P < .001) and ECV (mean [SD], 0.48 [0.09] vs 0.56 [0.09]; P < .001). Change in myocardial native T1 at 6 months was independently associated with mortality (hazard ratio, 2.41 [95% CI, 1.36-4.27]; P = .003). CONCLUSIONS AND RELEVANCE: Changes in native T1 in response to treatment, reflecting a composite of changes in T2 and ECV, are associated with in changes in traditional markers of cardiac response and associated with mortality. However, as a single-center study, these results require external validation in a larger cohort.
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spelling pubmed-103573572023-07-21 Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping Ioannou, Adam Patel, Rishi K. Martinez-Naharro, Ana Razvi, Yousuf Porcari, Aldostefano Rauf, Muhammad U. Bolhuis, Roos E. Fernando-Sayers, Jacob Virsinskaite, Ruta Bandera, Francesco Kotecha, Tushar Venneri, Lucia Knight, Daniel Manisty, Charlotte Moon, James Lachmann, Helen Whelan, Carol Kellman, Peter Hawkins, Philip N. Gillmore, Julian D. Wechalekar, Ashutosh Fontana, Marianna JAMA Cardiol Brief Report IMPORTANCE: Cardiac magnetic resonance (CMR) imaging–derived extracellular volume (ECV) mapping, generated from precontrast and postcontrast T1, accurately determines treatment response in cardiac light-chain amyloidosis. Native T1 mapping, which can be derived without the need for contrast, has demonstrated accuracy in diagnosis and prognostication, but it is unclear whether serial native T1 measurements could also track the cardiac treatment response. OBJECTIVE: To assess whether native T1 mapping can measure the cardiac treatment response and the association between changes in native T1 and prognosis. DESIGN, SETTING, AND PARTICIPANTS: This single-center cohort study evaluated patients diagnosed with cardiac light-chain amyloidosis (January 2016 to December 2020) who underwent CMR scans at diagnosis and a repeat scan following chemotherapy. Analysis took place between January 2016 and October 2022. MAIN OUTCOMES AND MEASURES: Comparison of biomarkers and cardiac imaging parameters between patients with a reduced, stable, or increased native T1 and association between changes in native T1 and mortality. RESULTS: The study comprised 221 patients (mean [SD] age, 64.7 [10.6] years; 130 male [59%]). At 6 months, 183 patients (mean [SD] age, 64.8 [10.5] years; 110 male [60%]) underwent repeat CMR imaging. Reduced native T1 of 50 milliseconds or more occurred in 8 patients (4%), all of whom had a good hematological response; by contrast, an increased native T1 of 50 milliseconds or more occurred in 42 patients (23%), most of whom had a poor hematological response (27 [68%]). At 12 months, 160 patients (mean [SD] age, 63.8 [11.1] years; 94 male [59%]) had a repeat CMR scan. A reduced native T1 occurred in 24 patients (15%), all of whom had a good hematological response, and was associated with a reduction in N-terminal pro-brain natriuretic peptide (median [IQR], 2638 [913-5767] vs 423 [128-1777] ng/L; P < .001), maximal wall thickness (mean [SD], 14.8 [3.6] vs 13.6 [3.9] mm; P = .009), and E/e' (mean [SD], 14.9 [6.8] vs 12.0 [4.0]; P = .007), improved longitudinal strain (mean [SD], −14.8% [4.0%] vs −16.7% [4.0%]; P = .004), and reduction in both myocardial T2 (mean [SD], 52.3 [2.9] vs 49.4 [2.0] milliseconds; P < .001) and ECV (mean [SD], 0.47 [0.07] vs 0.42 [0.08]; P < .001). At 12 months, an increased native T1 occurred in 24 patients (15%), most of whom had a poor hematological response (17 [71%]), and was associated with an increased N-terminal pro-brain natriuretic peptide (median [IQR], 1622 [554-5487] vs 3150 [1161-8745] ng/L; P = .007), reduced left ventricular ejection fraction (mean [SD], 65.8% [11.4%] vs 61.5% [12.4%]; P = .009), and an increase in both myocardial T2 (mean [SD], 52.5 [2.7] vs 55.3 [4.2] milliseconds; P < .001) and ECV (mean [SD], 0.48 [0.09] vs 0.56 [0.09]; P < .001). Change in myocardial native T1 at 6 months was independently associated with mortality (hazard ratio, 2.41 [95% CI, 1.36-4.27]; P = .003). CONCLUSIONS AND RELEVANCE: Changes in native T1 in response to treatment, reflecting a composite of changes in T2 and ECV, are associated with in changes in traditional markers of cardiac response and associated with mortality. However, as a single-center study, these results require external validation in a larger cohort. American Medical Association 2023-07-19 2023-09 /pmc/articles/PMC10357357/ /pubmed/37466990 http://dx.doi.org/10.1001/jamacardio.2023.2010 Text en Copyright 2023 Ioannou A et al. JAMA Cardiology. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Brief Report
Ioannou, Adam
Patel, Rishi K.
Martinez-Naharro, Ana
Razvi, Yousuf
Porcari, Aldostefano
Rauf, Muhammad U.
Bolhuis, Roos E.
Fernando-Sayers, Jacob
Virsinskaite, Ruta
Bandera, Francesco
Kotecha, Tushar
Venneri, Lucia
Knight, Daniel
Manisty, Charlotte
Moon, James
Lachmann, Helen
Whelan, Carol
Kellman, Peter
Hawkins, Philip N.
Gillmore, Julian D.
Wechalekar, Ashutosh
Fontana, Marianna
Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping
title Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping
title_full Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping
title_fullStr Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping
title_full_unstemmed Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping
title_short Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping
title_sort tracking treatment response in cardiac light-chain amyloidosis with native t1 mapping
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10357357/
https://www.ncbi.nlm.nih.gov/pubmed/37466990
http://dx.doi.org/10.1001/jamacardio.2023.2010
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