Left Ventricular Myocardial Deformation on Cine MR Images: Relationship to Severity of Disease and Prognosis in Light-Chain Amyloidosis

Purpose: To measure left ventricular (LV) myocardial strain with cine magnetic resonance (MR) imaging and a deformable registration algorithm (DRA) and to assess the prognostic value of myocardial strain in patients with light-chain (AL) amyloidosis. Materials and Methods: In this prospective study, 78 consecutive patients with AL amyloidosis who underwent contrast material-enhanced cardiac MR imaging were enrolled at West China Hospital. LV myocardial strains and late gadolinium enhancement (LGE) were evaluated. Association between myocardial strain and all-cause mortality was analyzed with the stepwise Cox regression model. Results: Global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly lower in the no or nonspecific LGE group compared with the subendocardial LGE and transmural LGE groups (mean GLS, -10% +/- 3 [standard deviation] vs -7%+/- 3 vs -4% +/- 1; P<.001) (mean GCS, -13%+/- 3 vs -11%+/- 3 vs -7%+/- 2; P<.001). GLS and GCS were reduced in patients without clinical cardiac amyloidosis (mean GLS, -13%+/- 3 vs -16%+/- 2; P=.005) (mean GCS, -16%+/- 1 vs -19%+/- 2; P=.02). Circumferential and radial strains were impaired in basal segments in accordance with the distribution of LGE. Multivariate Cox analysis revealed that GCS (hazard ratio [HR]= 1.16 per 1% absolute decrease; 95% confidence interval [CI]: 1.03, 1.31; P=.02) and the presence of transmural LGE (HR= 1.75; 95% CI: 1.10, 2.80; P=.02) were independent predictors of all-cause mortality after adjustment for LV ejection fraction, right ventricular ejection fraction, LV mass index, GLS, and global radial strain. Conclusion: Strain parameters derived with cine MR imaging-based DRA may be a new noninvasive imaging marker with which to evaluate the extent of cardiac amyloid infiltration and may offer independent prognostic information for all-cause mortality in patients with AL amyloidosis. (c) RSNA, 2018