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Native T1 Mapping, Extracellular Volume Mapping, and Late Gadolinium Enhancement in Cardiac Amyloidosis: A
Jonathan A Pan1, Matthew J Kerwin1, Michael Salerno2
1Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville.
Insights
Extracellular volume (ECV) mapping shows superior diagnostic and prognostic performance for cardiac amyloidosis compared to late gadolinium enhancement (LGE) and native T1 mapping. ECV offers higher accuracy in diagnosing cardiac amyloidosis and predicting patient outcomes.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Cardiac amyloidosis (CA) is an underdiagnosed infiltrative disease with a poor prognosis.
- CA affects the extracellular space, leading to progressive cardiac dysfunction.
- Cardiac magnetic resonance (CMR) imaging provides advanced techniques for CA assessment.
Purpose of the Study:
- To compare the diagnostic and prognostic capabilities of native T1 mapping, ECV mapping, and LGE imaging in evaluating CA.
- To determine the relative performance of these CMR techniques for CA detection and outcome prediction.
Main Methods:
- A systematic literature search was conducted on PubMed for studies utilizing native T1, ECV, or LGE for CA diagnosis and prognosis.
- Meta-analysis included 18 diagnostic studies (n=2,015) and 13 prognostic studies (n=1,483).
- Bivariate analysis assessed pooled sensitivities, specificities, diagnostic odds ratios (DORs), and hazard ratios (HRs) for mortality.
Main Results:
- ECV mapping demonstrated a significantly higher DOR for CA diagnosis compared to LGE (84.6 vs. 20.1).
- ECV mapping showed a significantly higher HR for mortality compared to LGE and native T1 (4.27 vs. 2.60 and 2.04).
- Native T1 mapping exhibited comparable sensitivity and specificity to ECV and LGE without contrast administration.
Conclusions:
- ECV mapping offers superior diagnostic and prognostic utility for cardiac amyloidosis assessment compared to LGE and native T1.
- Native T1 mapping provides a contrast-free alternative with similar diagnostic performance.
- Despite study heterogeneity, ECV mapping emerges as a valuable tool for evaluating CA burden and predicting outcomes.
Objectives:
This study aimed to compare the diagnostic and prognostic performance of native T1 mapping (T1), extracellular volume (ECV) mapping, and late gadolinium enhancement (LGE) imaging for evaluating cardiac amyloidosis (CA).
Background:
CA is a progressive infiltrative process in the extracellular space that is often underdiagnosed and holds a poor prognosis. Cardiac magnetic resonance (CMR) offers novel techniques for detecting and quantifying the disease burden of CA.
Methods:
We searched PubMed for published studies using native T1, ECV, or LGE to diagnose and prognosticate CA. A total of 18 diagnostic (n = 2,015) and 13 prognostic studies (n = 1,483) were included for analysis. Pooled sensitivities, specificities, diagnostic odds ratios (DORs) of all diagnostic tests were assessed by bivariate analysis. Pooled hazard ratios (HRs) for mortality for the 3 techniques were determined.
Results:
Bivariate comparison showed that ECV (DOR: 84.6; 95% confidence interval [CI]: 30.3 to 236.2) had a significantly higher DOR for CA than LGE (DOR: 20.1; 95% CI: 9.1 to 44.1; p = 0.03 vs. ECV). There was no significant difference between LGE and native T1 for sensitivity, specificity, and DOR. HR was significantly higher for ECV (HR: 4.27; 95% CI: 2.87 to 6.37) compared with LGE (HR: 2.60; 95% CI: 1.90 to 3.56; p = 0.03 vs. ECV) and native T1 (HR: 2.04; 95% CI: 1.24 to 3.37; p = 0.01 vs. ECV).
Conclusions:
ECV demonstrates a higher diagnostic OR for assessing cardiac amyloid than LGE and a higher HR for adverse events compared with LGE and native T1. In addition, native T1 showed similar sensitivity and specificity as ECV and LGE without requiring contrast material. Although limited by study heterogeneity, this meta-analysis suggests that ECV provides high diagnostic and prognostic utility for the assessment of cardiac amyloidosis.
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