BACKGROUND: Cardiac amyloidosis is a serious progressive disease with a high mortality rate.The differential diagnosis of cardiomyopathies due to amyloid light-chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis is important for selecting the optimal treatment strategy.AIM: The aim of this study was to evaluate the capabilities of cardiac magnetic resonance imaging in the differential diagnosis of cardiomyopathies due to AL and ATTR amyloidosis.MATERIALS AND METHODS: A retrospective analysis of the medical records of 25 patients with a confirmed diagnosis of amyloid cardiomyopathy was performed.
Patients were divided into two groups according to the type of amyloidosis, with group 1 including patients with cardiomyopathy due to AL amyloidosis and group 2 including patients with cardiomyopathy due to ATTR amyloidosis.All patients underwent contrast-enhanced cardiac magnetic resonance imaging.Volumetric and linear cardiac parameters, ventricular function, and late gadolinium enhancement patterns were assessed.Standard statistical methods were used, and differences were considered significant at p 0.
05.RESULTS: Group 2 showed a more significant thickening of the myocardial walls compared to group 1 (interventricular septum: 18 [17; 18] vs.14.5 mm [12.
8; 16.0], p 0.01, posterior wall of the left ventricle: 14 [13; 17] vs.10.
5 Optical Coherence Tomography Angiography for Evaluation of Conjunctival Vessels in Dry Eyes mm [10; 12.3], p 0.01).The indexed mass of the left ventricle myocardium was 110 [92; 125] in group 2 and 85 mm [69.
3; 91.8] in group 1 (p 0.01).In group 2, late gadolinium enhancement with a transmural left ventricle pattern was more frequently observed in the basal and mid-lower-lateral segments, whereas in group 1, a subendocardial pattern of late gadolinium enhancement was more frequent in the mid-anterior and lower-lateral segments (p 0.
05).In addition, frequency of simultaneous contrast enhancement in the subendocardial layers of Unrelated Parallel Machine Scheduling with Sequence-Dependent Setup Times in Multi-Factory Production Network: Modeling and Algorithm the interventricular septum on the left ventricle and right ventricle sides was higher in group 2 (100% of cases vs.50%, p 0.01).
Late gadolinium enhancement of the right ventricle was also more common in group 2 (100 vs.58%, p 0.05), especially in the interventricular septum and inferior wall area (p 0.05).
Semi-quantitative assessment of LGE using the Query Amyloid Late Enhancement (QALE) showed greater contrast enhancement in group 2: 13 [12; 14] vs.10.5 [1.75; 12], p 0.
01), and a score greater than 13 differentiated between cardiomyopathy due to AL amyloidosis and ATTR amyloidosis with a sensitivity of 69% and a specificity of 83%.CONCLUSIONS: Cardiac MRI identifies typical features of cardiomyopathies due to AL amyloidosis and ATTR amyloidosis for their differential diagnosis.Further research is needed to confirm diagnostic accuracy of the patterns identified.