Purpose: Differentiation of the cause of left ventricular hypertrophy (LVH) is challenging in cases with co-existing hypertension. CMR offers assessment of diffuse myocardial abnormalities via T1 mapping with extracellular volume fraction (ECV) and macroscopic fibrosis via late gadolinium enhancement imaging (LGE). The goal of the study was to understand if CMR parameters can differentiate hypertensive cardiomyopathy (HC) from cardiac amyloidosis (CA) in patients with hypertension and heart failure, using endomyocardial biopsy (EMB) as the gold standard.
Methods: We retrospectively analyzed patients with hypertension, LVH, and heart failure undergoing EMB due to uncertain diagnosis. CMR parameters including cine, LGE characteristics, T1 mapping, and ECV were analyzed.
Results: A total of 34 patients were included (mean age 66.5 ± 10.7 years, 79.4% male). The final EMB-based diagnosis was HC (10, 29%), light chain (AL) CA (7, 21%), and transthyretin (ATTR) CA (17, 50%). There was a significant difference in subendocardial LGE (p = 0.03) and number of AHA segments with subendocardial LGE (p = 0.005). The subendocardial LGE pattern was most common in AL-CA (85.7%) and African American with HC (80%). ECV elevation (≥ 29%) was present in all patients with CA (AL-CA: 57.6 ± 5.2%, ATTR-CA: 59.1 ± 15.3%) and HC (37.3 ± 4.5%).
Conclusions: Extensive subendocardial LGE pattern is not pathognomonic for CA but might also be present in African American patients with longstanding or poorly controlled HTN. The ECV elevation in HC with HF might be more significant than previously reported with an overlap of ECV values in HC and CA, particularly in younger African American patients.
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http://dx.doi.org/10.1007/s10554-024-03262-0 | DOI Listing |
J Cardiovasc Magn Reson
December 2024
Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China. Electronic address:
Background: Cardiac involvement in light chain (AL) amyloidosis is the main determinant of prognosis. Amyloid can be deposited in the extracellular space and cause an increase in extracellular volume (ECV). At the same time, amyloid can also be deposited in the wall of small vessels and cause microvascular dysfunction.
View Article and Find Full Text PDFEur Radiol
December 2024
University Clinic of Radiology, Medical University of Innsbruck, A-6020, Innsbruck, Austria.
Eur Heart J Case Rep
September 2024
Division of Cardiology, Cook County Health, 1969 W. Ogden Ave, Chicago, IL 60612, USA.
Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease caused by small- to medium-sized vessel vasculitis which can also impact the heart. Because of its rarity and diverse clinical manifestations, diagnosis can be challenging. Here, we present a unique case of EGPA causing perimyocarditis in a young female patient.
View Article and Find Full Text PDFInt J Cardiovasc Imaging
December 2024
Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, 452 W 10th Ave Columbus, Columbus, OH, 43210, USA.
Front Cardiovasc Med
September 2024
Department of Medical Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Purpose: To investigate the prevalence and characteristics of late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) and its prognostic value in patients with Takayasu arteritis (TA).
Materials And Methods: Sixty TA patients with a CMR examination were retrospectively included. All TA patients were divided into with LGE-positive and LGE-negative groups.
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