Prognostic Value of Left Ventricular Myocardial Strain Parameters Derived from Cardiac Magnetic Resonance Feature Tracking Technique in Light-Chain Cardiac Amyloidosis Patients: A Pilot Study.

Background: Previous research on the prognostic implications of left ventricular myocardial strain using cardiac magnetic resonance feature tracking (CMR-FT) in light-chain cardiac amyloidosis (AL-CA) has shown promising potential. This study aimed to evaluate the prognostic significance of global and segmental left ventricular myocardial strain in AL-CA patients, specifically analyzing the American Heart Association's 16 segments.

Methods: A total of 75 consecutive patients (50 men, mean age: 55.6 ± 10.0 years) who underwent CMR examination with histologically confirmed systemic AL-CA were retrospectively enrolled between January 2014 and November 2022. Both global and segmental myocardial strain and the American Heart Association's 16 segments were quantified using CMR-FT on the steady-state free precession (SSFP) cine sequence. A comparative analysis was conducted between survivors and non-survivors based on the defined endpoint. Student -test or Mann-Whitney U, receiver operating characteristic curve, Kaplan-Meier event-free survival curve, and Cox proportional hazards regression were used. Significance was set at < 0.05.

Results: Following a median follow-up of 34 months, 16 out of 75 patients experienced mortality events. B-type natriuretic peptides (BNP) ( < 0.001), global radial strain (RS) ( = 0.033), and RS in the basal inferior segment (RS) ( = 0.025) remained significant as independent predictors of all-cause mortality. The cut-off values were identified as 24.97% for RS, and 20.97% for RS. Kaplan-Meier survival curves revealed significantly reduced event-free survival for individuals in the lower cut-off groups for RS and RS ( = 0.013, < 0.001, respectively).

Conclusions: Radial strain for the global and the basal inferior segment may prove valuable for risk stratification in patients with AL-CA.