CMR T1 Mapping for Diagnosis of Cardiac Amyloidosis

Cardiac amyloidosis (CA) is an important differential diagnosis in older patients with symptomatic heart failure with preserved or mid-range ejection fraction and increased left ventricular wall thickness. The prevalence of CA among patients with heart failure and left ventricular (LV) hypertrophy is approximately 13%. However, diagnosis of CA is challenging because specific clinical signs are often lacking.

Amyloid fibrils deposit in the extracellular space of the myocardium increases myocardial T1 values on cardiac magnetic resonance (CMR). Therefore, T1 imaging provides a promising non-invasive method to identify CA.

A preliminary retrospective analysis of 128 patients with increased LV wall thickness identified an area under the curve of 0.9954 (p<0.0001) for native T1 to detect CA. The optimal cut-off value was 1341ms, with a sensitivity of 100% and a specificity of 97%.

The investigators aim to test the diagnostic accuracy of T1 mapping for the diagnosis of CA compared to the reference method prospectively. Moreover, the web-based ATTR probability estimator for the diagnosis of CA will be evaluated.

Inclusion criteria

• Age ≥ 60 years
• Symptomatic heart failure (NYHA II-IV) with LVEF ≥40%
• Increased LV wall thickness (≥12mm end-diastolic)
• NT-proBNP ≥1000pg/mL
• Elevated hs-troponin T ≥14ng/L

Exclusion criteria

• Contraindications for CMR
• Acute myocarditis
• Acute myocardial infarction <1 month
• Severe aortic stenosis and RAISE score < 2 points