The following is a summary of Multi-parametric non-contrast cardiac magnetic resonance for the differentiation between cardiac amyloidosis and hypertrophic cardiomyopathy, published in the December 2023 issue of Cardiology by Steen et al.

Researchers conducted a retrospective study to assess whether myocardial strain and T1 mapping derived from Fast Strain-Encoded Cardiac Magnetic Resonance (SENC-CMR) could effectively differentiate between Hypertrophic Cardiomyopathy (HCM) and Cardiac Amyloidosis.

They analyzed 99 patients (57 with hypertrophic cardiomyopathy and 42 with cardiac amyloidosis). Assessed were LV-ejection fraction, LV-mass index, septal wall thickness, and native T1 mapping values. Global and segmental circumferential/longitudinal strain were calculated in basal, mid-ventricular, and apical segments and constructed as a ratio by dividing native T1 values by basal segmental strain (T1-to-basal segmental strain ratio).

The results showed equal myocardial strain distribution in apical and basal segments in HCM patients. At the same time, cardiac amyloidosis exhibited apical sparing with less impaired apical strain (apical-to-basal ratio of 1.01 0.23 versus 1.20 0.28, P<0.001). T1 values were significantly higher in amyloidosis than in HCM patients (1170.7 66.4 ms versus 1078.3 57.4 ms, P<0.001). The T1-to-basal segmental strain ratio showed high accuracy for differentiation (Sensitivity = 85%, Specificity = 77%, AUC = 0.90, 95% CI = 0.810.95, P<0.001). In multivariable analysis, age and the T1-to-basal-strain ratio were the most robust factors for HCM and cardiac amyloidosis differentiation.

Investigators concluded that T1-to-basal strain, a quick MRI measure, effectively distinguished heart conditions HCM and amyloidosis, skipping risky contrast injections.

Source: link.springer.com/article/10.1007/s00392-023-02348-4

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Differentiating Cardiac Amyloidosis and HCM with Multi-Parametric Non-Contrast Cardiac MRI - Physician's Weekly