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Evaluation of myocardial strain assessed by CMR tissue-tracking to predict adverse cardiovascular events in patients with cardiac amyloidosis

Session Poster session 1

Speaker Ilaria Dentamaro

Congress : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Myocardium
  • Session type : Poster Session
  • FP Number : P185

Authors : I Dentamaro (Bari,IT), F Valente (Barcelona,ES), L Rodriguez (Barcelona,ES), A Quijada (Barcelona,ES), N Villalva (Barcelona,ES), V Pineda (Barcelona,ES), G Teixido (Barcelona,ES), R Fernandez-Galera (Barcelona,ES), I Ferreira (Barcelona,ES), A Evangelista (Barcelona,ES), H Cuellar (Barcelona,ES), J Rdriguez-Palomares (Barcelona,ES)

I Dentamaro1 , F Valente2 , L Rodriguez2 , A Quijada2 , N Villalva2 , V Pineda2 , G Teixido2 , R Fernandez-Galera2 , I Ferreira2 , A Evangelista2 , H Cuellar2 , J Rdriguez-Palomares2 , 1Polyclinic Hospital of Bari, Cardiology Department, DETO - Bari - Italy , 2University Hospital Vall d'Hebron - Barcelona - Spain ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii145

INTRODUCTION: Cardiac amyloidosis is the most frequent cause of restrictive cardiomyopathy. CMR is the most important technique used to diagnose cardiac involvement and the amount of LGE is associated with a worse prognosis. The role of other CMR derived parameters such as myocardial deformation are still unknown.The aim of this study is to analyze the prognostic implication of different CMR parameters, including tissue-deformation in patients with cardiac amyloidosis. METHODS: We recruited 53 patients, with histologically proven amyloidosis, prospectively followed in our cardiomyopathy unit, from 2010 to 2017. Patients were included after an echocardiography positive study of cardiac involvement. The patients underwent a CMR evaluation: left ventricular volumes, ejection fraction, mass, and deformation (radial, circumferential and longitudinal strain) were assessed using cine sequences. LGE images were obtained with the calculation of the percentage of affected mass. During the follow-up significant outcomes for a worse prognosis were considered: hospitalization for heart failure, stroke, ventricular arrhythmias and cardiac death. RESULTS: Patients were followed for a mean time of 50 months and at follow-up the 76% of the patients presented at least one significant cardiovascular events: 57% presented a hospitalization for heart failure, 4% presented a ventricular arrhythmia, stroke 4% and cardiovascular death in 39%. The mean characteristics of the population are displayed on table 1. In these univariate analysis, only the GLS was statistically significant related  to cardiovascular events. In the multivariate analysis GLS was considered the only significant predictor of events (HR: 1.046, CI 95% 1.000–1.095, p=0.05). The ROC curve analysis showed that a GLS > - 13% predicted cardiovascular events with an AUC of 0.7. The Kaplan-Meier curve showed that all the patients with cardiac amyloidosis have a bad prognosis, but the group of patients with GLS value higher than -13% presented a higher number of events in shorter time (Figure 1). CONCLUSIONS: Patients with cardiac amyloidosis present a high rate of cardiovascular events. CMR and assessment of GLSby tissue tracking constitutes an excellent imaging technique to diagnose and risk stratify these population.


without events

with events


Global radial strain (%)

34 ± 16

37 ± 17

31± 15


Global circumferential strain (%)

-15 ± 5

-17 ± 5

-15 ± 5


Global longitudinal strain (%)

-10 ± 6

-12± 4

-9 ± 7


Univariate analysis with the mean characteristics of the population with and without cardiovascular events. LGE: Late gadolinium enhancement

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