Delayed Hyper-Enhancement Magnetic Resonance Imaging Provides Incremental Diagnostic and Prognostic Utility in Suspected Cardiac Amyloidosis
Objectives We sought to assess the diagnostic accuracy and incremental prognostic value of delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR) compared with electrocardiographic and transthoracic echocardiographic (TTE) parameters in such patients. Background Utility of DHE-CMR in the dia...
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| Veröffentlicht in: | JACC. Cardiovascular imaging 2009-12, Vol.2 (12), p.1369-1377 |
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| creator | Austin, Bethany A., MD Tang, W.H. Wilson, MD Rodriguez, E. Rene, MD Tan, Carmela, MD Flamm, Scott D., MD Taylor, David O., MD Starling, Randall C., MD, MPH Desai, Milind Y., MD |
| description | Objectives We sought to assess the diagnostic accuracy and incremental prognostic value of delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR) compared with electrocardiographic and transthoracic echocardiographic (TTE) parameters in such patients. Background Utility of DHE-CMR in the diagnosis of patients with suspected cardiac amyloidosis (CA) has recently been demonstrated, but its incremental prognostic utility is unclear. Methods Forty-seven consecutive patients (mean age 63 years, 70% men, 55% New York Heart Association functional class >II) with suspected CA who underwent electrocardiography (ECG), TTE, DHE-CMR, and biopsy (38 endomyocardial, 9 extracardiac) were studied. Low voltage on ECG was defined as S-wave in lead V1 + R-wave in lead V5 or V6 15, and 47% had advanced (pseudonormal or restrictive) diastology. The diagnostic accuracy of DHE-CMR in patients undergoing endomyocardial biopsy was as follows: sensitivity 88%, specificity 90%, positive predictive value 88%, and negative predictive value 90%. On multivariable logistic regression testing of the diagnostic ability of various noninvasive imaging parameters, only DHE-CMR was significant (Wald chi-square statistic 9.6, p < 0.01). At 1-year post-biopsy, there were 9 (19%) deaths. On Cox proportional hazards analysis, only positive DHE-CMR was a predictor of 1-year mortality (Wald chi-square statistic 4.91, p = 0.03). Conclusions A characteristic DHE-CMR pattern is more accurate for diagnosis and is a stronger predictor of 1-year mortality in patients with suspected CA as compared with other noninvasive parameters. |
| doi_str_mv | 10.1016/j.jcmg.2009.08.008 |
| format | Article |
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Wilson, MD ; Rodriguez, E. Rene, MD ; Tan, Carmela, MD ; Flamm, Scott D., MD ; Taylor, David O., MD ; Starling, Randall C., MD, MPH ; Desai, Milind Y., MD</creator><creatorcontrib>Austin, Bethany A., MD ; Tang, W.H. Wilson, MD ; Rodriguez, E. Rene, MD ; Tan, Carmela, MD ; Flamm, Scott D., MD ; Taylor, David O., MD ; Starling, Randall C., MD, MPH ; Desai, Milind Y., MD</creatorcontrib><description>Objectives We sought to assess the diagnostic accuracy and incremental prognostic value of delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR) compared with electrocardiographic and transthoracic echocardiographic (TTE) parameters in such patients. Background Utility of DHE-CMR in the diagnosis of patients with suspected cardiac amyloidosis (CA) has recently been demonstrated, but its incremental prognostic utility is unclear. Methods Forty-seven consecutive patients (mean age 63 years, 70% men, 55% New York Heart Association functional class >II) with suspected CA who underwent electrocardiography (ECG), TTE, DHE-CMR, and biopsy (38 endomyocardial, 9 extracardiac) were studied. Low voltage on ECG was defined as S-wave in lead V1 + R-wave in lead V5 or V6 <15 mm. TTE parameters, including deceleration time, E/E′ ratio, and diastolic grade were recorded. CMR was considered positive with diffuse DHE of the subendocardium extending to adjacent myocardium. All-cause mortality was ascertained. Results In the study population, 59% had low voltage on ECG, 30% had abnormal deceleration time ≤150 ms, 38% had E/E′ ratio >15, and 47% had advanced (pseudonormal or restrictive) diastology. The diagnostic accuracy of DHE-CMR in patients undergoing endomyocardial biopsy was as follows: sensitivity 88%, specificity 90%, positive predictive value 88%, and negative predictive value 90%. On multivariable logistic regression testing of the diagnostic ability of various noninvasive imaging parameters, only DHE-CMR was significant (Wald chi-square statistic 9.6, p < 0.01). At 1-year post-biopsy, there were 9 (19%) deaths. On Cox proportional hazards analysis, only positive DHE-CMR was a predictor of 1-year mortality (Wald chi-square statistic 4.91, p = 0.03). Conclusions A characteristic DHE-CMR pattern is more accurate for diagnosis and is a stronger predictor of 1-year mortality in patients with suspected CA as compared with other noninvasive parameters.</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2009.08.008</identifier><identifier>PMID: 20083070</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Amyloidosis - diagnosis ; Amyloidosis - diagnostic imaging ; Amyloidosis - mortality ; Amyloidosis - pathology ; Biopsy ; Cardiovascular ; Contrast Media ; Echocardiography, Doppler ; Electrocardiography ; Female ; Heart Diseases - diagnosis ; Heart Diseases - diagnostic imaging ; Heart Diseases - mortality ; Heart Diseases - pathology ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myocardium - pathology ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Risk Assessment ; Sensitivity and Specificity ; Time Factors</subject><ispartof>JACC. Cardiovascular imaging, 2009-12, Vol.2 (12), p.1369-1377</ispartof><rights>American College of Cardiology Foundation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c505t-c124c93a1cf221e796396e61bd620afad153c7f2db04edda380b02bf1ee0ace03</citedby><cites>FETCH-LOGICAL-c505t-c124c93a1cf221e796396e61bd620afad153c7f2db04edda380b02bf1ee0ace03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20083070$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Austin, Bethany A., MD</creatorcontrib><creatorcontrib>Tang, W.H. Wilson, MD</creatorcontrib><creatorcontrib>Rodriguez, E. Rene, MD</creatorcontrib><creatorcontrib>Tan, Carmela, MD</creatorcontrib><creatorcontrib>Flamm, Scott D., MD</creatorcontrib><creatorcontrib>Taylor, David O., MD</creatorcontrib><creatorcontrib>Starling, Randall C., MD, MPH</creatorcontrib><creatorcontrib>Desai, Milind Y., MD</creatorcontrib><title>Delayed Hyper-Enhancement Magnetic Resonance Imaging Provides Incremental Diagnostic and Prognostic Utility in Suspected Cardiac Amyloidosis</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>Objectives We sought to assess the diagnostic accuracy and incremental prognostic value of delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR) compared with electrocardiographic and transthoracic echocardiographic (TTE) parameters in such patients. Background Utility of DHE-CMR in the diagnosis of patients with suspected cardiac amyloidosis (CA) has recently been demonstrated, but its incremental prognostic utility is unclear. Methods Forty-seven consecutive patients (mean age 63 years, 70% men, 55% New York Heart Association functional class >II) with suspected CA who underwent electrocardiography (ECG), TTE, DHE-CMR, and biopsy (38 endomyocardial, 9 extracardiac) were studied. Low voltage on ECG was defined as S-wave in lead V1 + R-wave in lead V5 or V6 <15 mm. TTE parameters, including deceleration time, E/E′ ratio, and diastolic grade were recorded. CMR was considered positive with diffuse DHE of the subendocardium extending to adjacent myocardium. All-cause mortality was ascertained. Results In the study population, 59% had low voltage on ECG, 30% had abnormal deceleration time ≤150 ms, 38% had E/E′ ratio >15, and 47% had advanced (pseudonormal or restrictive) diastology. The diagnostic accuracy of DHE-CMR in patients undergoing endomyocardial biopsy was as follows: sensitivity 88%, specificity 90%, positive predictive value 88%, and negative predictive value 90%. On multivariable logistic regression testing of the diagnostic ability of various noninvasive imaging parameters, only DHE-CMR was significant (Wald chi-square statistic 9.6, p < 0.01). At 1-year post-biopsy, there were 9 (19%) deaths. On Cox proportional hazards analysis, only positive DHE-CMR was a predictor of 1-year mortality (Wald chi-square statistic 4.91, p = 0.03). Conclusions A characteristic DHE-CMR pattern is more accurate for diagnosis and is a stronger predictor of 1-year mortality in patients with suspected CA as compared with other noninvasive parameters.</description><subject>Aged</subject><subject>Amyloidosis - diagnosis</subject><subject>Amyloidosis - diagnostic imaging</subject><subject>Amyloidosis - mortality</subject><subject>Amyloidosis - pathology</subject><subject>Biopsy</subject><subject>Cardiovascular</subject><subject>Contrast Media</subject><subject>Echocardiography, Doppler</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Heart Diseases - diagnosis</subject><subject>Heart Diseases - diagnostic imaging</subject><subject>Heart Diseases - mortality</subject><subject>Heart Diseases - pathology</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Time Factors</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kc9u1DAQhy0EomXhBTgg3zgljO2sk1yQqm2hKxWBKJW4WY49WRwSZ2snlfIOPDQx23LyH32_Gc18hLxlkDNg8kOXd2Y45BygzqHKAapn5JxVpczKbc2er_dayKwqq59n5FWMHYAEWZQvydkaqQSUcE7-XGKvF7T0ejliyK78L-0NDugn-kUfPE7O0O8YR5--6X7QB-cP9FsYH5zFSPfehH-07umlWwNjTAntbWKenneT6920UOfp7RyPaKa14U4H67ShF8PSj86O0cXX5EWr-4hvHs8Nuft09WN3nd18_bzfXdxkZgvbKTOMF6YWmpmWc4ZlLUUtUbLGSg661ZZthSlbbhso0FotKmiANy1DBG0QxIa8P9U9hvF-xjipwUWDfa89jnNUpRAVK4o6kfxEmjDGGLBVx-AGHRbFQCUJqlNJgkoSFFQqLXZD3j2Wn5sB7f_I09ZX4OMJwHXIB4dBmd55Z3T_GxeM3TgHv86vmIpcgbpNHpNGqFeFkpfiL5AqnJA</recordid><startdate>20091201</startdate><enddate>20091201</enddate><creator>Austin, Bethany A., MD</creator><creator>Tang, W.H. Wilson, MD</creator><creator>Rodriguez, E. Rene, MD</creator><creator>Tan, Carmela, MD</creator><creator>Flamm, Scott D., MD</creator><creator>Taylor, David O., MD</creator><creator>Starling, Randall C., MD, MPH</creator><creator>Desai, Milind Y., MD</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20091201</creationdate><title>Delayed Hyper-Enhancement Magnetic Resonance Imaging Provides Incremental Diagnostic and Prognostic Utility in Suspected Cardiac Amyloidosis</title><author>Austin, Bethany A., MD ; Tang, W.H. Wilson, MD ; Rodriguez, E. Rene, MD ; Tan, Carmela, MD ; Flamm, Scott D., MD ; Taylor, David O., MD ; Starling, Randall C., MD, MPH ; Desai, Milind Y., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c505t-c124c93a1cf221e796396e61bd620afad153c7f2db04edda380b02bf1ee0ace03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Amyloidosis - diagnosis</topic><topic>Amyloidosis - diagnostic imaging</topic><topic>Amyloidosis - mortality</topic><topic>Amyloidosis - pathology</topic><topic>Biopsy</topic><topic>Cardiovascular</topic><topic>Contrast Media</topic><topic>Echocardiography, Doppler</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Heart Diseases - diagnosis</topic><topic>Heart Diseases - diagnostic imaging</topic><topic>Heart Diseases - mortality</topic><topic>Heart Diseases - pathology</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardium - pathology</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Austin, Bethany A., MD</creatorcontrib><creatorcontrib>Tang, W.H. Wilson, MD</creatorcontrib><creatorcontrib>Rodriguez, E. Rene, MD</creatorcontrib><creatorcontrib>Tan, Carmela, MD</creatorcontrib><creatorcontrib>Flamm, Scott D., MD</creatorcontrib><creatorcontrib>Taylor, David O., MD</creatorcontrib><creatorcontrib>Starling, Randall C., MD, MPH</creatorcontrib><creatorcontrib>Desai, Milind Y., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Austin, Bethany A., MD</au><au>Tang, W.H. Wilson, MD</au><au>Rodriguez, E. Rene, MD</au><au>Tan, Carmela, MD</au><au>Flamm, Scott D., MD</au><au>Taylor, David O., MD</au><au>Starling, Randall C., MD, MPH</au><au>Desai, Milind Y., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delayed Hyper-Enhancement Magnetic Resonance Imaging Provides Incremental Diagnostic and Prognostic Utility in Suspected Cardiac Amyloidosis</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2009-12-01</date><risdate>2009</risdate><volume>2</volume><issue>12</issue><spage>1369</spage><epage>1377</epage><pages>1369-1377</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>Objectives We sought to assess the diagnostic accuracy and incremental prognostic value of delayed hyper-enhancement cardiac magnetic resonance (DHE-CMR) compared with electrocardiographic and transthoracic echocardiographic (TTE) parameters in such patients. Background Utility of DHE-CMR in the diagnosis of patients with suspected cardiac amyloidosis (CA) has recently been demonstrated, but its incremental prognostic utility is unclear. Methods Forty-seven consecutive patients (mean age 63 years, 70% men, 55% New York Heart Association functional class >II) with suspected CA who underwent electrocardiography (ECG), TTE, DHE-CMR, and biopsy (38 endomyocardial, 9 extracardiac) were studied. Low voltage on ECG was defined as S-wave in lead V1 + R-wave in lead V5 or V6 <15 mm. TTE parameters, including deceleration time, E/E′ ratio, and diastolic grade were recorded. CMR was considered positive with diffuse DHE of the subendocardium extending to adjacent myocardium. All-cause mortality was ascertained. Results In the study population, 59% had low voltage on ECG, 30% had abnormal deceleration time ≤150 ms, 38% had E/E′ ratio >15, and 47% had advanced (pseudonormal or restrictive) diastology. The diagnostic accuracy of DHE-CMR in patients undergoing endomyocardial biopsy was as follows: sensitivity 88%, specificity 90%, positive predictive value 88%, and negative predictive value 90%. On multivariable logistic regression testing of the diagnostic ability of various noninvasive imaging parameters, only DHE-CMR was significant (Wald chi-square statistic 9.6, p < 0.01). At 1-year post-biopsy, there were 9 (19%) deaths. On Cox proportional hazards analysis, only positive DHE-CMR was a predictor of 1-year mortality (Wald chi-square statistic 4.91, p = 0.03). Conclusions A characteristic DHE-CMR pattern is more accurate for diagnosis and is a stronger predictor of 1-year mortality in patients with suspected CA as compared with other noninvasive parameters.</abstract><cop>United States</cop><pmid>20083070</pmid><doi>10.1016/j.jcmg.2009.08.008</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Amyloidosis - diagnosis Amyloidosis - diagnostic imaging Amyloidosis - mortality Amyloidosis - pathology Biopsy Cardiovascular Contrast Media Echocardiography, Doppler Electrocardiography Female Heart Diseases - diagnosis Heart Diseases - diagnostic imaging Heart Diseases - mortality Heart Diseases - pathology Humans Kaplan-Meier Estimate Logistic Models Magnetic Resonance Imaging Male Middle Aged Myocardium - pathology Predictive Value of Tests Prognosis Proportional Hazards Models Risk Assessment Sensitivity and Specificity Time Factors |
| title | Delayed Hyper-Enhancement Magnetic Resonance Imaging Provides Incremental Diagnostic and Prognostic Utility in Suspected Cardiac Amyloidosis |
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