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Prognostic Value of Right Ventricular Dysfunction in Patients With AL Amyloidosis: Comparison of Different Techniques by Cardiac Magnetic Resonance
Author(s) -
Wan Ke,
Lin Jiayi,
Guo Xinli,
Song Rizhen,
Wang Jie,
Xu Yuanwei,
Li Weihao,
Cheng Wei,
Sun Jiayu,
Zhang Qing,
Han Yuchi,
Chen Yucheng
Publication year - 2020
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.27200
Subject(s) - medicine , cardiology , al amyloidosis , hazard ratio , proportional hazards model , interquartile range , ejection fraction , receiver operating characteristic , amyloidosis , confidence interval , cardiac amyloidosis , univariate analysis , magnetic resonance imaging , heart failure , radiology , multivariate analysis , immunoglobulin light chain , antibody , immunology
Background Right ventricular (RV) dysfunction is common in patients with amyloid light‐chain (AL) amyloidosis. While cardiac MRI is the reference standard tool for RV assessment, there are a number of measures of RV function that can be evaluated and it is yet unknown which of these results in the highest prognostic performance in AL amyloidosis. Purpose To examine the prognostic value of various measures of RV function in a bid to find which best predicts outcome in AL amyloidosis. Study Type Single‐center, prospective. Subjects In all, 129 patients (mean age, 58 ± 11 years; 61.2% men) with biopsy‐proven AL amyloidosis. Field Strength/Sequence 3.0T / balanced steady‐state free‐precession cine. Assessment RV ejection fraction (EF), RV fractional area change (FAC), RV long axis strain (LAS), RV free wall longitudinal strain (FWS), RV global longitudinal strain (GLS), and tricuspid annular plane systolic excursion (TAPSE). Statistical Tests Mann–Whitney U ‐tests, Student's t ‐tests, receiver‐operating characteristic curves, Kaplan–Meier curves, Cox proportional hazards regression models, and C‐statistics. Results During the median follow‐up period of 38.0 months (interquartile range, 18.5–58.0 months), all‐cause mortality occurred in 95 patients (73.6%). The RVEF, RVGLS, TAPSE, RVFAC, and RVFWS were significant predictors of outcome in univariate Cox regression (all P < 0.001). After adjusting for New York Heart Association (NYHA) class, Mayo staging 2004, left ventricular (LV) EF, and LV mass index, RVFWS (HR [hazard ratio] =1.074; 95% CI [confidence interval]: 1.041–1.108; P < 0.001) was an independent predictor of all‐cause mortality and had a higher C‐statistic (0.753) compared to the model including RVEF (C‐statistic = 0.724, P = 0.034), the model including RVFAC (C‐statistic = 0.723, P = 0.033), and the model including RVGLS (C‐statistic =0.733, P = 0.011). Data Conclusion RV dysfunction appears to be an independent determinant of outcome in patients with AL amyloidosis. RVFWS is a better predictor of all‐cause mortality than RVEF, RVFAC, or RVGLS. Evidence Level 2 Technical Efficacy Stage 5