Cardiovascular magnetic resonance in light-chain amyloidosis to guide treatment.

Autor:	Martinez-Naharro A; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Patel R; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Kotecha T; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK.; Institute of Cardiovascular Science, University College London, London, UK., Karia N; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK.; Institute of Cardiovascular Science, University College London, London, UK., Ioannou A; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Petrie A; UCL Eastman Dental Institute, London, UK., Chacko LA; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Razvi Y; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Ravichandran S; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Brown J; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK.; Institute of Cardiovascular Science, University College London, London, UK., Law S; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Quarta C; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Mahmood S; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Wisniowski B; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Pica S; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Sachchithanantham S; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Lachmann HJ; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Moon JC; Institute of Cardiovascular Science, University College London, London, UK.; Barts Heart Centre, West Smithfield, London, UK., Knight DS; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK.; Institute of Cardiovascular Science, University College London, London, UK., Whelan C; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Venneri L; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Xue H; National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA., Kellman P; National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA., Gillmore JD; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Hawkins PN; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Wechalekar AD; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK., Fontana M; National Amyloidosis Centre, Division of Medicine, University College London, Royal Free Hospital, London, UK.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2022 Dec 01; Vol. 43 (45), pp. 4722-4735.
DOI:	10.1093/eurheartj/ehac363
Abstrakt:	Aims: To assess the ability of cardiovascular magnetic resonance (CMR) to (i) measure changes in response to chemotherapy; (ii) assess the correlation between haematological response and changes in extracellular volume (ECV); and (iii) assess the association between changes in ECV and prognosis over and above existing predictors. Methods and Results: In total, 176 patients with cardiac AL amyloidosis were assessed using serial N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography, free light chains and CMR with T1 and ECV mapping at diagnosis and subsequently 6, 12, and 24 months after starting chemotherapy. Haematological response was graded as complete response (CR), very good partial response (VGPR), partial response (PR), or no response (NR). CMR response was graded by changes in ECV as progression (≥0.05 increase), stable (<0.05 change), or regression (≥0.05 decrease). At 6 months, CMR regression was observed in 3% (all CR/VGPR) and CMR progression in 32% (61% in PR/NR; 39% CR/VGPR). After 1 year, 22% had regression (all CR/VGPR), and 22% had progression (63% in PR/NR; 37% CR/VGPR). At 2 years, 38% had regression (all CR/VGPR), and 14% had progression (80% in PR/NR; 20% CR/VGPR). Thirty-six (25%) patients died during follow-up (40 ± 15 months); CMR response at 6 months predicted death (progression hazard ratio 3.82; 95% confidence interval 1.95-7.49; P < 0.001) and remained prognostic after adjusting for haematological response, NT-proBNP and longitudinal strain (P < 0.01). Conclusions: Cardiac amyloid deposits frequently regress following chemotherapy, but only in patients who achieve CR or VGPR. Changes in ECV predict outcome after adjusting for known predictors. Competing Interests: Conflict of interest: M.F. is supported by a British Heart Foundation Intermediate Clinical Research Fellowship (FS/18/21/33447). The other authors declare that there is no conflict of interest. (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.)
Databáze:	MEDLINE
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