Serial Native T1 Mapping to Monitor Cardiac Response to Treatment in Light-Chain Amyloidosis
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Amyloidosis is a condition in which misfolded proteins form insoluble deposits in the extracellular space of various tissues and organs, leading to interstitial expansion and disruption of structure and function. Light-chain (AL) amyloidosis is caused by an underlying plasma cell dyscrasia; cardiac involvement is common, is present in ≈50% of patients at presentation, and is a principal driver of morbidity and mortality.1 In practice, there has been reliance on ECG and echocardiographic features, as well as serum cardiac biomarkers, such as pro-brain natriuretic peptide and troponin T concentrations, for prognostic purposes and correlation to clinical response to treatment. However, these parameters can be of limited use because of concomitant etiologies for left ventricular (LV) hypertrophy and coexisting renal impairment. T1 relaxation time for hydrogen magnetization in the myocardium, an intrinsic characteristic of tissue, has been studied in a variety of pathologies with diffuse processes, including amyloidosis. Native, also known as noncontrast or precontrast, T1 mapping can be performed without the use of gadolinium-based contrast in patients with significantly reduced glomerular filtration rate. The technique of T1 mapping with cardiovascular magnetic resonance (CMR), in which T1 relaxation times for all pixels in the acquired image of the heart are measured, has been used for purposes of tissue characterization in regards to the diagnosis of cardiac involvement2 and prognosis in AL amyloidosis3 at single time point evaluations. Here we present a case using serial CMR native T1 mapping to assess treatment response of AL amyloidosis in a patient with renal failure.
A 60-year-old …