Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging
Abstract Background In-vivo cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) allows imaging of alterations of cardiac fiber architecture in diseased hearts. Cardiac amyloidosis (CA) causes myocardial infiltration of misfolded proteins with unknown consequences for myocardial mi...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-09-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12968-019-0563-2 |
| _version_ | 1797204873845932032 |
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| author | Alexander Gotschy Constantin von Deuster Robbert J. H. van Gorkum Mareike Gastl Ella Vintschger Rahel Schwotzer Andreas J. Flammer Robert Manka Christian T. Stoeck Sebastian Kozerke |
| author_facet | Alexander Gotschy Constantin von Deuster Robbert J. H. van Gorkum Mareike Gastl Ella Vintschger Rahel Schwotzer Andreas J. Flammer Robert Manka Christian T. Stoeck Sebastian Kozerke |
| author_sort | Alexander Gotschy |
| collection | DOAJ |
| description | Abstract Background In-vivo cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) allows imaging of alterations of cardiac fiber architecture in diseased hearts. Cardiac amyloidosis (CA) causes myocardial infiltration of misfolded proteins with unknown consequences for myocardial microstructure. This study applied CMR DTI in CA to assess microstructural alterations and their consequences for myocardial function compared to healthy controls. Methods Ten patients with CA (8 AL, 2 ATTR) and ten healthy controls were studied using a diffusion-weighed second-order motion-compensated spin-echo sequence at 1.5 T. Additionally, left ventricular morphology, ejection fraction, strain and native T1 values were obtained in all subjects. In CA patients, T1 mapping was repeated after the administration of gadolinium for extracellular volume fraction (ECV) calculation. CMR DTI analysis was performed to yield the scalar diffusion metrics mean diffusivity (MD) and fractional anisotropy (FA) as well as the characteristics of myofiber orientation including helix, transverse and E2A sheet angle (HA, TA, E2A). Results MD and FA were found to be significantly different between CA patients and healthy controls (MD 1.77 ± 0.17 10− 3 vs 1.41 ± 0.07 10− 3 mm2/s, p < 0.001; FA 0.25 ± 0.04 vs 0.35 ± 0.03, p < 0.001). MD demonstrated an excellent correlation with native T1 (r = 0.908, p < 0.001) while FA showed a significant correlation with ECV in the CA population (r = − 0.851, p < 0.002). HA exhibited a more circumferential orientation of myofibers in CA patients, in conjunction with a higher TA standard deviation and a higher absolute E2A sheet angle. The transmural HA slope was found to be strongly correlated with the global longitudinal strain (r = 0.921, p < 0.001). Conclusion CMR DTI reveals significant alterations of scalar diffusion metrics in CA patients versus healthy controls. Elevated MD and lower FA values indicate myocardial disarray with higher diffusion in CA that correlates well with native T1 and ECV measures. In CA patients, CMR DTI showed pronounced circumferential orientation of the myofibers, which may provide the rationale for the reduction of global longitudinal strain that occurs in amyloidosis patients. Accordingly, CMR DTI captures specific features of amyloid infiltration, which provides a deeper understanding of the microstructural consequences of CA. |
| first_indexed | 2024-04-24T08:42:09Z |
| format | Article |
| id | doaj.art-60840fc2ed744e18a93cff90b627d609 |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:42:09Z |
| publishDate | 2019-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-60840fc2ed744e18a93cff90b627d6092024-04-16T15:26:58ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2019-09-012111910.1186/s12968-019-0563-2Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imagingAlexander Gotschy0Constantin von Deuster1Robbert J. H. van Gorkum2Mareike Gastl3Ella Vintschger4Rahel Schwotzer5Andreas J. Flammer6Robert Manka7Christian T. Stoeck8Sebastian Kozerke9Institute for Biomedical Engineering, University and ETH ZurichInstitute for Biomedical Engineering, University and ETH ZurichInstitute for Biomedical Engineering, University and ETH ZurichInstitute for Biomedical Engineering, University and ETH ZurichInstitute for Biomedical Engineering, University and ETH ZurichDivision of Medical Oncology and Hematology, University Hospital ZurichDepartment of Cardiology, University Hospital ZurichDepartment of Cardiology, University Hospital ZurichInstitute for Biomedical Engineering, University and ETH ZurichInstitute for Biomedical Engineering, University and ETH ZurichAbstract Background In-vivo cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI) allows imaging of alterations of cardiac fiber architecture in diseased hearts. Cardiac amyloidosis (CA) causes myocardial infiltration of misfolded proteins with unknown consequences for myocardial microstructure. This study applied CMR DTI in CA to assess microstructural alterations and their consequences for myocardial function compared to healthy controls. Methods Ten patients with CA (8 AL, 2 ATTR) and ten healthy controls were studied using a diffusion-weighed second-order motion-compensated spin-echo sequence at 1.5 T. Additionally, left ventricular morphology, ejection fraction, strain and native T1 values were obtained in all subjects. In CA patients, T1 mapping was repeated after the administration of gadolinium for extracellular volume fraction (ECV) calculation. CMR DTI analysis was performed to yield the scalar diffusion metrics mean diffusivity (MD) and fractional anisotropy (FA) as well as the characteristics of myofiber orientation including helix, transverse and E2A sheet angle (HA, TA, E2A). Results MD and FA were found to be significantly different between CA patients and healthy controls (MD 1.77 ± 0.17 10− 3 vs 1.41 ± 0.07 10− 3 mm2/s, p < 0.001; FA 0.25 ± 0.04 vs 0.35 ± 0.03, p < 0.001). MD demonstrated an excellent correlation with native T1 (r = 0.908, p < 0.001) while FA showed a significant correlation with ECV in the CA population (r = − 0.851, p < 0.002). HA exhibited a more circumferential orientation of myofibers in CA patients, in conjunction with a higher TA standard deviation and a higher absolute E2A sheet angle. The transmural HA slope was found to be strongly correlated with the global longitudinal strain (r = 0.921, p < 0.001). Conclusion CMR DTI reveals significant alterations of scalar diffusion metrics in CA patients versus healthy controls. Elevated MD and lower FA values indicate myocardial disarray with higher diffusion in CA that correlates well with native T1 and ECV measures. In CA patients, CMR DTI showed pronounced circumferential orientation of the myofibers, which may provide the rationale for the reduction of global longitudinal strain that occurs in amyloidosis patients. Accordingly, CMR DTI captures specific features of amyloid infiltration, which provides a deeper understanding of the microstructural consequences of CA.http://link.springer.com/article/10.1186/s12968-019-0563-2Cardiovascular magnetic resonance imagingDiffusion tensor imagingCardiac amyloidosisMyocardial microstructureTissue characterization |
| spellingShingle | Alexander Gotschy Constantin von Deuster Robbert J. H. van Gorkum Mareike Gastl Ella Vintschger Rahel Schwotzer Andreas J. Flammer Robert Manka Christian T. Stoeck Sebastian Kozerke Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging Journal of Cardiovascular Magnetic Resonance Cardiovascular magnetic resonance imaging Diffusion tensor imaging Cardiac amyloidosis Myocardial microstructure Tissue characterization |
| title | Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging |
| title_full | Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging |
| title_fullStr | Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging |
| title_full_unstemmed | Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging |
| title_short | Characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging |
| title_sort | characterizing cardiac involvement in amyloidosis using cardiovascular magnetic resonance diffusion tensor imaging |
| topic | Cardiovascular magnetic resonance imaging Diffusion tensor imaging Cardiac amyloidosis Myocardial microstructure Tissue characterization |
| url | http://link.springer.com/article/10.1186/s12968-019-0563-2 |
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