Non-ischemic Primary and Secondary Cardiomyopathy

1352498 - Modeling of Late Gadolinium Enhancement Kinetics in Cardiac Amyloid

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

Leon Axel, MD, PhD

Professor
New York University Grossman School of Medicine
NEW YORK, New York, United States

Primary Author(s)

Leon Axel, MD, PhD

Professor
New York University Grossman School of Medicine
NEW YORK, New York, United States

Background: Cardiac involvement in amyloid deposition can lead to heart failure; it can sometimes be difficult to diagnose without biopsy. Magnetic resonance imaging (MRI) can provide useful information related to tissue characterization, as well as structure and function. Cardiac MRI (CMR) has been reported to be useful in the diagnosis of cardiac amyloid (CA). In particular, as reported by Maceira et al. (1), there can be some qualitatively distinctive features seen in CA, when using late gadolinium enhancement (LGE) imaging with inversion-recovery sensitization to the T1 effects of contrast agent (“contrast”). These distinctive findings include: 1) some patients have diffuse subendocardial LGE, and 2) there can be loss of the usually pronounced brightness difference between the relatively unenhanced portion of the myocardium and the normally brighter blood pool in the LV cavity (“dark blood”). However, the underlying mechanism of these findings has not been well investigated.

Methods: We created an interactive MATLAB-based computer program to qualitatively and quantitatively model the dynamics of LGE in the heart, incorporating a Tofts and Kermode 3-compartment model (2) of contrast enhancement kinetics, and used this program to assess the likely relative contributions of different physiologic factors in producing the characteristic LGE appearance of CA.

Results: The program was able to reproduce the qualitative features of both conventional “scar” LGE (Fig. 1) and CA LGE (Fig.2). The dark appearance of the blood in PSIR imaging is primarily due to increased enhancement of the reference myocardium.

Conclusion: The program was able to reproduce the qualitative features of both conventional “scar” LGE (Fig. 1) and CA LGE (Fig.2). The dark appearance of the blood in PSIR imaging is primarily due to increased enhancement of the reference myocardium.