Clinical Outcomes and Prognosis

1355944 - Association of Cardiac MRI Derived Left Ventricular Strain and Left Atrial Structure and Function with All-Cause Mortality in Patients with Cardiac Amyloidosis

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

KR

Kaveh Rezaei Bookani, MD

Cardiac Imaging Fellow
Cedars-Sinai Medical Center
Los Angeles, California, United States

Primary Author(s)

KR

Kaveh Rezaei Bookani, MD

Cardiac Imaging Fellow
Cedars-Sinai Medical Center
Los Angeles, California, United States

Co-Author(s)

SB

Senthil Surya Balasubramanian, MD

Cardiology Fellow
University of Chicago, Illinois, United States
DH

Donghee Han, MD

Associate Director
Cedars-Sinai Medical Center, California, United States
KH

Kifah Hussain, MD

Cardiology Fellow
University of Chicago, Illinois, United States
LW

Lucas Wathen

Research Assistant
NorthShore University HealthSystem, Illinois, United States
NS

Nitasha Sarswat, MD

Assistant Professor
University of Chicago Medicine, United States
AP

Amit Pursnani, MD

Program Director, Cardiology Fellowship Program
NorthShore University HealthSystem
EVANSTON, Illinois, United States

Background:

Cardiac involvement is a major determinant of adverse outcomes in patients with amyloidosis. We aim to explore prognostic value of cardiac MRI (CMR)-derived left atrial (LA) structure, LA function, and left ventricular (LV) strain in cardiac amyloidosis (CA) patients.

Methods: We evaluated 63 patients (67% ATTR, 33% AL) who had CMR-derived volumetric and strain measurements including LA minimum and maximum volume indexes, LA emptying fraction, LA longitudinal strain, and LV global longitudinal, radial, and circumferential strains. CMR data were obtained by automated feature tracking post-processing. The outcome was all-cause mortality.

Results: Of 63 patients, mean age was 82 years, 75% were men, 76.2% were Caucasian, 70.5% had HTN, and 59% had atrial fibrillation. They had reduced LV strains (LAX GLS -8.9 ± 3.3, LAX GRS 11.2± 3.6, SAX GRS 16.7 ± 5.8, SAX GCS -11.6 ± 3.2), enlarged LA (LAMaxVi 57.5 ± 22.9 mL/m², LAMinVi 44.1 ± 16.2 mL/m²), reduced LAEF (24.3 ± 5.2%), and LA strain (5.4± 2.2%). In multivariable Cox regression, LAX GRS, SAX GRS, SAX GCS, and LAMaxVi were significantly associated with all-cause mortality after adjustment for age, sex, type of CA, and LV function (Table). There was no association between LAEF and LA strain with mortality on either univariable or multivariable analysis.

Conclusion:

LV strains and LA structure and function analysis can be performed through fully automated post-processing methods. In our study, LV strains and LA volume were associated with all-cause mortality in patients with CA. Further studies are needed to establish their role in prognosis and response to therapy in patients with CA.