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Cardiovascular Magnetic Resonance Imaging-Based Right Atrial Strain Analysis of Cardiac Amyloidosis

ORCID
0000-0002-5172-8080
Affiliation
Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Eckstein, Jan;
ORCID
0000-0001-6303-2040
Affiliation
Clinic for Electrophysiology, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Sciacca, Vanessa;
ORCID
0000-0002-5425-8440
Affiliation
Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Körperich, Hermann;
ORCID
0000-0002-9095-1277
Affiliation
Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany
Paluszkiewicz, Lech;
Affiliation
Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Valdés, Elena Weise;
Affiliation
Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Burchert, Wolfgang;
Affiliation
Clinic for General and Interventional Cardiology, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Gerçek, Muhammed;
Affiliation
Cardiogenetic Laboratory, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany
Farr, Martin;
ORCID
0000-0002-3037-8704
Affiliation
Clinic for Electrophysiology, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Sommer, Philipp;
ORCID
0000-0003-0490-5862
Affiliation
Clinic for Electrophysiology, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Sohns, Christian;
ORCID
0000-0003-0539-0610
Affiliation
Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany
Piran, Misagh

Abstract Background : Cardiac amyloidosis (CA) manifests in a hypertrophic phenotype with a poor prognosis, making differentiation from hypertrophic cardiomyopathy (HCM) challenging and delaying early treatment. The extent to which magnetic resonance imaging (MRI) quantifies the right atrial strain (RAS) and strain rate (RASR), providing valuable diagnostic information, is not yet clinically established. Aims : This study assesses diagnostic differences in the longitudinal RAS and RASR between CA and HCM patients, control subjects (CTRL) and CA subtypes in addition to the impact of atrial fibrillation (AF) on the right atrial function in CA patients. The RAS and RASR of tricuspid regurgitation (TR) patients are used to assess the potential for diagnostic overlap. Methods : RAS and RASR quantification was conducted via MRI feature-tracking for biopsy-confirmed CA patients with subtypes identified. Strain parameters were compared for CTRL, HCM and TR patients. Post hoc testing identified intergroup differences. Results : In total, 41 CA patients were compared to 47 CTRL, 20 HCM and 31 TR patients. Reservoir (R), conduit and booster RAS and RASRs allow for significant differentiation ( p < 0.001) between CA and HCM patients (R: 10.6 ± 14.3% vs. R: 33.5 ± 16.3%) and CTRL (R: 44.6 ± 15.7%). Booster and reservoir RAS and RASRs qualified as reliable diagnostic tests (AUC > 0.8). CA patients with AF, in contrast to sinus rhythm, demonstrated a significantly impaired reservoir RAS and RASR and booster RASR. The discriminative power of RAS for CA vs. TR was insufficient (R: 10.6% ± 14.3% vs. 7.0% ± 6.0%, p = 0.069). Differentiation between 21 transthyretin and 20 light-chain amyloidosis subtypes was not achievable (R: 0.7% ± 1.0% vs. 0.7% ± 1.0%, p = 0.827). Conclusion : The MRI-derived RAS and RASR are impaired in CA patients and may support noninvasive differentiation between CA, HCM and CTRL.

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