Light-Chain Cardiac Amyloidosis: Cardiac Magnetic Resonance for Assessing Response to Chemotherapy

• Published in: Korean journal of radiology Vol. 25; no. 5; pp. 426 - 437
• Main Authors: Guo, Yubo, Li, Xiao, Gao, Yajuan, Shen, Kaini, Lin, Lu, Wang, Jian, Cao, Jian, Zhang, Zhuoli, Wan, Ke, Zhou, Xi Yang, Chen, Yucheng, Zhang, Long Jiang, Li, Jian, Wang, Yining
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.05.2024; 대한영상의학회
• Subjects: Amyloidosis - diagnostic imaging; Amyloidosis - drug therapy; Antineoplastic Agents - therapeutic use; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - drug therapy; Cardiovascular Imaging; Feasibility Studies; Female; Humans; Immunoglobulin Light-chain Amyloidosis - diagnostic imaging; Immunoglobulin Light-chain Amyloidosis - drug therapy; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Prospective Studies; Treatment Outcome; 방사선과학; Chemotherapy; Longitudinal strain; Amyloidosis; Tissue characterization; Cardiac magnetic resonance
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2023.0985

Cardiac magnetic resonance (CMR) is a diagnostic tool that provides precise and reproducible information about cardiac structure, function, and tissue characterization, aiding in the monitoring of chemotherapy response in patients with light-chain cardiac amyloidosis (AL-CA). This study aimed to evaluate the feasibility of CMR in monitoring responses to chemotherapy in patients with AL-CA. In this prospective study, we enrolled 111 patients with AL-CA (50.5% male; median age, 54 [interquartile range, 49-63] years). Patients underwent longitudinal monitoring using biomarkers and CMR imaging. At follow-up after chemotherapy, patients were categorized into superior and inferior response groups based on their hematological and cardiac laboratory responses to chemotherapy. Changes in CMR findings across therapies and differences between response groups were analyzed. Following chemotherapy (before vs. after), there were significant increases in myocardial T2 (43.6 ± 3.5 ms vs. 44.6 ± 4.1 ms; = 0.008), recovery in right ventricular (RV) longitudinal strain (median of -9.6% vs. -11.7%; = 0.031), and decrease in RV extracellular volume fraction (ECV) (median of 53.9% vs. 51.6%; = 0.048). These changes were more pronounced in the superior-response group. Patients with superior cardiac laboratory response showed significantly greater reductions in RV ECV (-2.9% [interquartile range, -8.7%-1.1%] vs. 1.7% [-5.5%-7.1%]; = 0.017) and left ventricular ECV (-2.0% [-6.0%-1.3%] vs. 2.0% [-3.0%-5.0%]; = 0.01) compared with those with inferior response. Cardiac amyloid deposition can regress following chemotherapy in patients with AL-CA, particularly showing more prominent regression, possibly earlier, in the RV. CMR emerges as an effective tool for monitoring associated tissue characteristics and ventricular functional recovery in patients with AL-CA undergoing chemotherapy, thereby supporting its utility in treatment response assessment.