Heart failure & cardiomyopathiesCohort study
Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping
- Retrospective cohort study
- single-centre
Authors' conclusion
Changes in native T1 in response to treatment, reflecting a composite of changes in T2 and ECV, are associated with in changes in traditional markers of cardiac response and associated with mortality.
Study context
- Population
- Patients with cardiac light-chain amyloidosis with cardiac magnetic resonance (CMR) at diagnosis and repeat CMR after chemotherapy, 2016–2020183 rescanned at 6 mo, 160 at 12 mo
- Participants
- 221 patients
- Exposure
- Reduced vs stable vs increased native T1 after chemotherapy
- Outcome
- Biomarkers and cardiac imaging parameters by change in native T1 (reduced, stable, increased); association of native T1 change with mortality
Main finding
Change in native T1 and prognosis · 6 and 12 months
Hazard ratio
2.41
95% CI 1.36–4.27
P = 0.003
Change in native T1 at 6 months vs Stable native T1
HR 2.41 (95% CI 1.36–4.27); P = 0.003
As reported in the abstract
- 6 mo: reduced native T1 ≥50 ms, all with good hematological response
- 8 (4%)
- 6 mo: increased native T1 ≥50 ms; poor hematological response 27 [68%]
- 42 (23%)
- 12 mo: reduced native T1, all with good hematological response
- 24 (15%)
- 12 mo: increased native T1; poor hematological response 17 [71%]
- 24 (15%)
Observational data: associations, not effects.
Further findings
Reduced native T1 at 12 months: change from baseline to 12 months
- NT-proBNP, median [IQR], ng/L
- 2638 [913-5767] vs 423 [128-1777]; P < .001
- Maximal wall thickness, mean [SD], mm
- 14.8 [3.6] vs 13.6 [3.9]; P = .009
- E/e', mean [SD]
- 14.9 [6.8] vs 12.0 [4.0]; P = .007
- Longitudinal strain, mean [SD]
- −14.8% [4.0%] vs −16.7% [4.0%]; P = .004
- Myocardial T2, mean [SD], ms
- 52.3 [2.9] vs 49.4 [2.0]; P < .001
- Extracellular volume (ECV), mean [SD]
- 0.47 [0.07] vs 0.42 [0.08]; P < .001
Increased native T1 at 12 months: change from baseline to 12 months
- NT-proBNP, median [IQR], ng/L
- 1622 [554-5487] vs 3150 [1161-8745]; P = .007
- LVEF, mean [SD]
- 65.8% [11.4%] vs 61.5% [12.4%]; P = .009
- Myocardial T2, mean [SD], ms
- 52.5 [2.7] vs 55.3 [4.2]; P < .001
- ECV, mean [SD]
- 0.48 [0.09] vs 0.56 [0.09]; P < .001
Original publication
Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping. JAMA Cardiol. Published 1 September 2023. doi:10.1001/jamacardio.2023.2010
Summarised from the published abstract; every number is checked against it