Cardiac amyloid burden assessment by T1 mapping predicts survival in patients with systemic AL amyloidosis - a 2 year follow-up study

Background Cardiac involvement drives outcome in systemic AL amyloidosis. Late gadolinium enhancement (LGE) CMR is useful for the detection of cardiac amyloid, but characteristic LGE patterns do not always occur or may appear late in the disease. Using CMR T1 mapping, we measured the pre contrast myocardial T1 and myocardial Extracellular Volume (ECV), reflecting myocardial amyloidosis burden and determined their prognostic significance. Methods 102 patients underwent CMR and T1 mapping preand post contrast. Myocardial ECV was calculated at contrast equilibrium. 54 healthy volunteers served as controls. Patients were followed up for a median duration of 23 months and survival analyses were performed. A secondary analysis compared predictive power of the following techniques: pre contrast T1, post contrast T1, ECV at equilibrium (ECVi) and ECV at 15 minutes i.e. bolus only ECV (ECVb).