Daniel Sado

James Moon

Matthew D Robson

Philip N Hawkins

Sanjay M Banypersad

Stefan K Piechnik

Stefan Neubauer

Theodoros Karamitsos

Vanessa Ferreira

Viviana Maestrini

Journal of Cardiovascular Magnetic Resonance

PubMed

Karamitsos, T

Banypersad, SM

Sado, D

Maestrini, V

Ferreira, V

Piechnik, SK

Robson, Matthew

Hawkins, PN

Neubauer, Stefan

Moon, J

Oxford University Research Archive

Pre-contrast ShMOLLI T1 mapping in cardiac AL amyloidosis.

Springer - Publisher Connector

Pre-contrast ShMOLLI T1 mapping in cardiac AL amyloidosis

Robson, MD

Neubauer, S

Oxford University Research Archive (ORA)

ORAL PRESENTATION Open Access
Pre-contrast ShMOLLI T1 mapping in cardiac AL
amyloidosis
Theodoros Karamitsos2*, Sanjay M Banypersad1,3, Daniel Sado1, Viviana Maestrini1, Vanessa Ferreira2,
Stefan K Piechnik2, Matthew D Robson2, Philip N Hawkins3, Stefan Neubauer2, James Moon1
From 15th Annual SCMR Scientific Sessions
Orlando, FL, USA. 2-5 February 2012
Background
Multi-organ disease with cardiac involvement carries a
very poor prognosis in Systemic AL Amyloidosis. The
risk of nephrogenic systemic fibrosis is a significant
obstacle in assessing cardiac status using CMR in
patients with systemic AL amyloidosis who have
advanced renal failure. Measurement of myocardial T1
values has been limited until now, due to long breath-
hold times. We have developed a robust and clinically
applicable technique for diagnosing cardiac amyloidosis
by measuring absolute myocardial T1 values using the
single breath hold, Shortened Modified Look-Locker
Inversion Recovery (ShMOLLI) sequence without gado-
linium administration.
Methods
Thirty-five patients (23 males, 12 females, mean age 60
years) with systemic AL amyloidosis underwent conven-
tional CMR scanning with cine imaging and late gadoli-
nium imaging as well as ShMOLLI pre-contrast T1-
mapping between both centres; all patients had an eGFR
of >30ml/min. Myocardial T1 values from the basal sep-
tum in the apical 4-chamber view were measured and
compared against cardiac biomarkers, and ECG data.
Results were compared to normal controls (n=54). Con-
ventional clinical assessment using the Mayo staging
system ranked cardiac involvement as definite, probable
and none.
Results
Myocardial T1 was significantly higher in all patients
with systemic AL amyloidosis compared to normals
(1057 vs 967, P<0.001). When assessed against pre-test
probability of cardiac involvement based on clinical eva-
luation, myocardial T1 in patients with probable and
definite cardiac disease was significantly higher than
normals (P<0.005) (see figure 1). Myocardial T1 corre-
lated linearly with indexed LV mass (R2 0.21, P<0.005),
BNP (R2 0.49, P<0.005) and inversely with ejection frac-
tion (R2 0.31, P<0.005) and QRS voltage on ECG (R2
0.32, P<0.005) (see figure 2). Correlations were not
observed with markers of functional assessment such as
NYHA class and ECOG status, possibly due to con-
founding variables such as co-existing peripheral neuro-
pathy and degree of fluid overload.
Conclusions
Using the ShMOLLI sequence to measure absolute myo-
cardial T1 times in patients with systemic AL
2Dept. of Cardiovascular Medicine, University of Oxford Centre for Clinical
Magnetic Resonance Research (OCMR), Oxford, UK
Full list of author information is available at the end of the article
Figure 1 showing pre-contrast, mean myocardial T1 in patients
with cardiac AL amyloidosis, subgrouped into pre-test clinical
probability of cardiac involvement.
Karamitsos et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):O76
http://www.jcmr-online.com/content/14/S1/O76
© 2012 Karamitsos et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
amyloidosis is a safe and accurate method for determin-
ing the presence or otherwise of cardiac involvement by
amyloid and it correlates well with currently accepted
measures of cardiac dysfunction in amyloidosis.
Funding
GSK, SKP, VMF, MDR funded by the NIHR Oxford
Biomedical Research Centre Programme.
Author details
1MRI, The Heart Hospital, London, UK. 2Dept. of Cardiovascular Medicine,
University of Oxford Centre for Clinical Magnetic Resonance Research
(OCMR), Oxford, UK. 3National Amyloidosis Centre, Royal Free Hospital,
London, UK.
Published: 1 February 2012
doi:10.1186/1532-429X-14-S1-O76
Cite this article as: Karamitsos et al.: Pre-contrast ShMOLLI T1 mapping
in cardiac AL amyloidosis. Journal of Cardiovascular Magnetic Resonance
2012 14(Suppl 1):O76.
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Figure 2 showing the correlation between pre-contrast, mean
myocardial T1 by ShMOLLI and mean indexed LV mass.
Karamitsos et al. Journal of Cardiovascular Magnetic Resonance 2012, 14(Suppl 1):O76
http://www.jcmr-online.com/content/14/S1/O76
Page 2 of 2


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Pre-contrast ShMOLLI T1 mapping in cardiac AL amyloidosis

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