eprintid: 10051749
rev_number: 23
eprint_status: archive
userid: 608
dir: disk0/10/05/17/49
datestamp: 2019-10-28 11:32:44
lastmod: 2021-10-11 22:41:53
status_changed: 2019-10-28 11:32:44
type: article
metadata_visibility: show
creators_name: Martinez-Naharro, A
title: Native T1 and ECV in ATTR amyloidosis
ispublished: pub
divisions: UCL
divisions: B02
divisions: C10
divisions: D17
divisions: C09
divisions: D14
keywords: Amyloidosis, ATTR, CMR, ECV
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: Objectives
This study evaluated the prognostic potential of native myocardial T1 in cardiac transthyretin amyloidosis (ATTR) and compared native T1 with extracellular volume (ECV) in terms of diagnostic accuracy and prognosis.

Background
ATTR is an increasingly recognized cause of heart failure that has an overlapping clinical phenotype with hypertrophic cardiomyopathy (HCM). Native T1 mapping by cardiac magnetic resonance (CMR) is useful for diagnosis in cardiac amyloidosis but its prognostic potential has never been assessed.

Methods
A total of 134 patients with wild-type ATTR (ATTRwt) (122 men; age 76 ± 7 years), 81 patients with hereditary-type ATTR (ATTRm) (60 men; age 69 ± 11 years), 44 patients with HCM (32 men; age 51 ± 13 years), and 12 asymptomatic mutation carriers (4 men; age 47 ± 10 years) were studied. All subjects underwent CMR with T1 mapping and ECV measurement. ATTR patients also underwent 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy.

Results
Native T1 and ECV were elevated in ATTR compared with HCM (p < 0.001) and were both associated with a high diagnostic accuracy (area under the curve [AUC]: 0.87; 95% confidence interval [CI]: 0.82 to 0.91) for T1 and an AUC of 0.91 (95% CI: 0.87 to 0.94) for ECV. No significant difference in native T1 and ECV was found between ATTRwt and ATTRm, and ECV correlated well with 99mTc-DPD scintigraphy. During follow-up of a mean of 32 ± 17 months, 55 ATTRwt and 40 ATTRm patients died. Native T1 and ECV predicted death (T1: hazard ratio [HR]: 1.225 for each 59-ms increase; 95% CI: 1.010 to 1.486; p < 0.05; ECV: HR: 1.155 for each 3% increase; 95% CI: 1.097 to 1.216; p < 0.001), but only ECV remained independently predictive after adjustment for age, N-terminal pro−B-type natriuretic peptide, left ventricular ejection fraction, E/E′, left ventricular mass index, DPD grade, and late gadolinium enhancement.

Conclusions
Native T1 mapping and ECV are good diagnostic techniques for cardiac ATTR that are associated with prognosis. Both parameters correlated with mortality, but only ECV remained independently predictive of prognosis, suggesting that it is a more robust marker in cardiac ATTR.
date: 2019-03-01
date_type: published
publisher: Elsevier
official_url: https://doi.org/10.1016/j.jcmg.2018.02.006
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
article_type_text: Article
verified: verified_manual
elements_id: 1565829
doi: 10.1016/j.jcmg.2018.02.006
lyricists_name: Knight, Daniel
lyricists_name: Martinez De Azcona Naharro, Ana
lyricists_id: DSKNI50
lyricists_id: AMARA76
actors_name: Martinez De Azcona Naharro, Ana
actors_id: AMARA76
actors_role: owner
full_text_status: public
publication: JACC: Cardiovascular Imaging
volume: 12
number: 5
pagerange: 810-819
issn: 1876-7591
citation:        Martinez-Naharro, A;      (2019)    Native T1 and ECV in ATTR amyloidosis.                   JACC: Cardiovascular Imaging , 12  (5)   pp. 810-819.    10.1016/j.jcmg.2018.02.006 <https://doi.org/10.1016/j.jcmg.2018.02.006>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10051749/1/Native%20T1%20and%20ECV%20in%20ATTR%20amyloidosis.pdf