Cardiac Magnetic Resonance For Evaluation And Prediction Of Chemotherapy Efficacy In Light Chain Amyloidosis

Objective:This study aimed to analyze the changes of CMR indexes before and after chemotherapy in patients with AL amyloidosis and to explore the value of CMR in the evaluation of the therapeutic efficacy.Materials and Methods:Retrospectively included 43 patients with AL cardiac amyloidosis.All the patients received chemotherapy and CMR images before treatment and after about 1 year of follow-up were obtained.Hematologic response was assessed with dFLC,and organ response was assessed with NT-proBNP,NYHA functional classification,etc.Ventricular volume,wall thickness,ejection fraction,cardiac output,native T1 mapping,T2 mapping,LGE,ECV and strain before and after treatment,and the improvement of these indexes in patients with different hematologic or organ response were analyzed.Results:1)After treatment,LVEDV and LVESV were significantly increased(pLVEDV<0.001,pLVESV=0.006).No significant difference was shown in the increase of LVEDV or LVESV between patients with and without hematological or organ response;2)The longitudinal strain in each segment was significantly increased(p<0.01);In patients with hematological or organ response,the improvement of the basal longitudinal strain and global longitudinal strain were significantly better than that of patients with no response(p<0.05);The improvement of strain has a certain correlation with the decrease of NT-proBNP.3)T2 mapping is significantly increased after treatment,and the increase is related to the organ response.Conclusion:CMR has some significant value in evaluating the chemotherapy effect of patients with AL cardiac amyloidosis.The basal longitudinal strain and global longitudinal strain can be useful in assessing the therapeutic effect.Objective:To explore the value of CMR in predicting the efficacy of chemotherapy drugs in AL patients with cardiac involvement.Materials and methods:43 AL patients with cardiac involvement were retrospectively included.After baseline CMR images were obtained,the patients received chemotherapy and were followed up for about 1 year.Cardiac response was assessed according to clinical indexes.Compare the baseline CMR indexes between remission group and non-remission group,and ROC curve was used to evaluate the predictive ability of the indexes.Results:The T2 mapping value in the remission group was significantly higher than that in the non-remission group(p=0.049);the area under the ROC curve for T2 mapping to predict cardiac efficacy was 0.761.With 42.3ms as the threshold,its sensitivity was 71.9%,and specific was 85.7%.Conclusion:T2 mapping in CMR has a predictive value for the cardiac efficacy of AL patients after chemotherapy.T2 mapping greater than 42.3ms indicates better cardiac efficacy.