Research article
Prognostic implication of late gadolinium enhancement on cardiac
MRI in light chain (AL) amyloidosis on long term follow up
RaymondQMigrino*1,2, RichardChristenson2, AnikoSzabo3,
MeganBright1, SethTruran1 and ParameswaranHari4
Abstract
Background: Light chain amyloidosis (AL) is a rare plasma cell dyscrasia associated with poor
survival especially in the setting of heart failure. Late gadolinium enhancement (LGE) on cardiac MRI
was recently found to correlate with myocardial amyloid deposition but the prognostic role is not
established. The aim is to determine the prognostic significance of LGE in AL by comparing long
term survival of AL patients with and without LGE.
Methods: Twenty nine consecutive patients (14 females; 62 ± 11 years) with biopsy-proven AL
undergoing cardiac MRI with gadolinium as part of AL workup were included. Survival was
prospectively followed 29 months (median) following MRI and compared between those with and
without LGE by Kaplan-Meier and log-rank analyses.
Results: LGE was positive in 23 subjects (79%) and negative in 6 (21%). Left ventricular ejection
fraction was 66 ± 17% in LGE-positive and 69 ± 12% in LGE-negative patients (p = 0.8). Overall 1-
year mortality was 36%. On follow-up, 14/23 LGE-positive and none of LGE-negative patients died
(log rank p = 0.0061). Presenting New York Heart Association heart failure class was also
associated with poor survival (p = 0.0059). Survival between two LGE groups stratified by heart
failure class still showed a significant difference by a stratified log-rank test (p = 0.04).
Conclusion: Late gadolinium enhancement is common and is associated with poor long-term
survival in light chain amyloidosis, even after adjustment for heart failure class presentation. The
prognostic significance of late gadolinium enhancement in this disease may be useful in patient risk-
stratification.
BMC Medical Physics 2009, 9:5
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