Native T1 CMR Imaging for Diagnosis of Cardiac Amyloidosis
Native T1 CMR Imaging for Diagnosis of Cardiac Amyloidosis
The study aims to test the diagnostic accuracy of native T1 mapping for the diagnosis of
 cardiac amyloidosis prospectively. The hypothesis is that native T1 mapping with a cut-off
 value of 1341ms (3 tesla CMR) in older patients with symptomatic heart failure, increased LV
 wall thickness and elevated cardiac biomarkers is non-inferior to the reference method to
 diagnose cardiac amyloidosis (CA).

 As secondary measure, a web-based ATTR probability estimator for the diagnosis of CA will be
 evaluated.
Cardiac amyloidosis (CA) is an important differential diagnosis in older patients with
 symptomatic heart failure with preserved or mid-range ejection fraction and increased left
 ventricular wall thickness. The prevalence of CA among patients with heart failure and left
 ventricular (LV) hypertrophy is approximately 13%. However, diagnosis of CA is challenging
 because specific clinical signs are often lacking.

 Amyloid fibrils deposit in the extracellular space of the myocardium increases myocardial T1
 values on cardiac magnetic resonance (CMR). Therefore, native T1 imaging provides a promising
 non-invasive method to identify CA.

 A preliminary retrospective analysis of 128 patients with increased LV wall thickness
 identified an area under the curve of 0.9954 (p<0.0001) for native T1 to detect CA. The
 optimal cut-off value was 1341ms, with a sensitivity of 100% and a specificity of 97%.

 The investigators aim to test the diagnostic accuracy of native T1 mapping with the threshold
 of 1341ms for the diagnosis of CA compared to the reference method prospectively. Moreover,
 the web-based ATTR probability estimator for the diagnosis of CA will be evaluated.
Inclusion Criteria:

 -  Age ≥ 60 years

 -  Symptomatic heart failure (NYHA II-IV) with LVEF ≥40%

 -  Increased LV wall thickness (≥12mm end-diastolic)

 -  NT-proBNP ≥1000pg/mL

 -  Elevated hs-troponin T ≥14ng/L

 Exclusion Criteria:

 -  Contraindications for CMR

 -  Acute myocarditis

 -  Acute myocardial infarction <1 month

 -  Severe aortic stenosis and RAISE score < 2 points