Advances in imaging-based diagnosis, prognosis, and response assessment in cardiac amyloidosis: a comprehensive multimodality review

Abstract

Cardiac amyloidosis, characterized by extracellular deposition of amyloid fibrils within the myocardium, is an increasingly recognized cause of heart failure. With the advent of disease-modifying therapies, imaging has become central to diagnosis, subtype differentiation, prognostication, and treatment monitoring. This review provides a comprehensive update on multimodality imaging in cardiac amyloidosis, emphasizing its clinical utility across the disease continuum. Echocardiography, technetium-labeled bone scintigraphy, amyloid-specific positron emission tomography, cardiac magnetic resonance, and cardiac computed tomography each contribute uniquely to detecting amyloid burden and assessing cardiac function. In addition to outlining a practical diagnostic approach, we highlight emerging imaging biomarkers for monitoring treatment response and predicting clinical outcomes. The integration of these modalities into clinical practice enhances diagnostic accuracy, enables individualized risk stratification, and supports optimized, evidence-based care for patients with cardiac amyloidosis.