Evaluating the Role of Multimodal Imaging in the Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

Objective

The objective of this study is to examine the evolving cardiac characteristics of patients with cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) by integrating multimodal imaging techniques, including conventional echocardiography, strain echocardiography, and cardiac magnetic resonance imaging.

Methods

A retrospective study was conducted, comprising 38 patients with CA, 20 patients with HCM, and 16 healthy individuals in the control group. Statistical analyses were conducted to assess conventional and strain echocardiography parameters across these groups. Furthermore, cardiac magnetic resonance imaging data from 15 patients with CA and 15 patients with HCM were analyzed and compared, focusing on correlations between imaging parameters and myocardial amyloid load.

Results

Analysis of conventional and strain echocardiography revealed that left ventricular ejection fraction, E/e′, relative apical longitudinal sparing, and the ejection fraction-to-longitudinal strain ratio were strongly associated with the diagnosis of CA and served as key differentiators between the CA and HCM groups. The combination of these four parameters yielded optimal diagnostic efficiency, with an area under the curve of 0.916.

Conclusion

The integration of conventional and strain multiparametric echocardiography demonstrated superior diagnostic efficacy in differentiating CA from HCM. Furthermore, the analysis of cardiac magnetic resonance parameters indicated that an increase in cardiac amyloid load is associated with changes in cardiac indices, with parameters such as E/e′, basal longitudinal strain, global longitudinal strain, and ejection fraction-to-strain ratio effectively reflecting the extent of amyloid infiltration in the myocardium.