{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:12:27Z","timestamp":1793391147909,"version":"4.5.0"},"reference-count":13,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec id=\"ab-hbr230011-4\"><jats:title>Importance<\/jats:title><jats:p>Cardiac magnetic resonance (CMR) imaging\u2013derived extracellular volume (ECV) mapping, generated from precontrast and postcontrast T1, accurately determines treatment response in cardiac light-chain amyloidosis. Native T1 mapping, which can be derived without the need for contrast, has demonstrated accuracy in diagnosis and prognostication, but it is unclear whether serial native T1 measurements could also track the cardiac treatment response.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr230011-5\"><jats:title>Objective<\/jats:title><jats:p>To assess whether native T1 mapping can measure the cardiac treatment response and the association between changes in native T1 and prognosis.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr230011-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This single-center cohort study evaluated patients diagnosed with cardiac light-chain amyloidosis (January 2016 to December 2020) who underwent CMR scans at diagnosis and a repeat scan following chemotherapy. Analysis took place between January 2016 and October 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr230011-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Comparison of biomarkers and cardiac imaging parameters between patients with a reduced, stable, or increased native T1 and association between changes in native T1 and mortality.<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr230011-8\"><jats:title>Results<\/jats:title><jats:p>The study comprised 221 patients (mean [SD] age, 64.7\u2009[10.6] years; 130 male [59%]). At 6 months, 183 patients (mean [SD] age, 64.8\u2009[10.5] years; 110 male [60%]) underwent repeat CMR imaging. Reduced native T1 of 50 milliseconds or more occurred in 8 patients (4%), all of whom had a good hematological response; by contrast, an increased native T1 of 50 milliseconds or more occurred in 42 patients (23%), most of whom had a poor hematological response (27 [68%]). At 12 months, 160 patients (mean [SD] age, 63.8\u2009[11.1] years; 94 male [59%]) had a repeat CMR scan. A reduced native T1 occurred in 24 patients (15%), all of whom had a good hematological response, and was associated with a reduction in N-terminal pro-brain natriuretic peptide (median [IQR], 2638 [913-5767] vs 423 [128-1777] ng\/L; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001), maximal wall thickness (mean [SD], 14.8\u2009[3.6] vs 13.6\u2009[3.9] mm; <jats:italic>P<\/jats:italic>\u2009=\u2009.009), and E\/e' (mean [SD], 14.9\u2009[6.8] vs 12.0\u2009[4.0]; <jats:italic>P<\/jats:italic>\u2009=\u2009.007), improved longitudinal strain (mean [SD], \u221214.8%\u2009[4.0%] vs \u221216.7% [4.0%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.004), and reduction in both myocardial T2 (mean [SD], 52.3\u2009[2.9] vs 49.4\u2009[2.0] milliseconds; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and ECV (mean [SD], 0.47\u2009[0.07] vs 0.42\u2009[0.08]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). At 12 months, an increased native T1 occurred in 24 patients (15%), most of whom had a poor hematological response (17 [71%]), and was associated with an increased N-terminal pro-brain natriuretic peptide (median [IQR], 1622 [554-5487] vs 3150 [1161-8745] ng\/L; <jats:italic>P<\/jats:italic>\u2009=\u2009.007), reduced left ventricular ejection fraction (mean [SD], 65.8% [11.4%] vs 61.5% [12.4%]; <jats:italic>P<\/jats:italic>\u2009=\u2009.009), and an increase in both myocardial T2 (mean [SD], 52.5\u2009[2.7] vs 55.3\u2009[4.2] milliseconds; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) and ECV (mean [SD], 0.48\u2009[0.09] vs 0.56\u2009[0.09]; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001). Change in myocardial native T1 at 6 months was independently associated with mortality (hazard ratio, 2.41 [95% CI, 1.36-4.27]; <jats:italic>P<\/jats:italic>\u2009=\u2009.003).<\/jats:p><\/jats:sec><jats:sec id=\"ab-hbr230011-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Changes in native T1 in response to treatment, reflecting a composite of changes in T2 and ECV, are associated with in changes in traditional markers of cardiac response and associated with mortality. However, as a single-center study, these results require external validation in a larger cohort.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamacardio.2023.2010","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T15:17:18Z","timestamp":1689779838000},"page":"848","source":"Crossref","is-referenced-by-count":46,"title":["Tracking Treatment Response in Cardiac Light-Chain Amyloidosis With Native T1 Mapping"],"prefix":"10.1001","volume":"8","author":[{"given":"Adam","family":"Ioannou","sequence":"first","affiliation":[{"name":"National Amyloidosis Centre, Royal Free Campus, University College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi K.","family":"Patel","sequence":"additional","affiliation":[{"name":"National Amyloidosis Centre, Royal Free Campus, University College London, London, United 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