Impact of cardiovascular magnetic resonance guided imaging pathway in cardiac amyloidosis
R L Godfrey, J Mcqueen, S Brown, K Flowers, M Elsewafy, T Corbett, T Chevassut, A Hosur, T Alway, J Silberbauer, A LiuAbstract
Background
In patients with cardiac amyloidosis (CA), timely diagnosis and initiation of therapies have important prognostic implications. Diagnostic pathways for CA can vary; some with an emphasis on the use of Cardiac Magnetic Resonance (CMR) prior to clinical decision-making, whilst others may proceed based on clinical information and transthoracic echocardiography (TTE) alone. We evaluated the effect of CMR- or TTE-guided pathways on the Time To a change in clinical Management (TTM).
Purpose
To assess whether imaging pathways (CMR- vs TTE-guided) influence TTM in CA patients.
Methods
We screened consecutive patients with CA from the clinical imaging databases in a UK tertiary cardiac centre between January 2023 to December 2025 using the keywords "amyloid" or "amyloidosis" in requests and reports. CA patients treated with Daratumumab, Bortezomib, Cyclophosphamide, and Dexamethasone (Dara-VCD - first-line for light chain amyloidosis) were also screened. Patients’ clinical, TTE and CMR data were collected. TTM was defined as the time period from imaging to a change in clinical management, including the initiation of Dara-VCD treatment locally, referral to specialist amyloidosis centre, or decision for conservative management.
Results
A total of 39 patients with CA were included (n=23 in the CMR-guided group and n=16 in the TTE-guided group). The median age of the patients was 80 (IQR 74-84) years, which was similar between the two pathways (median ages 79 [IQR 70.5–83] vs 81 [IQR 77.5–84] years; p = 0.14). Of the 39 patients, n=22 had transthyretin amyloidosis, n=16 had light-chain amyloidosis, and n=1 had an unclassified CA type. Although the proportion of men appears higher in the CMR group (91.3%) compared with TTE (75.0%), the difference was not statistically significant (p > 0.05). The CMR-guided group had a significantly shorter median TTM as compared the TTE-guided group (38 days [IQR 25–145] vs 155 days [IQR 62–285]; p=0.03). Of the 39 patients, 11 received Dara-VCD, 25 were referred to a CA specialist centre and 3 patients were managed conservatively (either asymptomatic or in a palliative stage).
Conclusions
In this single-centre study, CA patients whose management decisions were guided by CMR had an overall shorter time to a change in management, as compared to those guided by TTE. Where appropriate, incorporating CMR may help to facilitate clinical decision-making. Most patients in the study received an appropriate management plan, underscoring the efficacy of both imaging-guided pathways in clinical care. Further work is required to test these findings in a larger prospective study.