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Archives of cardiovascular diseases
Volume 103, n° 1
pages 55-56 (janvier 2010)
Doi : 10.1016/j.acvd.2008.11.006
Received : 26 June 2008 ;  accepted : 19 November 2008
Left ventricular hypertrophy: Cardiac magnetic resonance may help differentiate amyloidosis from hypertrophic cardiomyopathy
Hypertrophie ventriculaire gauche : l’IRM cardiaque différencie l’amylose cardiaque de la myocardiopathie hypertrophique

Mikaël Mabru a, Jean Nicolas Dacher b, Fabrice Bauer c,
a Cardiology Department, Rouen University Hospital, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France 
b Radiology Department, Rouen University Hospital, Rouen, France 
c Unité Inserm U644, Rouen University Medical School, Rouen, France 

Corresponding author. Fax: 02 32 88 87 14.

Keywords : Amyloidosis, Hypertrophic cardiomyopathy, MRI, Diagnosis, Echocardiography

Mots clés : Amylose, Cardiopathie hypertrophique primitive, IRM, Échocardiographie

Cardiac amyloidosis is rare, but when diagnosed it has an urgent and specific treatment. Two patients with similar concentric left ventricular hypertrophy on echocardiography were investigated with cardiac magnetic resonance (CMR) to differentiate cardiac amyloidosis from hypertrophic cardiomyopathy.

In the setting of hypertrophic cardiomyopathy, early hyperenhancement occurs around 200ms, comparable to normal (Figure 1, arrows in top and middle rows). Late myocardium enhancement is characterized by multiple non-specific interstitial nodules within the hypertrophic myocardium suggesting interstitial fibrosis. When a diagnosis of cardiac amyloidosis is established, CMR demonstrates late subendocardial enhancement on delayed images associated with a short inversion time, around 150ms (Figure 1, arrow in bottom row).

Figure 1

Figure 1. 

CMR short axis view at papillary muscle level showing shortened inversion-time in cardiac amyloidosis.

HCM: hypertrophic cardiomyopathy.


The inversion time is assessed according to the TI scouting technique (Look Locker sequence), which estimates the normal myocardial T1 relaxation time. Briefly, 10 to 15minutes after gadolinium injection, the same short-axis T1-weighted sequence is acquired sequentially, typically around 50ms. The inversion time is chosen visually when the myocardium turns black. It is dependent on the dose of gadolinium injected, the time elapsed between gadolinium injection and imaging, and the patient. The normal inversion time ranges from 250 to 300ms, and normally shortens in patients with cardiac amyloidosis, which is not observed with the other types of left ventricular hypertrophy.

CMR could therefore be a non-invasive alternative to myocardial biopsy to diagnose cardiac amyloidosis, with a sensitivity of 100% when the analysis is combined with an electrocardiogram and echocardiography. Moreover, in amyloidosis, CMR is useful for following up patients (T1 correlates with left ventricular mass, thickness and systolic function) and to evaluate the response to chemotherapy.

Conflicts of interest and disclosures


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