# The value of cardiac magnetic resonance delayed enhancement combined with tissue tracking in discriminating cardiac amyloidosis from hypertrophic cardiomyopathy

## TL;DR

This study shows that combining cardiac MRI techniques can help distinguish between two heart conditions with similar symptoms.

## Contribution

The study introduces a noninvasive imaging approach combining delayed enhancement and tissue tracking for diagnosing heart conditions.

## Key findings

- Linear subendocardial enhancement was the most common pattern in cardiac amyloidosis.
- Global circumferential and longitudinal strain values significantly differ between cardiac amyloidosis and hypertrophic cardiomyopathy.
- Optimal cutoff values for GCS and GLS improve noninvasive diagnosis of these conditions.

## Abstract

Cardiac amyloidosis (CA) and hypertrophic cardiomyopathy (HCM) may both present with left ventricular hypertrophy, making differential diagnosis challenging. This study aimed to evaluate the value of cardiac magnetic resonance (CMR) delayed enhancement combined with tissue tracking (CMR-TT) in discriminating CA from HCM.

Data from 30 patients with CA, 29 patients with HCM, and 20 normal controls (NC) were retrospectively analyzed. All subjects underwent CMR examinations. Tissue tracking techniques were adopted for CMR cine sequences to directly quantify global radial strain (GRS), global circumferential strain (GCS), and global longitudinal strain (GLS).

The most common delayed enhancement pattern in CA was linear subendocardial enhancement (76.7%). Half of the CA patients had delayed enhancement involving atria and right ventricle, while 33.3% exhibited the characteristic “chaotic sign.” The GRS and GCS values were significantly different between the CA group and the HCM group and between the CA group and the NC group (P < 0.05). GLS differed significantly among the CA, HCM, and NC groups (P < 0.05). ROC analysis revealed that GCS (AUC = 0.748, P = 0.001) and GLS (AUC = 0.732, P = 0.002) provided good diagnostic efficiency in differentiating CA from HCM.

CMR delayed enhancement patterns combined with myocardial strain parameters, particularly GLS and GCS, can aid in the differential diagnosis of CA and HCM. Optimal cutoff values of GCS (−14.6%) and GLS (−9.22%) provide a noninvasive imaging approach with significant clinical implications for guiding treatment and improving prognosis.