Multi-modality imaging of cardiac amyloidosis: Contemporary update

Abstract

Cardiac amyloidosis is a heterogeneous and challenging diagnostic disease with poor prognosis that is now being altered by introduction of new therapies. Echocardiography remains the first-line imaging tool, and when disease is suspected on echocardiography, cardiac magnetic resonance imaging and nuclear imaging play critical roles in the non-invasive diagnosis and evaluation of cardiac amyloidosis. Advances in multi-modality cardiac imaging allowing earlier diagnosis and initiation of novel therapies have significantly improved the outcomes in these patients. Cardiac imaging also plays important roles in the risk stratification of patients presenting with cardiac amyloidosis. In the current review, we provide a clinical and imaging focused update, and importantly outline the imaging protocols, diagnostic and prognostic utility of multimodality cardiac imaging in the assessment of cardiac amyloidosis.

Keywords: Cardiac amyloidosis; Echocardiography; Cardiac magnetic resonance imaging; Nuclear imaging

Core tip: Cardiac amyloidosis remains a heterogeneous disease and diagnostic challenge with poor prognosis. The clinical perspectives from epidemiology, presentation, differential diagnoses and initial investigations are discussed. The key roles of the three cornerstone imaging modalities including echocardiography, magnetic resonance imaging and nuclear imaging are discussed pertaining to their techniques, protocols, findings, strengths and limitations. These are integrated into diagnostic criteria, followed by summaries of the novel therapeutics from recent clinical trials.