Benefits of advanced MRI for patients with heart stiffening disease

An advanced form of cardiac MRI, developed by academics at UCL in collaboration with the Royal Free Hospital, has for the first-time enabled clinicians to measure the effectiveness of chemotherapy in patients with the life-limiting condition 'stiff heart syndrome'.

Researchers say the breakthrough, published in the European Heart Journal, means doctors will now be able to better guide treatment strategies and, by doing so, improve patients' prognosis.

Assessing the condition has been difficult, as while clinicians can detect the presence of amyloid in the heart, there has been no safe test to measure the amount.

This has also meant there has been no way of measuring the therapeutic effect of chemotherapy – the normal first-line treatment.

A patient's response is currently assessed with indirect biological markers, but these do not measure the amount (or reduction) of cardiac amyloid – the drug's ultimate target – and doctors find the markers less useful when trying to assess second-line chemotherapy treatments.

Now for the first time they have used the technology to evaluate the success of chemotherapy treatment, by assessing cardiac amyloid regression or progression.

For the study 176 patients with light-chain cardiac amyloidosis had Cardiovascular Magnetic Resonance with Extracellular Volume Mapping. CMR scans with ECV mapping were done at diagnosis, and then at six, 12 and 24 months after starting chemotherapy.

The advanced MRI technique allowed researchers to accurately measure the amount of amyloid protein in hearts, and, for the first-time ever, to measure the changes in response to chemotherapy on repeat scans. By measuring the changes they could detect which patients would have a better or worse prognosis.

Further, combining the results with blood tests for the disease, it was found almost 40% of patients had a substantial improvement (reduction) in amyloid deposition, something that was not thought to be possible before – showing how effective chemotherapy can be.

Ref:

Ana Martinez-Naharro et. al, 'Cardiac magnetic resonance in light-chain amyloidosis to guide treatment',28 July, 2022, DOI: 10.1093/eurheartj/ehac363