Cardiovascular Magnetic Resonance in the Management of Cardiac Amyloidosis Current and Future Clinical Applications

CA is a progressive disease causing extracellular myocardial infiltration by AL or ATTR fibrils. Timely diagnosis and treatment are critical to reverse a poor prognosis. CMR is a key tool in the diagnosis and assessment of CA: cine sequences provide superior morphologic and functional information, while LGE, T1 mapping, and ECV are used for diagnosis, localization, and quantification of myocardial amyloid infiltration and correlated with prognosis. Overall, ECV is considered the best quantitative measure of amyloid burden as it is specific for the extracellular space, while less sensitive to edema. In patients with severe renal impairment, where gadolinium administration is a relative contraindication, noncontrast technique (in particular native T1) may be an alternative.