Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2020; 12(6): 87-100
Published online Jun 28, 2020. doi: 10.4329/wjr.v12.i6.87
Multi-modality imaging of cardiac amyloidosis: Contemporary update
Tom Kai Ming Wang, Ossama K Abou Hassan, Wael Jaber, Bo Xu
Tom Kai Ming Wang, Ossama K Abou Hassan, Wael Jaber, Bo Xu, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: Wang TKM, Abou Hassan OK, Jaber W and Xu B involved in the conceptualization, writing, revision and final approval of the manuscript.
Conflict-of-interest statement: No conflicts of interest to declare for all authors for this article
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bo Xu, MB BS (Hons), FRACP, FACC, FASE, Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, United States. xub@ccf.org
Received: February 20, 2020
Peer-review started: February 20, 2020
First decision: March 28, 2020
Revised: May 13, 2020
Accepted: June 2, 2020
Article in press: June 2, 2020
Published online: June 28, 2020
Processing time: 128 Days and 12.1 Hours
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.