Imperial College London


Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology



+44 (0)20 7351 8810d.pennell




CMR UnitRoyal BromptonRoyal Brompton Campus






BibTex format

author = {Khalique, Z and Ferreira, PF and Scott, AD and Nielles-Vallespin, S and Martinez-Naharro, A and Fontana, M and Hawkins, P and Firmin, DN and Pennell, DJ},
doi = {10.1161/CIRCIMAGING.119.009901},
journal = {Circulation: Cardiovascular Imaging},
title = {Diffusion tensor cardiovascular magnetic resonance in cardiac amyloidosis},
url = {},
volume = {13},
year = {2020}

RIS format (EndNote, RefMan)

AB - Background Cardiac amyloidosis (CA) is a disease of interstitial myocardial infiltration, usually by light chains or transthyretin. We used diffusion tensor cardiovascular magnetic resonance (DT-CMR) to noninvasively assess the effects of amyloid infiltration on the cardiac microstructure. Methods DT-CMR was performed at diastole and systole in 20 CA, 11 hypertrophic cardiomyopathy, and 10 control subjects with calculation of mean diffusivity, fractional anisotropy, and sheetlet orientation (secondary eigenvector angle). Results Mean diffusivity was elevated and fractional anisotropy reduced in CA compared with both controls and hypertrophic cardiomyopathy (P<0.001). In CA, mean diffusivity was correlated with extracellular volume (r=0.68, P=0.004), and fractional anisotropy was inversely correlated with circumferential strain (r=-0.65, P=0.02). In CA, diastolic secondary eigenvector angle was elevated, and secondary eigenvector angle mobility was reduced compared with controls (both P<0.001). Diastolic secondary eigenvector angle was correlated with amyloid burden measured by extracellular volume in transthyretin, but not light chain amyloidosis. Conclusions DT-CMR can characterize the microstructural effects of amyloid infiltration and is a contrast-free method to identify the location and extent of the expanded disorganized myocardium. The diffusion biomarkers mean diffusivity and fractional anisotropy effectively discriminate CA from hypertrophic cardiomyopathy. DT-CMR demonstrated that failure of sheetlet relaxation in diastole correlated with extracellular volume in transthyretin, but not light chain amyloidosis. This indicates that different mechanisms may be responsible for impaired contractility in CA, with an amyloid burden effect in transthyretin, but an idiosyncratic effect in light chain amyloidosis. Consequently, DT-CMR offers a contrast-free tool to identify novel pathophysiology, improve diagnostics, and monitor disease through noninvasive micr
AU - Khalique,Z
AU - Ferreira,PF
AU - Scott,AD
AU - Nielles-Vallespin,S
AU - Martinez-Naharro,A
AU - Fontana,M
AU - Hawkins,P
AU - Firmin,DN
AU - Pennell,DJ
DO - 10.1161/CIRCIMAGING.119.009901
PY - 2020///
SN - 1941-9651
TI - Diffusion tensor cardiovascular magnetic resonance in cardiac amyloidosis
T2 - Circulation: Cardiovascular Imaging
UR -
UR -
UR -
VL - 13
ER -