SPC365

Prognostic Significance of MRI-Derived Lung Water Density in Cardiac Amyloidosis

Session: Sessão de Posters 28 - Do diagnóstico à decisão: cuidados orientados por imagem na era moderna
Speaker: Mariana Rocha Morato Silveira Ramos

Congress: CPC 2026
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.3 Cardiac Magnetic Resonance
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Mariana Silveira Ramos; Débora Correia; Rui Gomes; Gonçalo Cunha; Pedro Freitas; Carlos Aguiar; Bruno M. Rocha

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Background:&nbsp;</span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Lung Water Density (LWD), quantified by thoracic magnetic resonance imaging (MRI), is a validated non-invasive marker of pulmonary congestion. A cut-off of &gt;21.2% was previously established and externally validated in heart failure (HF). However, it has not been evaluated specifically in cardiac amyloidosis.</span> <span style="font-size:12.0pt">Its prognostic value in this population, characterized by restrictive physiology, remains unclear.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Aims:&nbsp;</span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">To evaluate the prognostic value of LWD in patients with cardiac amyloidosis.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Methods:</span></strong><strong><span style="font-size:12.0pt"> </span></strong><span style="font-size:12.0pt">We performed a retrospective study of patients with cardiac amyloidosis (TTR &ndash; transthyretin amyloidosis; and AL &ndash; light-chain amyloidosis) whom underwent standardized thoracic MRI between 2018 and 2025. Quantitative lung water was computed using validated MRI sequences, and patients were stratified using the published LWD &gt;21.2% threshold for HF. The primary endpoint was a composite of all-cause death or hospitalization for HF. The main secondary endpoints included 30-month survival and composite event-free survival. Kaplan&ndash;Meier curves were truncated at 30 months, and Cox proportional hazards regression (univariable and multivariable) assessed the prognostic impact of LWD.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Results:</span></strong><strong><span style="font-size:12.0pt"> </span></strong><span style="font-size:12.0pt">We included 101 patients (mean age 81</span> <span style="font-size:12.0pt">&plusmn;</span> <span style="font-size:12.0pt">8 years; 87% male; 93% ATTR). Overall, 20 patients had increased LWD (median 26%, IQR 23&ndash;28) and 81 had LWD</span> <span style="font-size:12.0pt">&lt;21.2% (median 15%, interquartile range [IQR] 12&ndash;18). Baseline characteristics were similar between groups, except for left ventricular ejection fraction, which was greater in patients with low LWD (48 &plusmn;</span> <span style="font-size:12.0pt">11 vs. 40</span> <span style="font-size:12.0pt">&plusmn;</span> <span style="font-size:12.0pt">17, p=0.020). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">During 30 months follow-up, 29 patients died and 17 had HF hospitalization. Patients with elevated LWD had significantly higher rates of the 30-month composite endpoint (16.0% vs. 68.8%, p&lt;0.001). In the multivariable model,</span>&nbsp;<span style="font-size:12.0pt">adjusted for amyloid protein subtype, clinical congestion and NYHA, LWD remained has a strong predictor of the primary outcome (HR:</span> <span style="font-size:12.0pt">5.26; 95% CI 2.04-12.5, p=0.001). </span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Conclusion:&nbsp;</span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Elevated MRI-derived lung water emerged as a powerful independent predictor of adverse outcomes in patients with cardiac amyloidosis, strongly associated with reduced survival and a substantially higher incidence of cardiovascular events. These findings support LWD as a clinically meaningful, objective biomarker of congestion and risk stratification in cardiac amyloidosis.</span></span></span></p>