Ashraf F. Evolving role of cardiac magnetic resonance in cardiac amyloidosis. World J Cardiol 2026; 18(10): 125443 [DOI: 10.4330/wjc.125443]
Corresponding Author of This Article
Farhan Ashraf, MD, Director, Department of Cardiology, LifeCore Private Clinic, 13 Al Halawi St - Al Muntazah - Ministries Complex, Abu Dhabi 68311, United Arab Emirates. faht47@hotmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
review-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Cardiol. Oct 26, 2026; 18(10): 125443 Published online Oct 26, 2026. doi: 10.4330/wjc.125443
Evolving role of cardiac magnetic resonance in cardiac amyloidosis
Farhan Ashraf
Farhan Ashraf, Department of Cardiology, LifeCore Private Clinic, Abu Dhabi 68311, United Arab Emirates
Author contributions: Ashraf F conceived the idea for the review, did the literature search, wrote and edited the manuscript.
AI contribution statement: An AI assistant (Claude, Anthropic PBC) was used in preparing this manuscript for the following purposes: Support for literature screening and identification of candidate references for manual retrieval; language editing and refinement of the author's draft text; and assistance with the structure and layout of Tables 1, 2 and 3. It was not used to generate original scientific claims, to analyse data, or to produce content not subsequently checked against primary sources. The author retrieved and read in full every source cited, individually verified every reference against PubMed for bibliographic details, publication status, PMID and DOI. The author takes full responsibility for the scientific content, accuracy, evidence summaries, numerical claims, conclusions and integrity of the manuscript.
Conflict-of-interest statement: The author declares no conflict of interests for this article.
Corresponding author: Farhan Ashraf, MD, Director, Department of Cardiology, LifeCore Private Clinic, 13 Al Halawi St - Al Muntazah - Ministries Complex, Abu Dhabi 68311, United Arab Emirates. faht47@hotmail.com
Received: July 7, 2026 Revised: September 6, 2026 Accepted: October 8, 2026 Published online: October 26, 2026 Processing time: 108 Days and 16 Hours
Abstract
Cardiac amyloidosis, characterized by misfolded transthyretin (ATTR) or immunoglobulin amyloid light-chain (AL) proteins, has shifted from a rarely diagnosed, near fatal or fatal condition, to a recognized and treatable cause of heart failure. This transformation has been enabled in large part by advances in non-invasive multimodality imaging, with cardiac magnetic resonance (CMR) occupying a prominent diagnostic and prognostic role. Late gadolinium enhancement, native T1 and T2 mapping, and extracellular volume quantification allow detection of amyloid infiltration with high sensitivity, often before overt phenotypic expression. CMR also provides robust and reproducible prognostic information that complements biomarkers and bone-avid scintigraphy. This review summarizes the established CMR diagnostic yield, its role within contemporary diagnostic algorithms for ATTR and AL amyloidosis, the prognostic value of quantitative tissue characterization, and the expanding evidence base for using CMR to monitor response to the new generation of disease modifying therapies. It also examines emerging evidence, including artificial intelligence assisted interpretation, non-contrast diagnostic strategies, extracardiac tissue mapping, and refinement of tissue mapping thresholds, that is likely to shape CMR practice in amyloidosis over the coming years.
Core Tip: Cardiac magnetic resonance imaging role in cardiac amyloidosis has evolved over time. Initially, cine imaging, chamber quantification, and characteristic delayed enhancement findings were used to identify this condition. With evolving technology, T1, T2 mapping and extra cellular volume have added to diagnostic accuracy. Further data has shown potential of differentiating transthyretin amyloidosis from amyloid light-chain amyloidosis. Extracellular volume and delayed enhancement imaging carry robust prognostic information, and serial extracellular volume is under active investigation as a treatment-monitoring biomarker.
