EDITORIAL T1 mapping and amyloid cardiomyopathy: how much better can it get?

This editorial refers to ‘T1 mapping and survival in sys-temic light-chain amyloidosis’†, by S.M. Banypersad et al., on page 244. Systemic light-chain (AL) amyloidosis carries a high risk of cardiac in-volvement and portends poor prognosis.1 Patients with cardiac AL amyloidosis have a median survival of 8 months compared with 4 years when the heart is spared. Therefore, confirmation of cardiac involvement is critical for therapeutic decision-making and patient counselling. Furthermore, differentiation from other cardio-myopathies with left ventricular hypertrophy or features of restrict-ive physiology on echocardiography is frequently necessary. Over the last decade, cardiovascular magnetic resonance (CMR), and particularly the late gadolinium enhancement (LGE) technique, has been validated as a means to identify cardiac involvement in AL amyloidosis.2–4 The appearance of global, subendocardial LGE i