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Identification and typing of cardiac amyloidosis by noninvasive imaging: Two cases for two patterns

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Journal of Nuclear Cardiology Aims and scope

Abstract

Cardiac amyloidosis is a restrictive infiltrative cardiomyopathy burdened by high mortality. The two more common forms are immunoglobulin light-chain amyloidosis and transthyretin-related amyloidosis with different prognoses and treatments. However, distinguishing between them is challenging. Appropriate utilization of the different available imaging techniques in the evaluation of patients with known or suspected cardiac amyloidosis is mandatory. We report two cases with cardiac amyloidosis of different etiology and with distinct imaging patterns. In the first case, the negative 99mTc-diphosphonate imaging was useful to support the diagnosis of cardiac amyloid light-chain; the second case emphasized the utility of whole-body scintigraphy in recognizing transthyretin-related cardiac amyloidosis and the potential role of cadmium-zinc-telluride SPECT imaging for the evaluation of segmental distribution of cardiac disease. Both cases support the growing interest in looking for noninvasive methods to type cardiac amyloidosis in the place of invasive myocardial biopsy highlighting both possibilities and limitations of available imaging techniques in diagnosis and treatment monitoring.

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Abbreviations

AL:

Amyloid light-chain

ATTR:

Transthyretin-related cardiac amyloidosis

LV:

Left ventricular

MR:

Magnetic resonance

DTPA:

Diethylenetriamine pentaacetic acid

DPD:

3,3-Diphosphono-1,2-propanodicarboxylicacid

SPECT:

Single-photon emission tomography

CZT:

Cadmium-zinc-telluride

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Disclosures

C. Nappi, E. Zampella, F. Volpe, M. De Risi, L. Piscopo, A. Ponsiglione, M. Imbriaco, W. Acampa, M. Petretta, and A. Cuocolo declare that they have no financial conflict of interest.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy

    Carmela Nappi MD, PhD, Emilia Zampella MD, PhD, Fabio Volpe MD, Marina De Risi MD, Leandra Piscopo MD, Andrea Ponsiglione MD, Massimo Imbriaco MD, Wanda Acampa MD, PhD & Alberto Cuocolo MD

  2. Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy

    Wanda Acampa MD, PhD

  3. Department of Translational Medical Sciences, University Federico II, Naples, Italy

    Mario Petretta MD, FAHA

Authors
  1. Carmela Nappi MD, PhD
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  2. Emilia Zampella MD, PhD
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  3. Fabio Volpe MD
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  4. Marina De Risi MD
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  5. Leandra Piscopo MD
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  6. Andrea Ponsiglione MD
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  7. Massimo Imbriaco MD
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  8. Wanda Acampa MD, PhD
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  9. Mario Petretta MD, FAHA
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  10. Alberto Cuocolo MD
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Correspondence to Alberto Cuocolo MD.

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Nappi, C., Zampella, E., Volpe, F. et al. Identification and typing of cardiac amyloidosis by noninvasive imaging: Two cases for two patterns. J. Nucl. Cardiol. 27, 915–920 (2020). https://doi.org/10.1007/s12350-019-01982-8

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  • DOI: https://doi.org/10.1007/s12350-019-01982-8

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