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Imaging cardiac amyloidosis: a pilot study using 18F-florbetapir positron emission tomography

  • Sharmila Dorbala
  • Divya Vangala
  • James Semer
  • Christopher Strader
  • John R. BruyereJr
  • Marcelo F. Di Carli
  • Stephen C. Moore
  • Rodney H Falk
Original Article

Abstract

Purpose

Cardiac amyloidosis, a restrictive heart disease with high mortality and morbidity, is underdiagnosed due to limited targeted diagnostic imaging. The primary aim of this study was to evaluate the utility of 18F-florbetapir for imaging cardiac amyloidosis.

Methods

We performed a pilot study of cardiac 18F-florbetapir PET in 14 subjects: 5 control subjects without amyloidosis and 9 subjects with documented cardiac amyloidosis. Standardized uptake values (SUV) of 18F-florbetapir in the left ventricular (LV) myocardium, blood pool, liver, and vertebral bone were determined. A 18F-florbetapir retention index (RI) was computed. Mean LV myocardial SUVs, target-to-background ratio (TBR, myocardial/blood pool SUV ratio) and myocardial-to-liver SUV ratio between 0 and 30 min were calculated.

Results

Left and right ventricular myocardial uptake of 18F-florbetapir were noted in all the amyloid subjects and in none of the control subjects. The RI, TBR, LV myocardial SUV and LV myocardial to liver SUV ratio were all significantly higher in the amyloidosis subjects than in the control subjects (RI median 0.043 min−1, IQR 0.034 – 0.051 min−1, vs. 0.023 min−1, IQR 0.015 – 0.025 min−1, P = 0.002; TBR 1.84, 1.64 – 2.50, vs. 1.26, IQR 0.91 – 1.36, P = 0.001; LV myocardial SUV 3.84, IQR 1.87 – 5.65, vs. 1.35, IQR 1.17 – 2.28, P = 0.029; ratio of LV myocardial to liver SUV 0.67, IQR 0.44 – 1.64, vs. 0.18, IQR 0.15 – 0.35, P = 0.004). The myocardial RI, TBR and myocardial to liver SUV ratio also distinguished the control subjects from subjects with transthyretin and those with light chain amyloid.

Conclusion

18F-Florbetapir PET may be a promising technique to image light chain and transthyretin cardiac amyloidosis. Its role in diagnosing amyloid in other organ systems and in assessing response to therapy needs to be further studied.

Keywords

Amyloidosis Heart 18F-Florbetapir Positron emission tomography Diagnosis 

Notes

Acknowledgments

We are indebted to the subjects who participated in this study. We are appreciative of the research support for this study from the Amyloid Foundation. Dr. Dorbala was supported by NIH NHLBI grant K23HL092299. We are grateful to our colleagues at the Brigham and Women’s Hospital Cardiac Amyloidosis Program.

Financial Disclosures

Dorbala: Research Grant Astellas Global Pharma Development.

Di Carli: Research grant from Gilead Sciences.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Sharmila Dorbala
    • 1
    • 2
    • 3
    • 4
  • Divya Vangala
    • 2
    • 4
  • James Semer
    • 2
    • 4
  • Christopher Strader
    • 2
    • 4
  • John R. BruyereJr
    • 2
    • 4
  • Marcelo F. Di Carli
    • 1
    • 2
    • 4
  • Stephen C. Moore
    • 2
    • 4
  • Rodney H Falk
    • 3
    • 4
  1. 1.Noninvasive Cardiovascular Imaging Program, Heart and Vascular Center, Departments of Radiology and Medicine (Cardiology)Brigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Division of Nuclear Medicine and Molecular Imaging, Department of RadiologyBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Cardiovascular Division and the Cardiac Amyloidosis Program, Department of MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA
  4. 4.Brigham and Women’s HospitalBostonUSA

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