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Technetium pyrophosphate uptake in transthyretin cardiac amyloidosis: Associations with echocardiographic disease severity and outcomes

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Quantitative uptake of Technetium 99 m-pyrophosphate (TcPYP) is sensitive and specific for diagnosing transthyretin cardiac amyloidosis (ATTR). We sought to examine the association between TcPYP uptake intensity and echocardiographic measures of disease severity and clinical outcomes.

Methods and Results

A retrospective analysis was performed of 75 patients who underwent TcPYP scintigraphy. Planar images were evaluated semiquantitatively and using heart-to-contralateral lung (H/CL) ratio. The associations between H/CL ratio and echocardiographic parameters and outcomes were evaluated using linear regression and Cox models, respectively. There were 48 patients diagnosed with ATTR with mean H/CL ratio 1.58 ± 0.22 (vs 1.08 ± 0.09 if semiquantitative score = 0). The H/CL ratio was not associated with any measured echocardiographic parameter. Both semiquantitative uptake grade and H/CL ratio were associated with all-cause mortality (P = 0.009 and 0.007, respectively) and all-cause mortality or heart failure hospitalization (P = 0.001 and 0.020, respectively); however, neither were associated with outcomes when limited to patients with confirmed ATTR (P = 0.18 and 0.465, respectively).

Conclusion

In patients with suspected ATTR, quantitative and semiquantitative uptake intensity of TcPYP is associated with all-cause mortality as well as all-cause mortality or heart failure hospitalization. However, in those with confirmed ATTR, there is no association with echocardiographic disease severity or outcomes.

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Abbreviations

AL:

Light chain amyloidosis

ATTR:

Transthyretin amyloidosis

H/CL:

Heart-to-contralateral lung

TcPYP:

99 m technetium pyrophosphate

CMR:

Cardiac magnetic resonance imaging

SPECT:

Single-photon emission computed tomography

LV:

Left ventricular

RV:

Right ventricular

LS:

Longitudinal strain

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Disclosures

The authors report no conflicts of interest related to this manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA

    Michael N. Vranian MD, Brett W. Sperry MD, Mazen Hanna MD, Rory Hachamovitch MD, Asad Ikram MD & Wael A. Jaber MD

  2. Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA

    Richard C. Brunken MD

Authors
  1. Michael N. Vranian MD
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  2. Brett W. Sperry MD
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  3. Mazen Hanna MD
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  4. Rory Hachamovitch MD
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  5. Asad Ikram MD
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  6. Richard C. Brunken MD
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  7. Wael A. Jaber MD
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Correspondence to Brett W. Sperry MD.

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Vranian, M.N., Sperry, B.W., Hanna, M. et al. Technetium pyrophosphate uptake in transthyretin cardiac amyloidosis: Associations with echocardiographic disease severity and outcomes. J. Nucl. Cardiol. 25, 1247–1256 (2018). https://doi.org/10.1007/s12350-016-0768-9

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  • DOI: https://doi.org/10.1007/s12350-016-0768-9

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