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Cardiac scintigraphy and echocardiography assessment in the diagnosis of transthyretin cardiac amyloidosis

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Abstract

The aim is to evaluate the diagnostic yield of echocardiography and [99mTc]Tc-DPD scintigraphy in the detection of amyloid cardiomyopathy (CM) and define potential prognostic echocardiographic parameters. 133 patients were retrospectively studied, from 2016 to 2021, with a mean age of 80.2 ± 7.5 years. The final diagnosis was established according to international consensus. Patients had a transthoracic echocardiogram (TTE) and [99mTc]Tc-DPD scintigraphy; RWT, E/e, LS, TAPSE, SAB, and IWT scores were calculated. All patients with ATTR-CM were classified into 3 prognostic stages and were compared with Perugini grades and echocardiographic parameters. CM was confirmed in 85 cases (63.9%), 76 (57.1%) ATTR-CM, and 9 (6.8%) AL-CM. The diagnostic yield of [99mTc]Tc-DPD scintigraphy and echocardiography were calculated, with a sensitivity of 90.7%, specificity of 100%, PPV of 100%, and NPV of 87.2% in myocardial scintigraphy, versus 74.6%, 62.5%, 75.6%, 61.2% in the echocardiogram. According to the IWT score, most patients were classified in the intermediate group; 33 presented with grade 2–3 uptakes. Significant results were obtained when comparing Perugini score with IWT (p: 0.02) and SAB (p: 0.03); and between biomarkers stages and LVEF (p: 0.028), E/e´ (p: 0.001), and GLS% (p: 0.022). [99mTc]Tc-DPD scintigraphy is superior in diagnosing CA. SAB could be the most reliable parameter in an early diagnostic phase, showing a strong correlation with Perugini grades 2 and 3.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. University of Santiago de Compostela, 15703, A Coruña, Spain

    María del Carmen Mallón Araujo

  2. Nuclear Medicine Department, Lucus Augusti University Hospital, Rúa Dr. Ulises Romero, 1, 27003, Lugo, Spain

    Estephany Abou Jokh Casas

  3. Cardiology Department, Lucus Augusti University Hospital, 27003, Lugo, Spain

    Charigan Abou Jokh Casas

  4. Cardiology Department, Santiago de Compostela University Hospital, 15706, A Coruña, Spain

    María Amparo Martinez Monzonis

  5. Nuclear Medicine Department, Santiago de Compostela University Hospital, 15706, A Coruña, Spain

    Álvaro Ruibal Morell & Virginia Pubul Núñez

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  1. María del Carmen Mallón Araujo
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  6. Virginia Pubul Núñez
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Contributions

MdelCMA, EAJC, and CAJC: have written the manuscript, collected the data, and performed the statistical analysis. VPN and AMM: contributed to the diagnosis and follow-up of the patients. ÁRM: supervised the data collection and the study design.

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Correspondence to Estephany Abou Jokh Casas.

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The authors declare no competing interests.

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All authors have approved the manuscript and agree with its submission to this Journal and have not declared any conflicts of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Galician (Santiago-Lugo) Clinical Research Ethics Committee under reference number 2021/371.

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Patients have given their written consent and permission to reproduce and distribute the information in this study.

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Informed consent was obtained from all individual participants included in the study.

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del Carmen Mallón Araujo, M., Casas, E.A.J., Casas, C.A.J. et al. Cardiac scintigraphy and echocardiography assessment in the diagnosis of transthyretin cardiac amyloidosis. Int J Cardiovasc Imaging 40, 415–424 (2024). https://doi.org/10.1007/s10554-023-02987-8

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  • DOI: https://doi.org/10.1007/s10554-023-02987-8

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