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Serial scanning with technetium pyrophosphate (99mTc-PYP) in advanced ATTR cardiac amyloidosis

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Development of noninvasive imaging modalities to quantify amyloid burden over time is an unmet clinical need. Technetium pyrophosphate (99mTc-PYP) scintigraphy is a simple and widely available radiotracer useful to differentiate transthyretin from light-chain amyloidosis in patients with advanced cardiac amyloidosis. We examined the utility of serial 99mTc-PYP scanning to quantify amyloid burden over time in TTR cardiac amyloidosis (ATTR-CA).

Methods and Results

Twenty subjects with ATTR-CA (10 wild type, 10 mutant) underwent serial 99mTc-PYP planar cardiac imaging. Cardiac retention was assessed both semiquantitatively (visual score 0, no uptake to 3, uptake greater than bone) and quantitatively (region of interest drawn over the heart, copied, and mirrored over the contralateral chest) to calculate a heart-to-contralateral (H/CL) ratio. Index scan mean visual score and H/CL were 3.0 ± 0.2 and 1.79 ± 0.2, respectively, and after an average 1.5 ± 0.5 years follow-up, did not differ, 3.0 ± 0.2, P = .33 and 1.76 ± 0.2, P = .44. H/CL change was minimal, 0.03 ± 0.17, did not correlate with time between scans, r = 0.19, P = .43, and was observed despite obvious clinical progression (increase in troponin ≥ 0.1 ng/mL, BNP ≥ 400 pg/mL, NYHA class, and/or death).

Conclusions

Serial 99mTc-PYP scanning in subjects with advanced ATTR-CA does not show significant changes over an average 1.5 years of follow-up despite obvious clinical progression.

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Abbreviations

AL:

Amyloid light-chain

ATTR:

Transthyretin amyloidosis

EF:

Ejection fraction

HFpEF:

Heart failure preserved ejection fraction

ROI:

Region of interest

99mTc-PYP:

Technetium pyrophosphate

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Acknowledgments

We would like to acknowledge the patients with cardiac amyloidosis who participated in this study and who continue to hope for methods to improve outcomes including earlier and more efficient diagnosis and better therapeutics.

Conflicts of interest

Dr. Maurer’s institution, Columbia University Medical Center, receives funding for research and serving on advisory boards and DSMBs from Pfizer, Inc, Alnylam Pharmaceuticals Inc, ISIS Pharmaceuticals and Prothena Inc.

Disclosure

Alnylam Pharmaceuticals provided a grant to support the imaging performed in this study. Dr. Maurer’s institution, Columbia University Medical Center, receives funding for research and serving on advisory boards and DSMBs from Pfizer, Inc, Alnylam Pharmaceuticals Inc, ISIS Pharmaceuticals and Prothena Inc.

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Authors and Affiliations

  1. Nuclear Cardiology Laboratory, Columbia College of Physicians & Surgeons, 622 W 168th St. P.H. 10-203, New York, NY, 10032, USA

    Adam Castaño MD, Albert DeLuca MD, Richard Weinberg MD, PhD, Ted Pozniakoff BS, ARRT, Altaf Pirmohamed MD & Sabahat Bokhari MD

  2. Division of Cardiology, Center for Advanced Cardiac Care, Columbia College of Physicians & Surgeons, New York, NY, USA

    Adam Castaño MD & Mathew S. Maurer MD

  3. Department of Medicine, Institute of Human Nutrition, Columbia College of Physicians & Surgeons, New York, NY, USA

    William S. Blaner PhD

  4. Mailman School of Public Health, Columbia College of Physicians & Surgeons, New York, NY, USA

    Codruta Chiuzan PhD

  5. Alnylam Pharmaceuticals, Cambridge, MA, USA

    Brian Bettencourt PhD, Jared Gollob MD, Verena Karsten PhD & John A. Vest MD

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  1. Adam Castaño MD
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  2. Albert DeLuca MD
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  12. Mathew S. Maurer MD
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  13. Sabahat Bokhari MD
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Corresponding author

Correspondence to Adam Castaño MD.

Additional information

See related editorial, doi:10.1007/s12350-015-0295-0.

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Castaño, A., DeLuca, A., Weinberg, R. et al. Serial scanning with technetium pyrophosphate (99mTc-PYP) in advanced ATTR cardiac amyloidosis. J. Nucl. Cardiol. 23, 1355–1363 (2016). https://doi.org/10.1007/s12350-015-0261-x

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  • DOI: https://doi.org/10.1007/s12350-015-0261-x

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