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Quantitative technetium pyrophosphate and cardiovascular magnetic resonance in patients with suspected cardiac amyloidosis

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Quantitation of myocardial 99m Tc-pyrophosphate activity may have high diagnostic accuracy, but its correlation with disease burden is unknown. We examined the relationship between 99m Tc-pyrophosphate quantitation and cardiac magnetic resonance (CMR) measures in patients with suspected transthyretin cardiac amyloidosis (ATTR-CM) or light chain cardiac amyloidosis (AL-CM).

Methods

Consecutive patients who underwent 99mTc-pyrophosphate imaging and CMR were included. ATTR-CM and AL-CM were diagnosed using standard criteria. 99mTc-pyrophosphate images were assessed with standard parameters and quantified with cardiac pyrophosphate activity (CPA) and volume of involvement (VOI). We assessed the association between 99mTc-pyrophosphate image interpretation and CMR tissue characteristics.

Results

Seventy patients were identified, mean age 70.4 ± 11.4 years, with ATTR-CM and AL-CM diagnosed in 22 (31%) and 11 (16%) patients, respectively. In patients with ATTR-CM, there were significant correlations between CPA (r2 = 0.509, P < 0.001) and VOI (r2 = 0.586, P < 0.001) with native myocardial T1 mapping values. Additionally, CPA (adjusted hazard ratio (aHR) 1.04, P = 0.016), VOI (aHR 1.12, P = 0.034), and average myocardial T1 (aHR 1.12, P = 0.025) were associated with incidence of heart failure hospitalization or death.

Conclusion

CPA and VOI were correlated with CMR measures of myocardial fibrosis in patients with ATTR-CM. 99mTc-pyrophosphate quantitation may have a role in ATTR-CM disease staging, guiding treatment, or following response to therapy.

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Abbreviations

AL:

Light chain cardiac amyloidosis

CMR:

Cardiovascular magnetic resonance

CPA:

Cardiac pyrophosphate activity

ECV:

Extracellular volume

HCL:

Heart/contralateral ratio

IQR:

Interquartile range

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVBP:

Left ventricular blood pool

PET:

Positron emission tomography

PSIR:

Phase-sensitive inversion recovery

ROI:

Region of interest

SD:

Standard deviation

SPECT:

Single photon emission computed tomography

Tc:

Technetium

ATTR-CM:

Transthyretin cardiac amyloidosis

VOI:

Volume of involvement

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Acknowledgments

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Disclosures

This research was supported in part by NIH Grant R01-HL135557. Dr. Fine reports research and consulting support from Pfizer, Akcea, Ionis, Alnylam, and Eidos. Dr. White receives funding from the Calgary Health Trust and Siemens Healthineers and is a shareholder in Cohesic Inc. Dr. Miller reports consulting support from Alnylam and Pfizer. The other authors have no other relevant disclosures.

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Authors and Affiliations

  1. Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada

    Golnaz Roshankar MD, Geneva C. White, Nowell M. Fine MD, SM, James A. White MD & Robert J. H. Miller MD

  2. Department of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Sebastien Cadet MSc & Piotr J. Slomka PhD

  3. Department of Nuclear Medicine, University of Calgary, Calgary, AB, Canada

    Denise Chan MD

  4. Department of Hematology, University of Calgary, Calgary, AB, Canada

    Victor Jimenez-Zepeda MD

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  1. Golnaz Roshankar MD
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This research was supported in part by NIH Grant R01-HL135557.

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Roshankar, G., White, G.C., Cadet, S. et al. Quantitative technetium pyrophosphate and cardiovascular magnetic resonance in patients with suspected cardiac amyloidosis. J. Nucl. Cardiol. 29, 2679–2690 (2022). https://doi.org/10.1007/s12350-021-02806-4

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  • DOI: https://doi.org/10.1007/s12350-021-02806-4

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