Abstract
A 71-year-old African man without history of cardiac disease was referred to our center for dyspnea. Transthoracic echocardiogram and cardiac MRI were suggestive of cardiac amyloidosis (CA). The diagnosis of the light-chain cardiac amyloidosis (AL-CA) was made after a first endomyocardial biopsy. Accordingly chemotherapy was started. Systematic 99mTc-HMDP scintigraphy showed moderate cardiac uptake (visual score of 2), unusual for AL-CA, and permitted to rectify the diagnosis. Hereditary transthyretin cardiac amyloidosis was confirmed by a second endomyocardial biopsy with a positive Congo-red and anti-transthyretin antibody stainings, mass spectrometry and genetic analysis (Val122Ile mutation).
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References
Glaudemans AWJM, van Rheenen RWJ, van den Berg MP, Noordzij W, Koole M, Blokzijl H, et al. Bone scintigraphy with (99m)technetium-hydroxymethylene diphosphonate allows early diagnosis of cardiac involvement in patients with transthyretin-derived systemic amyloidosis. Amyloid 2014;21:35-44.
Eriksson P, Backman C, Bjerle P, Eriksson A, Holm S, Olofsson BO. Non-invasive assessment of the presence and severity of cardiac amyloidosis. A study in familial amyloidosis with polyneuropathy by cross sectional echocardiography and technetium-99m pyrophosphate scintigraphy. Br Heart J 1984;52:321-6.
Worsley DF, Lentle BC. Uptake of technetium-99m MDP in primary amyloidosis with a review of the mechanisms of soft tissue localization of bone seeking radiopharmaceuticals. J Nucl Med 1993;34:1612-5.
Kulhanek J, Movahed A. Uptake of technetium 99m HDP in cardiac amyloidosis. Int J Cardiovasc Imaging 2003;19:225-7.
Rapezzi C, Quarta CC, Guidalotti PL, Pettinato C, Fanti S, Leone O, et al. Role of (99m)Tc-DPD scintigraphy in diagnosis and prognosis of hereditary transthyretin-related cardiac amyloidosis. JACC Cardiovasc Imaging 2011;4:659-70.
Lee VW, Caldarone AG, Falk RH, Rubinow A, Cohen AS. Amyloidosis of heart and liver: Comparison of Tc-99m pyrophosphate and Tc-99m methylene diphosphonate for detection. Radiology 1983;148:239-42.
De Haro-del Moral FJ, Sánchez-Lajusticia A, Gómez-Bueno M, García-Pavía P, Salas-Antón C, Segovia-Cubero J. Role of cardiac scintigraphy with 99mTc-DPD in the differentiation of cardiac amyloidosis subtype. Rev Esp Cardiol 2012;65:440-6.
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We thank all the physicians involved in the Amyloidosis Network of the Henri Mondor Hospital who participated in the assessment and care of the patients included in this study.
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The authors have indicated that they have no financial conflict of interest.
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Arnault Galat and Axel Van Der Gucht have contributed equally to this work.
All authors have approved the manuscript, and agree with its submission to the Journal of Nuclear Cardiology. The procedure followed was in accordance with the ethical standard guidelines of the responsible committee on human experimentation.
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Galat, A., Van Der Gucht, A., Colombat, M. et al. 99mTc-HMDP scintigraphy rectifies wrong diagnosis of AL amyloidosis. J. Nucl. Cardiol. 22, 853–857 (2015). https://doi.org/10.1007/s12350-015-0176-6
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DOI: https://doi.org/10.1007/s12350-015-0176-6