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Echocardiographic indices of left ventricular function and filling pressure are not related to blood pool activity on pyrophosphate scintigraphy

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Pyrophosphate (PYP) imaging has a high diagnostic accuracy for transthyretin cardiac amyloidosis (ATTR-CA). Indeterminate findings are often reported due to persistent blood pool activity, presumed to be from low cardiac output. We evaluated the relationship between blood pool activity on PYP imaging and echocardiographic indices of cardiac function.

Methods

Clinical and imaging data of 189 patients referred for PYP scintigraphy were evaluated. All patients underwent planar imaging and SPECT (diagnostic standard). Among those with a negative PYP SPECT, persistent left ventricular blood pool activity on planar images was inferred by a visual score ≥2 or a heart-to-contralateral (HCL) ratio ≥ 1.5. Absence of blood pool activity was inferred when both visual score was < 2 and HCL was < 1.5. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), stroke volume index (SVi), and left atrial pressure (LAP) were calculated from standard transthoracic echocardiograms.

Results

ATTR-CA was present in 43 (23%) patients. Among those with a negative PYP SPECT, 11 patients had significant blood pool activity. Patients with ATTR-CA had a lower LVEF, SVi, and GLS, with a higher LAP, compared to those without ATTR-CA. Among those without ATTR-CA, there were no significant differences in these parameters.

Conclusion

Approximately 8% of patients with a negative PYP SPECT have significant blood pool activity. Measures of cardiac function are not different among those with and without blood pool activity. PYP SPECT should be routinely performed in all patients to avoid false image interpretation.

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Figure 1
Figure 2

Abbreviations

ATTR-CA:

Transthyretin cardiac amyloidosis

PYP:

Pyrophosphate

H/CL:

Heart-to-contralateral

SPECT:

Single photon emission computed tomography

LVEF:

Left ventricular ejection fraction

SVi:

Stroke volume index

GLS:

Global longitudinal strain

LAP:

Left atrial pressure

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Authors and Affiliations

  1. Division of Cardiology, Cook County Health, Chicago, IL, USA

    Talal Asif MD & Saurabh Malhotra MD, MPH, FASNC

  2. Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

    Aman Gupta MD

  3. Department of Internal Medicine, Cook County Health, Chicago, IL, USA

    Mukunthan Murthi MD

  4. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Prem Soman MD, PhD, FASNC

  5. Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas City, MO, USA

    Vasvi Singh MD

  6. Division of Cardiology, Rush Medical College, Chicago, IL, 60612, USA

    Saurabh Malhotra MD, MPH, FASNC

Authors
  1. Talal Asif MD
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  2. Aman Gupta MD
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  3. Mukunthan Murthi MD
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  4. Prem Soman MD, PhD, FASNC
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  5. Vasvi Singh MD
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  6. Saurabh Malhotra MD, MPH, FASNC
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Corresponding author

Correspondence to Saurabh Malhotra MD, MPH, FASNC.

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Disclosures

Talal Asif had none to disclose; Aman Gupta had none to disclose; Mukunthan Murthy had none to disclose; Prem Soman received institutional grant funding from Astellas and Pfizer. Personal consulting and Advisory Board Fees: Pfizer, Eidos, Alnylam, and Spectrum Dynamics; Vasvi Singh received research support from ASNC/Pfizer Inc.; Saurabh Malhotra received research support from ASNC/Pfizer Inc.; Speakers Bureau: Pfizer Inc. and Alnylam; Advisory Board: Alnylam.

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Funding

This study was supported in part by the Becker Fund for Heart Research, Community Foundation of Greater Buffalo.

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Asif, T., Gupta, A., Murthi, M. et al. Echocardiographic indices of left ventricular function and filling pressure are not related to blood pool activity on pyrophosphate scintigraphy. J. Nucl. Cardiol. 30, 708–715 (2023). https://doi.org/10.1007/s12350-022-02989-4

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  • DOI: https://doi.org/10.1007/s12350-022-02989-4

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