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Manrique A, Dudoignon D, Brun S, N'Ganoa C, Cassol E, Legallois D, Lavie-Badie Y, Agostini D, Lairez O. Quantification of myocardial 99mTc-labeled bisphosphonate uptake with cadmium zinc telluride camera in patients with transthyretin-related cardiac amyloidosis. EJNMMI Res 2019; 9:117. [PMID: 31873816 PMCID: PMC6928186 DOI: 10.1186/s13550-019-0584-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/06/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE We aimed to compare different methods for semi-quantitative analysis of cardiac retention of bone tracers in patients with cardiac transthyretin amyloidosis (ATTR). METHODS Data from 67 patients with ATTR who underwent both conventional whole-body scan and a CZT myocardial SPECT (DSPECT, Spectrum Dynamics) 3 h after injection of 99mTc-labeled bone tracer were analyzed. Visual scoring of cardiac retention was performed on whole-body scan according to Perugini 4-point grading system from 0 (no uptake) to 3 (strong cardiac uptake with mild/absent bone uptake). A planar heart-to-background (H:B) ratio was calculated using whole-body scan (wb-H:B). CZT SPECT was quantified using three methods: planar H:B ratio calculated from anterior reprojection (ant-H:B), left anterior oblique reprojection (LAO-H:B), and 3D-H:B ratio calculated from transaxial slices as mean counts in a VOI encompassing the heart divided by background VOI in the contralateral lung. Interventricular septal thickness was obtained using echocardiography. RESULTS H:Bs obtained from planar and reprojected data were not statistically different (wb-H:B, 2.05 ± 0.64, ant-H:B, 1.97 ± 0.61, LAO-H:B, 2.06 ± 0.64, all p = ns). However, 3D-H:B was increased compared to planar H:Bs (3D-H:B, 4.06 ± 1.77, all p < 0.0001 vs. wb-H:B, ant-H:B, and LAO-H:B). Bland-Altman plots demonstrated that the difference between 3D and planar H:Bs increased with the mean value of myocardial uptake. 3D-H:B was best correlated to septal thickness (r = 0.45, p < 0.001). Finally, abnormal right ventricular uptake was associated with higher values of cardiac retention. CONCLUSION 3D semi-quantitative analysis of CZT SPECT optimized the assessment of 99mTc-labeled bone tracer myocardial uptake in patients with cardiac amyloidosis.
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Affiliation(s)
- Alain Manrique
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France. .,GIP Cyceron, Campus Jules Horowitz, Boulevard Henri Becquerel, BP 5229, 14074, Caen, France.
| | - David Dudoignon
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Stéphanie Brun
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.,Medical School, Toulouse III Paul Sabatier University, Toulouse, France
| | - Catherine N'Ganoa
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Emmanuelle Cassol
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.,Medical School, Toulouse III Paul Sabatier University, Toulouse, France
| | - Damien Legallois
- Department of Cardiology, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Yoan Lavie-Badie
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Denis Agostini
- Department of Nuclear Medicine, Normandie Univ, UNICAEN, EA4650 SEILIRM, CHU de Caen, 14000, Caen, France
| | - Olivier Lairez
- Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.,Medical School, Toulouse III Paul Sabatier University, Toulouse, France
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102
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Boldrini M, Cappelli F, Chacko L, Restrepo-Cordoba MA, Lopez-Sainz A, Giannoni A, Aimo A, Baggiano A, Martinez-Naharro A, Whelan C, Quarta C, Passino C, Castiglione V, Chubuchnyi V, Spini V, Taddei C, Vergaro G, Petrie A, Ruiz-Guerrero L, Moñivas V, Mingo-Santos S, Mirelis JG, Dominguez F, Gonzalez-Lopez E, Perlini S, Pontone G, Gillmore J, Hawkins PN, Garcia-Pavia P, Emdin M, Fontana M. Multiparametric Echocardiography Scores for the Diagnosis of Cardiac Amyloidosis. JACC Cardiovasc Imaging 2019; 13:909-920. [PMID: 31864973 DOI: 10.1016/j.jcmg.2019.10.011] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aimed to investigate the accuracy of a broad range of echocardiographic variables to develop multiparametric scores to diagnose CA in patients with proven light chain (AL) amyloidosis or those with increased heart wall thickness who had amyloid was suspected. We also aimed to further characterize the structural and functional changes associated with amyloid infiltration. BACKGROUND Cardiac amyloidosis (CA) is a serious but increasingly treatable cause of heart failure. Diagnosis is challenging and frequently unclear at echocardiography, which remains the most often used imaging tool. METHODS We studied 1,187 consecutive patients evaluated at 3 referral centers for CA and analyzed morphological, functional, and strain-derived echocardiogram parameters with the aim of developing a score-based diagnostic algorithm. Cardiac amyloid burden was quantified by using extracellular volume measurements at cardiac magnetic resonance. RESULTS A total of 332 patients were diagnosed with AL amyloidosis and 339 patients with transthyretin CA. Concentric remodeling and strain-derived parameters displayed the best diagnostic performance. A multivariable logistic regression model incorporating relative wall thickness, E wave/e' wave ratio, longitudinal strain, and tricuspid annular plane systolic excursion had the greatest diagnostic performance in AL amyloidosis (area under the curve: 0.90; 95% confidence interval: 0.87 to 0.92), whereas the addition of septal apical-to-base ratio yielded the best diagnostic accuracy in the increased heart wall thickness group (area under the curve: 0.80; 95% confidence interval: 0.85 to 0.90). CONCLUSIONS Specific functional and structural parameters characterize different burdens of CA deposition with different diagnostic performances and enable the definition of 2 scores that are sensitive and specific tools with which diagnose or exclude CA.
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Affiliation(s)
- Michele Boldrini
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Emergency Department, Internal Medicine Department, Amyloidosis Research and Treatment Center, Istituto di Ricerca a Carattere Clinico e Scientifico Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloid Centre, Careggi University Hospital, Florence, Italy
| | - Liza Chacko
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Maria Alejandra Restrepo-Cordoba
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Angela Lopez-Sainz
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Alberto Giannoni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Aimo
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Ana Martinez-Naharro
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Carol Whelan
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Cristina Quarta
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Claudio Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | | | - Giuseppe Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Aviva Petrie
- Eastman Dental Institute, University College London, Grays Inn Road, London, United Kingdom
| | - Luis Ruiz-Guerrero
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Vanessa Moñivas
- University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | | | - Jesus G Mirelis
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Esther Gonzalez-Lopez
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain
| | - Stefano Perlini
- Emergency Department, Internal Medicine Department, Amyloidosis Research and Treatment Center, Istituto di Ricerca a Carattere Clinico e Scientifico Policlinico San Matteo Foundation, Pavia, Italy
| | | | - Julian Gillmore
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, Madrid, Spain; University Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Michele Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Campus, London, United Kingdom.
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103
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Lopes LR, Futema M, Akhtar MM, Lorenzini M, Pittman A, Syrris P, Elliott PM. Prevalence of TTR variants detected by whole-exome sequencing in hypertrophic cardiomyopathy. Amyloid 2019; 26:243-247. [PMID: 31554435 DOI: 10.1080/13506129.2019.1665996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/24/2019] [Accepted: 09/06/2019] [Indexed: 12/12/2022]
Abstract
Background: A proportion of patients with hypertrophic cardiomyopathy (HCM) have a diagnosis of cardiac amyloidosis. Hereditary transthyretin amyloid cardiomyopathy (ATTRv-CM) is caused by mutations in the TTR gene. Our aim was to study the prevalence of potentially amyloidogenic TTR variants in a whole-exome sequencing (WES) study of a large HCM cohort. Methods and results: 770 consecutive HCM probands underwent WES and clinical characterisation. Patients with rare or known pathogenic variants in TTR underwent 99mTechnetium labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy and were retrospectively re-assessed for clinical features of amyloidosis. Two patients had rare TTR variants of unknown significance and four had the known pathogenic V122I (p.V142I) variant (one homozygous and also heterozygous for a likely pathogenic MYL3 variant and another double heterozygous for a likely pathogenic MYBPC3 variant). Four out of 6 patients with TTR variants underwent DPD scintigraphy; the only positive study was in the patient with the homozygous V122I (p.V142I) variant. Conclusions: Pathogenic TTR variants are rare in carefully assessed HCM patients and may occur in double heterozygosity with pathogenic sarcomere variants. The lack of evidence for an amyloidosis phenotype in all but one TTR variant carrier illustrates the importance of complete clinical evaluation of HCM patients that harbour pathogenic TTR variants.
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Affiliation(s)
- Luis R Lopes
- St. Bartholomew's Centre for Inherited Cardiovascular Disease, St Bartholomew's Hospital , London , UK
- UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London , London , UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART , http://guardheart.ern-net.eu/ )
| | - Marta Futema
- UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London , London , UK
| | - Mohammed M Akhtar
- St. Bartholomew's Centre for Inherited Cardiovascular Disease, St Bartholomew's Hospital , London , UK
- UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London , London , UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART , http://guardheart.ern-net.eu/ )
| | - Massimiliano Lorenzini
- St. Bartholomew's Centre for Inherited Cardiovascular Disease, St Bartholomew's Hospital , London , UK
- UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London , London , UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART , http://guardheart.ern-net.eu/ )
| | - Alan Pittman
- Genetic Research Centre, St George's, University of London , London , UK
| | - Petros Syrris
- UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London , London , UK
| | - Perry M Elliott
- St. Bartholomew's Centre for Inherited Cardiovascular Disease, St Bartholomew's Hospital , London , UK
- UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London , London , UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART , http://guardheart.ern-net.eu/ )
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104
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Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol 2019; 26:2065-2123. [PMID: 31468376 DOI: 10.1007/s12350-019-01760-6] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, UK
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, VA, USA
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105
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Myocardial Amyloidosis. JACC Cardiovasc Imaging 2019; 12:2345-2356. [DOI: 10.1016/j.jcmg.2019.06.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/27/2022]
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106
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Dorbala S, Ando Y, Bokhari S, Dispenzieri A, Falk RH, Ferrari VA, Fontana M, Gheysens O, Gillmore JD, Glaudemans AWJM, Hanna MA, Hazenberg BPC, Kristen AV, Kwong RY, Maurer MS, Merlini G, Miller EJ, Moon JC, Murthy VL, Quarta CC, Rapezzi C, Ruberg FL, Shah SJ, Slart RHJA, Verberne HJ, Bourque JM. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2-Evidence Base and Standardized Methods of Imaging. J Card Fail 2019; 25:e1-e39. [PMID: 31473268 DOI: 10.1016/j.cardfail.2019.08.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marianna Fontana
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arnt V Kristen
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Raymond Y Kwong
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, New York, New York
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - James C Moon
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - C Cristina Quarta
- Division of Medicine, National Amyloidosis Centre, University College London, London, United Kingdom
| | - Claudio Rapezzi
- Cardiology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, Bologna, Italy
| | - Frederick L Ruberg
- Amyloidosis Center and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jamieson M Bourque
- Departments of Medicine and Radiology, Cardiovascular Imaging Center, University of Virginia, Charlottesville, Virginia
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Brownrigg J, Lorenzini M, Lumley M, Elliott P. Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta-analysis. ESC Heart Fail 2019; 6:1041-1051. [PMID: 31487121 PMCID: PMC6816075 DOI: 10.1002/ehf2.12511] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS The study aims to systematically assess the diagnostic performance of cardiac magnetic resonance (CMR) and nuclear scintigraphy (index tests) for the diagnosis and differentiation of subtypes of cardiac amyloidosis. METHODS AND RESULTS MEDLINE and Embase electronic databases were searched for studies evaluating the diagnostic performance of CMR or nuclear scintigraphy in detecting cardiac amyloidosis and subsequently in differentiating transthyretin amyloidosis (ATTR) from immunoglobulin light-chain (AL) amyloidosis. In this meta-analysis, histopathological examination of tissue from endomyocardial biopsy (EMB) or extra-cardiac organs were reference standards. Pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated, and a random effects meta-analysis was used to estimate diagnostic odds ratios. Methodological quality was assessed using a validated instrument. Of the 2947 studies identified, 27 met the criteria for inclusion. Sensitivity and specificity of CMR in diagnosing cardiac amyloidosis was 85.7% and 92.0% against EMB reference and 78.9% and 93.9% with any organ histology reference. Corresponding sensitivity and specificity of nuclear scintigraphy was 88.4% and 87.2% against EMB reference and 82.0% and 98.8% with histology from any organ. CMR was unable to reliably differentiate ATTR from AL amyloidosis (sensitivity 28.1-99.0% and specificity 11.0-60.0%). Sensitivity and specificity of nuclear scintigraphy in the differentiation of ATTR from AL amyloidosis ranged from 90.9% to 91.5% and from 88.6% to 97.1%. Pooled negative likelihood ratio and positive likelihood ratio for scintigraphy in this setting were 0.1 and 8, with EMB reference standard. Study quality assessed by QUADAS-2 was generally poor with evidence of bias. CONCLUSIONS Cardiac magnetic resonance is a useful test for diagnosing cardiac amyloidosis but is not reliable in further classifying the disease. Nuclear scintigraphy offers strong diagnostic performance in both the detection of cardiac amyloidosis and differentiating ATTR from AL amyloidosis. Our findings support the use of both imaging modalities in a non-invasive diagnostic algorithm that also tests for the presence of monoclonal protein.
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Affiliation(s)
- Jack Brownrigg
- Pfizer LimitedWalton Oaks, Dorking Road, Walton‐on‐the‐Hill, TadworthSurreyKT20 7NSUK
| | | | - Matthew Lumley
- Pfizer LimitedWalton Oaks, Dorking Road, Walton‐on‐the‐Hill, TadworthSurreyKT20 7NSUK
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108
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Rapezzi C, Gagliardi C, Milandri A. Analogies and disparities among scintigraphic bone tracers in the diagnosis of cardiac and non-cardiac ATTR amyloidosis. J Nucl Cardiol 2019; 26:1638-1641. [PMID: 29473120 DOI: 10.1007/s12350-018-1235-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/06/2018] [Indexed: 01/15/2023]
Abstract
In this issue of JNC, BW Spery and Coll report a retrospective analysis of 57 patients with transthyretin-related amyloidosis (ATTR) in an advanced phase of the disease who underwent 99mTechnetium-pyrophosphate (99mTcPYP) scintigraphy. Although relatively small and "negative," the study is relevant since it broadens our knowledge on the uptake of "bone tracers" in ATTR and contributes to understand the limitations of the clinical use of scintigraphy in this disease. The paper raises, directly or indirectly, at least three questions: To what extent are the different bone tracers interchangeable for the diagnosis of ATTR cardiac amyloidosis? Are bone tracers able to image non-cardiac ATTR amyloidosis? What is the explanation for the variable performance of the different bone tracers in the diagnosis of cardiac and extracardiac ATTR amyloidosis?
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Affiliation(s)
- Claudio Rapezzi
- Cardiology, DIMES, Alma Mater University of Bologna, Bologna, Italy.
- Policlinico S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy.
| | - Christian Gagliardi
- Cardiology, DIMES, Alma Mater University of Bologna, Bologna, Italy
- Policlinico S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
| | - Agnese Milandri
- Cardiology, DIMES, Alma Mater University of Bologna, Bologna, Italy
- Policlinico S.Orsola-Malpighi, Via Massarenti 9, 40138, Bologna, Italy
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Maurer MS, Bokhari S, Damy T, Dorbala S, Drachman BM, Fontana M, Grogan M, Kristen AV, Lousada I, Nativi-Nicolau J, Cristina Quarta C, Rapezzi C, Ruberg FL, Witteles R, Merlini G. Expert Consensus Recommendations for the Suspicion and Diagnosis of Transthyretin Cardiac Amyloidosis. Circ Heart Fail 2019; 12:e006075. [PMID: 31480867 DOI: 10.1161/circheartfailure.119.006075] [Citation(s) in RCA: 283] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiomyopathy is a manifestation of transthyretin amyloidosis (ATTR), which is an underrecognized systemic disease whereby the transthyretin protein misfolds to form fibrils that deposit in various tissues and organs. ATTR amyloidosis is debilitating and associated with poor life expectancy, especially in those with cardiac dysfunction, but a variety of treatment options have recently become available. Considered a rare disease, ATTR amyloidosis may be more prevalent than thought, particularly in older persons. Diagnosis is often delayed because of a lack of disease awareness and the heterogeneity of symptoms at presentation. Given the recent availability of effective treatments, early recognition and diagnosis are especially critical because treatment is likely more effective earlier in the disease course. The Amyloidosis Research Consortium recently convened a group of experts in ATTR amyloidosis who, through an iterative process, agreed on best practices for suspicion, diagnosis, and characterization of disease. This review describes these consensus recommendations for ATTR associated with cardiomyopathy as a resource to aid cardiologists and others in the recognition and diagnosis of ATTR associated with cardiomyopathy. Included in this review is an overview of red flag signs and symptoms and a recommended diagnostic approach, including testing for monoclonal protein, scintigraphy, or biopsy and, if ATTR associated with cardiomyopathy is identified, TTR genotyping.
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Affiliation(s)
- Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York (M.S.M., S.B.)
| | - Sabahat Bokhari
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York (M.S.M., S.B.)
| | - Thibaud Damy
- Department of Cardiology, Center for Cardiac Amyloidosis, GRC Amyloid Research Institute, DHU A-TVB, APHP CHU Henri Mondor and Université Paris Est Créteil, France (T.D.)
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA (S.D.)
| | - Brian M Drachman
- Department of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (B.M.D.)
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, United Kingdom (M.F., C.C.Q.)
| | - Martha Grogan
- Cardiovascular Medicine, Mayo Clinic, Rochester, MN (M.G.)
| | - Arnt V Kristen
- Department of Cardiology, Amyloidosis Center, University of Heidelberg, Germany (A.V.K.)
| | | | - Jose Nativi-Nicolau
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City (J.N.-N.)
| | - Candida Cristina Quarta
- National Amyloidosis Centre, Division of Medicine, University College London, United Kingdom (M.F., C.C.Q.).,Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.C.Q., C.R.)
| | - Claudio Rapezzi
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Italy (C.C.Q., C.R.)
| | - Frederick L Ruberg
- Cardiovascular Center, Boston University School of Medicine, Boston Medical Center, MA (F.L.R.)
| | - Ronald Witteles
- Stanford Amyloid Center, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (R.W.)
| | - Giampaolo Merlini
- Amyloidosis Center Foundation IRCCS Policlinico San Matteo, Italy (G.M.).,Department of Molecular Medicine, University of Pavia, Italy (G.M.)
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110
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Manolis AS, Manolis AA, Manolis TA, Melita H. Cardiac amyloidosis: An underdiagnosed/underappreciated disease. Eur J Intern Med 2019; 67:1-13. [PMID: 31375251 DOI: 10.1016/j.ejim.2019.07.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
Cardiac amyloidosis or amyloid cardiomyopathy (ACM), commonly resulting from extracellular deposition of amyloid fibrils consisted of misfolded immunoglobulin light chain (AL) or transthyretin (TTR) protein, is an underestimated cause of heart failure and cardiac arrhythmias. Among the three types of cardiac amyloidosis (wild-type or familial TTR and light-chain), the wild-type (Wt) TTR-related amyloidosis (ATTR) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF), and amyloidosis should be considered in the differential diagnosis of this heart failure group of patients. Recent advances in the diagnosis and drug treatment of ACM have ushered in a new era in early disease detection and better management of these patients. Certain clues in cardiac and extracardiac manifestations of ACM may heighten clinical suspicion and guide further confirmatory testing. Newer noninvasive imaging methods (strain echocardiography, cardiac magnetic resonance and bone scintigraphy) may obviate the need for endomyocardial biopsy in ATTR patients, while newer targeted therapies may alter the adverse prognosis in these patients. Early recognition of ACM is crucial in halting the disease process before irreversible organ damage occurs. Chemotherapy and stem-cell transplantation combined with immunomodulatory therapy may also favorably affect the course and prognosis of light chain ACM. Finally, in select patients with end-stage disease, heart transplantation may render results comparable to non-ACM patients. All these issues are herein reviewed.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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111
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Prevalence of cardiac amyloidosis among adult patients referred to tertiary centres with an initial diagnosis of hypertrophic cardiomyopathy. Int J Cardiol 2019; 300:191-195. [PMID: 31371117 DOI: 10.1016/j.ijcard.2019.07.051] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/15/2019] [Accepted: 07/15/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Differential diagnosis of genetic causes of left ventricular hypertrophy (LVH) is crucial for disease-specific therapy. We aim to describe the prevalence of Cardiac Amyloidosis (CA) among patients ≥40 years with an initial diagnosis of HCM referred for second opinion to national cardiomyopathy centres. METHODS Consecutive patients aged ≥40 years referred with a tentative HCM diagnosis in the period 2014-2017 underwent clinical evaluation and genetic testing for HCM (including trans-thyretin-TTR). Patients with at least one red flag for CA underwent blood/urine tests, abdominal fat biopsy and/or bone-scintigraphy tracing and eventually ApoAI sequencing. RESULTS Out of 343 patients (age 60 ± 13 years), 251 (73%) carried a likely/pathogenic gene variant, including 12 (3.5%) in the CA-associated genes TTR (n = 11) and ApoAI (n = 1). Furthermore, 6 (2%) patients had a mutation in GLA. Among the remaining, mutation-negative patients, 26 with ≥1 CA red-flag were investigated further: 3 AL-CA and 17 wild-type-TTR-CA were identified. Ultimately, 32(9%) patients were diagnosed with CA. Prevalence of CA increased with age: 1/75 (1%) at age 40-49, 2/86 (2%) at age 50-59, 8/84 (9%) at age 60-69, 13/61 (21%) at age 70-79, 8/31 (26%) at age ≥80 (p for trend <0.01). CONCLUSIONS Among patients referred with and initial diagnosis of HCM, CA was the most common unrecognized mimic (9% prevalence) and increased with age (from 1% at ages 40-49 years to 26% >80 years). Age at diagnosis should be considered one of the most relevant red flags for CA in patients with HCM phenotypes; however, there is no clear age cut-off mandating scintigraphy and other second level investigations in the absence of other features suggestive of CA.
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112
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Tsutsui Y, Kubota T, Kato S, Nozoe M, Suematsu N, Okabe M, Yamamoto Y, Tsutsui H. Utility of 99 mTc-Pyrophosphate Scintigraphy in Diagnosing Transthyretin Cardiac Amyloidosis in Real-World Practice. Circ Rep 2019; 1:277-285. [PMID: 33693151 PMCID: PMC7892493 DOI: 10.1253/circrep.cr-19-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background:
Amyloid transthyretin (ATTR) cardiac amyloidosis has now been recognized as one of the major causes of heart failure, especially in elderly patients. The purpose of the present study was to validate the usefulness of technetium-99 m (99 mTc)-pyrophosphate (99 mTc-PYP) scintigraphy in the screening diagnosis for ATTR amyloidosis in daily clinical practice. Methods and Results:
Ninety-eight patients underwent 99 mTc-PYP scintigraphy in the previous 3 years (PYP positive/negative, 18/80), of whom 29 underwent concomitant endomyocardial biopsy (ATTR positive/negative, 9/20). The sensitivity and specificity of 99 mTc-PYP scintigraphy for the diagnosis of biopsy-proven ATTR amyloidosis were 0.889 and 0.950, respectively. Age, gender, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) level, or electrocardiogram findings did not differ significantly between PYP-positive and PYP-negative patients. Left ventricular (LV) wall thickness was significantly greater in PYP-positive than in PYP-negative patients, but LV ejection fraction or prevalence of atrial fibrillation was similar between groups. In the PYP-positive patients, higher uptake of PYP correlated with younger age and lower NT-proBNP. Conclusions:99 mTc-PYP scintigraphy was useful, with high sensitivity and specificity in the screening diagnosis for ATTR cardiac amyloidosis, which is difficult to diagnose on clinical characteristics alone. 99 mTc-PYP scintigraphy should be considered to elucidate the underlying causes of heart failure, especially in elderly patients based on the higher prevalence of ATTR cardiac amyloidosis in this population.
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Affiliation(s)
- Yoshitomo Tsutsui
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital Fukuoka Japan.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University Fukuoka Japan
| | - Toru Kubota
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Masatsugu Nozoe
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Nobuhiro Suematsu
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Masanori Okabe
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Yusuke Yamamoto
- Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital Fukuoka Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University Fukuoka Japan
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113
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Ruberg FL, Grogan M, Hanna M, Kelly JW, Maurer MS. Transthyretin Amyloid Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:2872-2891. [PMID: 31171094 PMCID: PMC6724183 DOI: 10.1016/j.jacc.2019.04.003] [Citation(s) in RCA: 560] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 12/16/2022]
Abstract
Transthyretin amyloid cardiomyopathy (ATTR-CM) is an under-recognized cause of heart failure (HF) in older adults, resulting from myocardial deposition of misfolded transthyretin (TTR) or pre-albumin. Characteristic patterns of echocardiography and cardiac magnetic resonance can strongly suggest the disease but are not diagnostic. The diagnosis can be made with noninvasive nuclear imaging when there is no evidence of a monoclonal protein. Amyloid fibril formation results from a destabilizing mutation in hereditary ATTR amyloidosis (hATTR) or from an aging-linked process in wild-type ATTR amyloidosis (wtATTR). Recent studies have suggested that up to 10% to 15% of older adults with HF may have unrecognized wtATTR. Associated features, including carpal tunnel syndrome and lumbar spinal stenosis, raise suspicion and may afford a means for early diagnosis. Previously treatable only by organ transplantation, pharmaceutical therapy that slows or halts ATTR-CM progression and favorably affects clinical outcomes is now available. Early recognition remains essential to afford the best treatment efficacy.
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Affiliation(s)
- Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jeffery W Kelly
- Departments of Chemistry and Molecular Medicine, Scripps Research Institute, La Jolla, California
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Center for Advanced Cardiac Care, Columbia University Medical Center, New York, New York.
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114
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Hellman U, Lång K, Ihse E, Jonasson J, Olsson M, Lundgren HE, Pilebro B, Westermark P, Wixner J, Anan I. Transthyretin Glu54Leu - an unknown mutation within the Swedish population associated with amyloid cardiomyopathy and a unique fibril type. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:372-376. [PMID: 31169435 DOI: 10.1080/00365513.2019.1624977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
For the first time, we report of a Swedish family of five individuals with a TTR Glu54Leu (p. Glu74Leu) mutation in the transthyretin gene. This mutation has been previously described a few times in the literature, but no phenotypic or clinical description has been done before. The most common mutation in the Swedish population is TTRVal30Met and is mostly found in the Northern part of Sweden. Interestingly, the TTRGlu54Leu mutation was found in the same endemic area. The main phenotype of the TTR Glu54Leu patients is severe cardiomyopathy, which resulted in heart transplantation for the index person. As previously seen for ATTR amyloidosis patients with mainly cardiomyopathy, the amyloid fibrils consisted of a mixture of full-length and fragmented TTR species. However, western blot analyses detected a previously unrecognized band, indicating that these patients may have a third, so far unrecognized, fibril composition type that is distinct from the usual type A band pattern.
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Affiliation(s)
- Urban Hellman
- Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden
| | - Kenneth Lång
- Department of Medicine, Piteå Hospital , Piteå , Sweden
| | - Elisabet Ihse
- Department of Immunology, Genetics and Pathology, Uppsala University , Uppsala , Sweden
| | - Jenni Jonasson
- Clinical Genetics, Laboratory Medicine, Department of Medical Bioscience/Medical and Clinical Genetics, Umeå University , Umeå , Sweden
| | - Malin Olsson
- Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University , Umeå , Sweden
| | - Hans-Erik Lundgren
- Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden
| | - Björn Pilebro
- Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden
| | - Per Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University , Uppsala , Sweden
| | - Jonas Wixner
- Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden
| | - Intissar Anan
- Department of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden.,Wallenberg Centre for Molecular Medicine, Umeå University , Umeå , Sweden
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115
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Amyloid PET imaging in cardiac amyloidosis: a pilot study using 18F-flutemetamol positron emission tomography. Ann Nucl Med 2019; 33:624-628. [PMID: 31140154 DOI: 10.1007/s12149-019-01372-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Cardiac amyloidosis is a rare disease characterized by amyloid heart deposits and is usually a part of systemic amyloidosis, in relation to systemic light chain (AL) and transthyretin (ATTR wild-type or genetic) amyloidosis. Several recent studies suggest a promising role of amyloid PET imaging to image cardiac amyloidosis, and several PET tracers are now available for in vivo detection of amyloid deposits. The aim of this study was to evaluate 18F-flutemetamol in diagnosing cardiac amyloidosis. METHODS We performed a pilot study using 18F-flutemetamol (Vizamyl™) in 12 patients, 3 control subjects without cardiac amyloidosis, and 9 subjects with documented cardiac amyloidosis. Mean standardized uptake value (SUV) in the left ventricular myocardium and blood pool was determined and semi-quantitative parameter as target to background ratio (TBR, myocardial/blood pool mean SUV ratio) between 10th and 30th minutes was calculated. RESULTS Uptake of 18F-flutemetamol in the left ventricular myocardium was noted in all patients with cardiac amyloidosis except one and none in control patient. The TBR was significantly higher in amyloidosis patients than in control subjects: 1.46, interquartile range (IQR) 1.32-2.06 versus 1.06, IQR 0.72-1.1 (p = 0.033). Only one patient in our study had light chain amyloidosis and showed higher TBR than patients with transthyretin amyloid: TBR 3.0 versus TBR median 1.44, IQR 1.33-1.69. CONCLUSION Amyloid PET tracers such as 18F-flutemetamol could be a promising tool in diagnosing and in therapy response assessment for patients with cardiac amyloidosis.
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116
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Gargiulo P, Perrone-Filardi P. Dangerous relationships: aortic stenosis and transthyretin cardiac amyloidosis. Eur Heart J 2019; 38:2888-2889. [PMID: 29019616 DOI: 10.1093/eurheartj/ehx513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paola Gargiulo
- IRCCS SDN spa, Institute of Diagnostic and Nuclear Development, Naples, Italy
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117
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Michels da Silva D, Langer H, Graf T. Inflammatory and Molecular Pathways in Heart Failure-Ischemia, HFpEF and Transthyretin Cardiac Amyloidosis. Int J Mol Sci 2019; 20:ijms20092322. [PMID: 31083399 PMCID: PMC6540104 DOI: 10.3390/ijms20092322] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/01/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023] Open
Abstract
Elevated pro-inflammatory biomarkers and cytokines are associated with morbidity and mortality in heart failure (HF). Preclinical and clinical studies have shown multiple inflammatory mechanisms causing cardiac remodeling, dysfunction and chronic failure. Therapeutics in trials targeting the immune response in heart failure and its effects did not result in evident benefits regarding clinical endpoints and mortality. This review elaborates pathways of immune cytokines in pathogenesis and worsening of heart failure in clinical and cellular settings. Besides the well-known mechanisms of immune activation and inflammation in atherosclerosis causing ischemic cardiomyopathy or myocarditis, attention is focused on other mechanisms leading to heart failure such as transthyretin (TTR) amyloidosis or heart failure with preserved ejection fraction. The knowledge of the pathogenesis in heart failure and amyloidosis on a molecular and cellular level might help to highlight new disease defining biomarkers and to lead the way to new therapeutic targets.
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Affiliation(s)
- Diana Michels da Silva
- Department of Cardiology, Angiology and Intensive Care, Medicine Medical Clinic II, University Heart Center Lübeck, 23562 Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany.
| | - Harald Langer
- Department of Cardiology, Angiology and Intensive Care, Medicine Medical Clinic II, University Heart Center Lübeck, 23562 Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany.
| | - Tobias Graf
- Department of Cardiology, Angiology and Intensive Care, Medicine Medical Clinic II, University Heart Center Lübeck, 23562 Lübeck, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23562 Lübeck, Germany.
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Moñivas Palomero V, Durante-Lopez A, Sanabria MT, Cubero JS, González-Mirelis J, Lopez-Ibor JV, Navarro Rico SM, Krsnik I, Dominguez F, Mingo AM, Hernandez-Perez FJ, Cavero G, Santos SM. Role of Right Ventricular Strain Measured by Two-Dimensional Echocardiography in the Diagnosis of Cardiac Amyloidosis. J Am Soc Echocardiogr 2019; 32:845-853.e1. [PMID: 31078369 DOI: 10.1016/j.echo.2019.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiac amyloidosis (CA) causes restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic light-chain CA (ALCA) and transthyretin-derived CA (either wild type transthyretin amyloidosis [TTRwt] or mutant transthyretin amyloidosis [TTRm]). Left ventricular (LV) apical sparing has been extensively studied using speckle-tracking echocardiography for diagnosis, but the right ventricular (RV) deformation pattern has not been described. The aims of this study were to characterize RV involvement in patients with CA and to identify parameters that may help in the differential diagnosis between ALCA and transthyretin-derived CA subtypes. METHODS Seventy-eight patients with CA (47 with ALCA, 20 with TTRwt, and 11 with TTRm) and 24 healthy control subjects were included. Global longitudinal strain (GLS) was analyzed in 16 LV and six RV segments. LV and RV apical ratios (ARs) were obtained. GLS was expressed as an absolute value. RESULTS LV GLS and free-wall RV longitudinal strain were impaired in all patients (LV GLS: 11.9 ± 2.9% in ALCA, 12.5 ± 3.8% in TTRwt, 14.9 ± 2.7% in TTRm, and 21.9 ± 2.6% in control subjects [P < .01]; free-wall RV longitudinal strain: 13.1 ± 6.8%, 14.9 ± 4.5%, 17.2 ± 3.4%, and 22.1 ± 3.1%, respectively [P < .01]). LV and RV ARs were higher in ALCA compared with both TTRwt, TTRm, and control subjects (LV AR: 1.1 ± 0.2, 0.8 ± 0.2, 0.9 ± 0.1, and 0.7 ± 0.1, respectively [P < .001]; RV AR: 1.1 ± 0.2, 0.6 ± 0.2, 0.6 ± 0.1, and 0.6 ± 0.1, respectively [P < .001]). Cutoff values of LV AR > 0.96 and RV AR > 0.8 showed high accuracy to differentiate between ALCA and transthyretin-derived CA. CONCLUSIONS RV dysfunction is common in patients with CA. Analysis of RV strain showed an apical sparing pattern, as previously described in the left ventricle, with a higher AR as a specific finding in patients with ALCA. RV AR may be a parameter that can differentiate the subtypes of amyloidosis on the basis of speckle-tracking echocardiographic analysis.
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Affiliation(s)
- Vanessa Moñivas Palomero
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | | | - Mario Torres Sanabria
- Cardiology Department, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Javier Segovia Cubero
- Department of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Jesús González-Mirelis
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Jorge Vazquez Lopez-Ibor
- Department of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Sara M Navarro Rico
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Isabel Krsnik
- Hematology, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Alejandro Martinez Mingo
- Methodology and Statistics, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Francisco J Hernandez-Perez
- Department of Advanced Heart Failure and Heart Transplantation, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Gibanel Cavero
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain
| | - Susana Mingo Santos
- Department of Cardiac Imaging, University Hospital Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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119
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Kim HM, Sohn DW, Paeng JC. Prevalence of Positive 99 mTc-DPD Scintigraphy as an Indicator of the Prevalence of Wild-type Transthyretin Amyloidosis in the Elderly. Int Heart J 2019; 60:643-647. [PMID: 31019172 DOI: 10.1536/ihj.18-345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Senile or wild-type transthyretin (wtTTR) amyloidosis is an age-related disease caused by the deposition of wtTTR amyloid protein. In contrast to light chain amyloidosis, 99 mTc-DPD scintigraphy (DPD scan) is a useful diagnostic modality for wtTTR amyloidosis.We retrospectively analyzed patients older than 30 years who underwent DPD scanning for non-cardiac reasons at our hospital between June 2014 and March 2017 (n = 9,581). Transthoracic echocardiography was used to assess left ventricular hypertrophy (LVH), as well as systolic and diastolic function.A positive DPD scan was observed in only six patients (0.06%). All six of these patients were older than 70 years, and they constitute only 0.4% of patients in this age group (6/1652). Among the patients with a positive DPD scan, four showed concentric LVH and two showed a normal wall thickness. With respect to the severity of diastolic dysfunction and pulmonary artery pressure, patients with a positive DPD scan showed the expected E' and pulmonary artery systolic pressure for their age.Even considering the limited sensitivity of a positive DPD scan detecting wtTTR amyloidosis, the incidence of a positive DPD scan in non-cardiac patients indicated that wtTTR amyloid deposition does not seem to be a major cause for age-related diastolic dysfunction, nor does appear to have a high incidence in patients with heart failure with preserved EF in the elderly.
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Affiliation(s)
- Hyue Mee Kim
- Division of Cardiology, Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital
| | - Dae-Won Sohn
- Division of Cardiology, Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital
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120
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Transthyretin Val122Ile amyloidosis associated with isolated gastrointestinal disease and bowel rupture in a Caucasian woman. Pathology 2019; 51:436-439. [PMID: 31003840 DOI: 10.1016/j.pathol.2018.12.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 11/23/2022]
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Cappelli F, Gallini C, Di Mario C, Costanzo EN, Vaggelli L, Tutino F, Ciaccio A, Bartolini S, Angelotti P, Frusconi S, Farsetti S, Vergaro G, Giorgetti A, Marzullo P, Genovesi D, Emdin M, Perfetto F. Accuracy of 99mTc-Hydroxymethylene diphosphonate scintigraphy for diagnosis of transthyretin cardiac amyloidosis. J Nucl Cardiol 2019; 26:497-504. [PMID: 28537040 DOI: 10.1007/s12350-017-0922-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 05/04/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Either 99mTechnetium diphosphonate (Tc-DPD) or pyrophosphate (Tc-PYP) scintigraphy plays a relevant role in diagnosing transthyretin cardiac amyloidosis (CA), and labeled radiotracers have been extensively studied in diagnosing CA. Few studies have analyzed and validated 99mTc-Hydroxymethylene diphosphonate (Tc-HMDP). Our aim was to validate the diagnostic accuracy of Tc-HMDP total-body scintigraphy in a cohort of patients with biopsy-proven transthyretin CA. METHODS AND RESULTS We retrospectively evaluated all patients undergoing 99mTc-HMDP total-body scintigraphy, in adjunct to a comprehensive diagnostic work-up for suspected CA. Sixty-five patients were finally diagnosed with CA, while it was excluded in 20 subjects with left ventricular hypertrophy of various etiologies. Twenty-six patients had AL-CA, 39 had TTR CA (16 TTRm, 23 TTRwt). At Tc-HMDP scintigraphy, 2 AL patients showed a Perugini score grade 1 heart uptake, while 24 showed no uptake. All TTR patients showed Tc-HMDP uptake, with three patients showing a Perugini score grade 1, 16 grade 2, and 20 grade 3, respectively. No uptake was observed in patients with left ventricular hypertrophy. A positive Tc-HMDP scintigraphy showed a 100% sensitivity and a 96% specificity for TTR CA identification. CONCLUSIONS Tc-HMDP scintigraphy is as accurate as Tc-DPD or Tc-PYP, and may therefore de facto be considered a valuable tool for the diagnosis of TTR CA.
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Affiliation(s)
- Francesco Cappelli
- Tuscan Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy.
- Department of Heart, Lung and Vessels, Intensive Cardiac Care Unit, Interventional Structural Cardiology Division, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Chiara Gallini
- Nuclear Medicine Division, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy
| | | | - Luca Vaggelli
- Nuclear Medicine Division, Careggi University Hospital, Florence, Italy
| | - Francesca Tutino
- Nuclear Medicine Division, Careggi University Hospital, Florence, Italy
| | - Alfonso Ciaccio
- Nuclear Medicine Division, Careggi University Hospital, Florence, Italy
| | - Simone Bartolini
- Interventional Structural Cardiology Division, Careggi University Hospital, Florence, Italy
| | - Paola Angelotti
- Tuscan Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Sabrina Frusconi
- Tuscan Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia Farsetti
- Tuscan Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | | | | | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloid Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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122
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Andrikopoulou E, Bhambhvani P. Nuclear imaging of cardiac amyloidosis. J Nucl Cardiol 2019; 26:505-508. [PMID: 28822085 DOI: 10.1007/s12350-017-1028-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Efstathia Andrikopoulou
- Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, USA
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123
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Correction to: Reference Ranges for the Size of the Fetal Cardiac Outflow Tracts From 13 to 36 Weeks Gestation: A Single-Center Study of Over 7000 Cases. Circ Cardiovasc Imaging 2019; 12:e000025. [PMID: 30866649 DOI: 10.1161/hci.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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124
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Pelletier-Galarneau M, Abikhzer G, Giraldeau G, Harel F. Molecular Imaging of Cardiac Amyloidosis. Curr Cardiol Rep 2019; 21:12. [DOI: 10.1007/s11886-019-1097-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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125
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Singh V, Falk R, Di Carli MF, Kijewski M, Rapezzi C, Dorbala S. State-of-the-art radionuclide imaging in cardiac transthyretin amyloidosis. J Nucl Cardiol 2019; 26:158-173. [PMID: 30569412 PMCID: PMC6541031 DOI: 10.1007/s12350-018-01552-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/27/2022]
Abstract
Cardiac amyloidosis, once considered untreatable, is now gaining well-deserved attention due to advances in imaging and the recent approval of targeted breakthrough therapies. In this paper, we discuss the role of radionuclide imaging in the evaluation and management of patients with the most common form of amyloidosis-cardiac transthyretin amyloidosis (ATTR). We provide a comprehensive summary of the literature interspersed with our institutional experience as appropriate, to deliver our perspective.
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Affiliation(s)
- Vasvi Singh
- Division of Nuclear Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA, 2115, USA
| | - Rodney Falk
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, 2115, USA
| | - Marcelo F Di Carli
- Division of Nuclear Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA, 2115, USA
| | - Marie Kijewski
- Division of Nuclear Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA, 2115, USA
| | - Claudio Rapezzi
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sharmila Dorbala
- Division of Nuclear Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, MA, 2115, USA.
- Cardiac Amyloidosis Program, Brigham and Women's Hospital, Boston, MA, 2115, USA.
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Heart and Vascular Center, Division of Nuclear Medicine and Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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126
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Lee SP, Park JB, Kim HK, Kim YJ, Grogan M, Sohn DW. Contemporary Imaging Diagnosis of Cardiac Amyloidosis. J Cardiovasc Imaging 2019; 27:1-10. [PMID: 30701710 PMCID: PMC6358430 DOI: 10.4250/jcvi.2019.27.e9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
Cardiac amyloidosis is a rare disease that frequently presents as ventricular hypertrophy. However, diagnosis is not always easy or straightforward as there are several myocardial disorders that phenocopy cardiac amyloidosis. Here, we present a narrative review of the current modalities that are actively used or being developed for diagnosis and follow-up of cardiac amyloidosis. Although not all of the findings may be present in those with cardiac amyloidosis, there are some clues in each diagnostic step that help lead to confirmatory diagnosis of cardiac amyloidosis; we believe that cardiologists should be familiar with these clues.
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Affiliation(s)
- Seung Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jun Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Dae Won Sohn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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127
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Luigetti M, Primiano G, Bisogni G, Cuccagna C, Carrozzo R, Obici L, Bernardo D, Sancricca C, Servidei S. Progressive axonal polyneuropathy in a mitochondrial disorder: an uncommon association with familial amyloid neuropathy. Amyloid 2018; 25:261-262. [PMID: 30193540 DOI: 10.1080/13506129.2018.1506919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marco Luigetti
- a Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurologia, Roma , Italia.,b Università Cattolica del Sacro Cuore , Roma , Italia
| | - Guido Primiano
- c Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurofisiopatologia, Roma , Italia
| | | | - Cristina Cuccagna
- e Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurologia, Roma , Italia
| | - Rosalba Carrozzo
- f Unit of Neuromuscular and Neurodegenerative Disorders , Bambino Gesù Children's Research Hospital , Rome , Italy
| | - Laura Obici
- g Amyloidosis Research and Treatment Center , Foundation IRCCS Policlinico San Matteo, Pavia , Italy
| | | | - Cristina Sancricca
- i Fondazione Policlinico Universitario A. Gemelli IRCCS , UOC Neurologia, Roma , Italia
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128
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Massalha S, Ruddy TD. Emerging role of echocardiography, cardiac magnetic resonance imaging and 99mTc-labeled bone tracer scintigraphy for the diagnosis of cardiac amyloidosis. J Nucl Cardiol 2018; 25:2080-2083. [PMID: 28585032 DOI: 10.1007/s12350-017-0943-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Samia Massalha
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H1220, Ottawa, ON, K1Y 4W7, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Terrence D Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H1220, Ottawa, ON, K1Y 4W7, Canada.
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
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129
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Van Der Gucht A, Cottereau AS, Abulizi M, Guellich A, Blanc-Durand P, Israel JM, Galat A, Plante-Bordeneuve V, Dubois-Randé JL, Bodez D, Rosso J, Damy T, Itti E. Apical sparing pattern of left ventricular myocardial 99mTc-HMDP uptake in patients with transthyretin cardiac amyloidosis. J Nucl Cardiol 2018; 25:2072-2079. [PMID: 28447284 DOI: 10.1007/s12350-017-0894-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/05/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND A decreased longitudinal strain in basal segments with a base-to-apex gradient has been described in patients with cardiac amyloidosis (CA). OBJECTIVES Aim was to investigate the left ventricular (LV) regional distribution of early-phase 99mTc-Hydroxymethylene diphosphonate (99mTc-HMDP) uptake in patients with transthyretin-related cardiac amyloidosis (TTR-CA). METHODS All patients underwent a whole-body planar 99mTc-HMDP scintigraphy acquired at 10-min post-injection (early-phase) followed by a thorax SPECT/CT. The segmental uptake (expressed as % of maximal myocardial HMDP uptake) was investigated on the AHA 17-segment model and 3-segment model (basal, mid-cavity, apical). RESULTS Sixty-one TTR-CA patients were included of whom 29 were wild-type (wt-TTR-CA) and 32 had hereditary TTR-CA (m-TTR-CA). Early myocardial 99mTc-HMDP uptake occurred in all TTR-CA. In all patients, segmental analysis of the LV myocardial distribution of 99mTc-HMDP uptake showed an increased median uptake (interquartile range) in basal/mid-cavity segments compared to the lowest median uptake of apical segments (respectively, 79% [72%-86%] vs. 72% [64%-81%]; P < 10-6). This pattern was similar in wt-TTR-CA group (78% [70%-84%] vs. 70% [61%-81%]; P < 10-6), in m-TTR-CA group (80% [74%-86%] vs. 73 [66%-82%]; P < 10-7) and remained constant independently of the TTR mutation subtype with P ranging 10-5 to 0.03. CONCLUSIONS Early-phase myocardial scintigraphy identified regional distribution of 99mTc-HMDP uptake characterized by a base-to-apex gradient, corroborating echocardiographic, and cardiac magnetic resonance findings. This apical sparing pattern was similar across TTR-CA and TTR mutation subtypes.
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Affiliation(s)
- Axel Van Der Gucht
- Mondor Amyloidosis Network, Créteil, France.
- Department of Nuclear Medicine, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France.
| | - Anne-Ségolène Cottereau
- Mondor Amyloidosis Network, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Mukedaisi Abulizi
- Mondor Amyloidosis Network, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Aziz Guellich
- Mondor Amyloidosis Network, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, Créteil, France
| | - Paul Blanc-Durand
- Mondor Amyloidosis Network, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Jean-Marc Israel
- Mondor Amyloidosis Network, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Arnault Galat
- Mondor Amyloidosis Network, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, Créteil, France
| | - Violaine Plante-Bordeneuve
- Mondor Amyloidosis Network, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, Créteil, France
- Department of Neurology, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Jean-Luc Dubois-Randé
- Mondor Amyloidosis Network, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, Créteil, France
| | - Diane Bodez
- Mondor Amyloidosis Network, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, Créteil, France
| | - Jean Rosso
- Mondor Amyloidosis Network, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
| | - Thibaud Damy
- Mondor Amyloidosis Network, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, Créteil, France
| | - Emmanuel Itti
- Mondor Amyloidosis Network, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Teaching Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94010, Créteil, France
- DHU ATVB, Paris Est University, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, Créteil, France
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130
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Morgenstern R, Yeh R, Castano A, Maurer MS, Bokhari S. 18Fluorine sodium fluoride positron emission tomography, a potential biomarker of transthyretin cardiac amyloidosis. J Nucl Cardiol 2018; 25:1559-1567. [PMID: 28176254 DOI: 10.1007/s12350-017-0799-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/07/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Non-invasive imaging to diagnose and quantify amyloid load, progression, and response to treatment are central for the care of patients with cardiac amyloidosis. 18Fluorine-labeled sodium fluoride (18F-NaF) is a widely available radioisotope and PET imaging allows for absolute quantification of tracer uptake. METHODS Patients with biopsy-proven transthyretin (ATTR-CA) and light-chain cardiac amyloidosis (AL) (3 ATTRwt, 2 ATTRV122I, 2 AL) and controls (n = 5), underwent 18F-NaF PET imaging. Scans were assessed visually for radiotracer uptake and analyzed using standard uptake values in the entire myocardium (SUVm) and in a 17-segment cardiac model. Wilcoxon rank-sum tests were used for statistical analyses. RESULTS Qualitative 18F-NaF uptake was absent in controls and AL patients. There was qualitative 18F-NaF uptake in ATTR-CA patients, with slightly increased uptake in wild-type patients. SUVm for controls and AL patients overlapped at 0.8(0.4-0.9) and 0.95(0.9-1.0), respectively (P = 0.434). At 1.5(1.4-1.7), SUVm for ATTR-CA patients was ≈1.5*SUVm of controls (P = 0.012) and AL patients (P = 0.078). While there was diffuse 18F-NaF myocardial in ATTR-CA patients, the degree of uptake varied according to cardiac segment. CONCLUSION 18F-NaF PET effectively imaged and differentiated ATTR-CA patients. Semi-automatic software enabled quantification of radiotracer uptake and regional distribution. 18F-NaF PET may be useful for disease monitoring and localizing amyloid deposition in ATTR-CA patients.
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Affiliation(s)
- Rachelle Morgenstern
- Nuclear Cardiology Lab, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH10-203E, New York, NY, 10032, USA.
| | - Randy Yeh
- Department of Radiology, Columbia University College of Physicians and Surgeons, Box 28, New York, NY, 10032, USA
| | - Adam Castano
- Nuclear Cardiology Lab, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH10-203E, New York, NY, 10032, USA
| | - Mathew S Maurer
- Center for Advanced Center for Heart Failure, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH12-1391, New York, NY, 10032, USA
| | - Sabahat Bokhari
- Nuclear Cardiology Lab, Columbia University College of Physicians and Surgeons, 622 West 168th street, PH10-203E, New York, NY, 10032, USA
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131
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Ross JC, Hutt DF, Burniston M, Page J, Steeden JA, Gillmore JD, Wechalekar AD, Hawkins PN, Fontana M. Quantitation of 99mTc-DPD uptake in patients with transthyretin-related cardiac amyloidosis. Amyloid 2018; 25:203-210. [PMID: 30486686 DOI: 10.1080/13506129.2018.1520087] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Transthyretin (ATTR) amyloidosis is a rare but serious infiltrative disease associated with a wide spectrum of morphologic and functional cardiac involvement. 99mTc-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD), initially developed as a bone-seeking radiotracer, is remarkably sensitive for imaging cardiac ATTR amyloid deposits. Our aim was to investigate the feasibility and utility of estimating 99mTc-DPD uptake in myocardial tissue; this has the potential to yield reliable quantitative information on cardiac amyloid burden, which is urgently required to monitor disease progression and response to novel treatments. METHODS Three methods of quantitation were developed and tested on 74 patients with proven cardiac ATTR amyloidosis who had recently undergone 99mTc-DPD planar whole-body imaging and SPECT-CT. Quantitative results were compared to measurements of extracellular volume fraction (ECV) by cardiac magnetic resonance imaging, a validated technique for measuring amyloid burden. RESULTS An experienced clinician graded uptake using a widely-used visual scoring system as 1 (n = 15), 2 (n = 39) or 3 (n = 20). Linear correlations between the SPECT and ECV data (p < .001) were demonstrated. None of the methods showed that 99mTc-DPD uptake in the heart was significantly greater in patients with grade-3 uptake than in those with grade-2 uptake. CONCLUSIONS Quantitation of 99mTc-DPD uptake in cardiac transthyretin amyloid deposits is complex and is hindered by competition for radiotracer with amyloid in skeletal muscle. The latter underlies differences in uptake between grade-2 and grade-3 patients, not cardiac uptake.
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Affiliation(s)
- James C Ross
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK.,b Institute of Nuclear Medicine , University College London Hospitals NHS Foundation Trust , London , UK
| | - David F Hutt
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Maria Burniston
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK.,c Nuclear Medicine Department, Nuclear Medicine , Barts Health NHS Trust , London , UK
| | - Joanne Page
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK.,d Nuclear Medicine Department , Royal Free London NHS Foundation Trust , London , UK
| | - Jennifer A Steeden
- e UCL Centre for Cardiovascular Imaging , University College London , London , UK
| | - Julian D Gillmore
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Ashutosh D Wechalekar
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Philip N Hawkins
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
| | - Marianna Fontana
- a National Amyloidosis Centre , UCL Medical School (Royal Free Campus) , London , UK
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132
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Trivieri MG, Dweck MR, Abgral R, Robson PM, Karakatsanis NA, Lala A, Contreras J, Sahni G, Gopalan R, Gorevic P, Fuster V, Narula J, Fayad ZA. 18F-Sodium Fluoride PET/MR for the Assessment of Cardiac Amyloidosis. J Am Coll Cardiol 2018; 68:2712-2714. [PMID: 27978955 DOI: 10.1016/j.jacc.2016.09.953] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/26/2016] [Accepted: 09/28/2016] [Indexed: 01/15/2023]
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133
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Vranian MN, Sperry BW, Hanna M, Hachamovitch R, Ikram A, Brunken RC, Jaber WA. Technetium pyrophosphate uptake in transthyretin cardiac amyloidosis: Associations with echocardiographic disease severity and outcomes. J Nucl Cardiol 2018; 25:1247-1256. [PMID: 28050864 DOI: 10.1007/s12350-016-0768-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/05/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Quantitative uptake of Technetium 99 m-pyrophosphate (TcPYP) is sensitive and specific for diagnosing transthyretin cardiac amyloidosis (ATTR). We sought to examine the association between TcPYP uptake intensity and echocardiographic measures of disease severity and clinical outcomes. METHODS AND RESULTS A retrospective analysis was performed of 75 patients who underwent TcPYP scintigraphy. Planar images were evaluated semiquantitatively and using heart-to-contralateral lung (H/CL) ratio. The associations between H/CL ratio and echocardiographic parameters and outcomes were evaluated using linear regression and Cox models, respectively. There were 48 patients diagnosed with ATTR with mean H/CL ratio 1.58 ± 0.22 (vs 1.08 ± 0.09 if semiquantitative score = 0). The H/CL ratio was not associated with any measured echocardiographic parameter. Both semiquantitative uptake grade and H/CL ratio were associated with all-cause mortality (P = 0.009 and 0.007, respectively) and all-cause mortality or heart failure hospitalization (P = 0.001 and 0.020, respectively); however, neither were associated with outcomes when limited to patients with confirmed ATTR (P = 0.18 and 0.465, respectively). CONCLUSION In patients with suspected ATTR, quantitative and semiquantitative uptake intensity of TcPYP is associated with all-cause mortality as well as all-cause mortality or heart failure hospitalization. However, in those with confirmed ATTR, there is no association with echocardiographic disease severity or outcomes.
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Affiliation(s)
- Michael N Vranian
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Brett W Sperry
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Asad Ikram
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Richard C Brunken
- Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
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134
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Castaño A, Maurer MS, Bokhari S. Technetium 99m pyrophosphate radioisotope for diagnosis and prognosis of transthyretin cardiac amyloidosis: A call for collaboration. J Nucl Cardiol 2018; 25:1257-1259. [PMID: 28150156 DOI: 10.1007/s12350-017-0803-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Adam Castaño
- Nuclear Cardiology Laboratory, Center for Advanced Cardiac Care, Division of Cardiology, Columbia University College of Physicians & Surgeons, 622W 168th St. P.H. 10-203, New York, NY, 10032, USA.
- Center for Advanced Cardiac Care, Division of Cardiology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA.
| | - Mathew S Maurer
- Center for Advanced Cardiac Care, Division of Cardiology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Sabahat Bokhari
- Nuclear Cardiology Laboratory, Center for Advanced Cardiac Care, Division of Cardiology, Columbia University College of Physicians & Surgeons, 622W 168th St. P.H. 10-203, New York, NY, 10032, USA
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135
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Habib G, Bucciarelli-Ducci C, Caforio ALP, Cardim N, Charron P, Cosyns B, Dehaene A, Derumeaux G, Donal E, Dweck MR, Edvardsen T, Erba PA, Ernande L, Gaemperli O, Galderisi M, Grapsa J, Jacquier A, Klingel K, Lancellotti P, Neglia D, Pepe A, Perrone-Filardi P, Petersen SE, Plein S, Popescu BA, Reant P, Sade LE, Salaun E, Slart RHJA, Tribouilloy C, Zamorano J. Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography. Eur Heart J Cardiovasc Imaging 2018; 18:1090-1121. [PMID: 28510718 DOI: 10.1093/ehjci/jex034] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 12/11/2022] Open
Abstract
Restrictive cardiomyopathies (RCMs) are a diverse group of myocardial diseases with a wide range of aetiologies, including familial, genetic and acquired diseases and ranging from very rare to relatively frequent cardiac disorders. In all these diseases, imaging techniques play a central role. Advanced imaging techniques provide important novel data on the diagnostic and prognostic assessment of RCMs. This EACVI consensus document provides comprehensive information for the appropriateness of all non-invasive imaging techniques for the diagnosis, prognostic evaluation, and management of patients with RCM.
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Affiliation(s)
- Gilbert Habib
- Aix- Aix-Marseille Univ, URMITE, Aix Marseille Université-UM63, CNRS 7278, IRD 198, INSERM 1095.,Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, 13005 Marseille, France
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, National Institute of Health Research (NIHR) Bristol Cardiovascular Biomedical Research Unit (BRU), University of Bristol, Bristol, UK
| | - Alida L P Caforio
- Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padova, Italy
| | - Nuno Cardim
- Multimodality Cardiac Imaging Department, Sports Cardiology and Cardiomyopathies Centre-Hospital da Luz; Lisbon, Portugal
| | - Philippe Charron
- Université Versailles Saint Quentin, INSERM U1018, Hôpital Ambroise Paré, Boulogne-Billancourt, France.,Centre de référence pour les maladies cardiaques héréditaires, APHP, ICAN, Hôpital de la Pitié Salpêtrière, Paris, France
| | | | - Aurélie Dehaene
- Department of Radiology and Cardiovascular Imaging, APHM, Hôpitaux de la Timone, Pôle d'imagerie Médicale, 13005 Marseille, France
| | - Genevieve Derumeaux
- Department of Physiology, INSERM U955, Université Paris-Est Creteil, Henri Mondor Hospital, DHU-ATVB, AP-HP, Créteil, France
| | - Erwan Donal
- Cardiologie-CHU Rennes & CIC-IT 1414 & LTSI INSERM 1099 - Université Rennes-1
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh
| | - Thor Edvardsen
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
| | - Laura Ernande
- Department of Physiology, INSERM U955, Université Paris-Est Creteil, Henri Mondor Hospital, DHU-ATVB, AP-HP, Créteil, France
| | - Oliver Gaemperli
- University Heart Center Zurich, Interventional Cardiology and Cardiac Imaging 19, Zurich
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Julia Grapsa
- Department of Cardiovascular Sciences, Imperial College of London, London, UK
| | - Alexis Jacquier
- Department of Radiology and Cardiovascular Imaging, APHM, Hôpitaux de la Timone, Pôle d'imagerie Médicale, Aix-Marseille Université, CNRS, CRMBM UMR 7339, 13385 Marseille, France
| | - Karin Klingel
- Department of Molecular Pathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Patrizio Lancellotti
- Departments of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Danilo Neglia
- Cardiovascular Department, Fondazione Toscana G. Monasterio, CNR Institute of Clinical Physiology, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R.-Regione Toscana Pisa, Italy
| | | | - Steffen E Petersen
- Department of Advanced Cardiovascular Imaging, William Harvey Research Institute, National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts, London, UK
| | - Sven Plein
- Division of Biomedical Imaging, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Cardiovascular and Metabolic Medicine LIGHT Laboratories, University of Leeds, UK
| | - Bogdan A Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | | | | | - Erwan Salaun
- Cardiology Department, La Timone Hospital, Marseille France
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, PO Box 217, 7500 AEEnschede, The Netherlands
| | - Christophe Tribouilloy
- Department of Cardiology, University Hospital Amiens, Amiens, France and INSERM U-1088, Jules Verne University of Picardie, Amiens, France
| | - Jose Zamorano
- University Hospital Ramon y Cajal Carretera de Colmenar Km 9,100, 28034 Madrid, Spain
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136
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Mohamed-Salem L, Santos-Mateo JJ, Sanchez-Serna J, Hernández-Vicente Á, Reyes-Marle R, Castellón Sánchez MI, Claver-Valderas MA, Gonzalez-Vioque E, Haro-Del Moral FJ, García-Pavía P, Pascual-Figal DA. Prevalence of wild type ATTR assessed as myocardial uptake in bone scan in the elderly population. Int J Cardiol 2018; 270:192-196. [PMID: 29903517 DOI: 10.1016/j.ijcard.2018.06.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/20/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myocardial uptake of bone tracers has emerged as useful tool for the early detection of transthyretin amyloidosis (ATTR). The prevalence of wild-type ATTR (ATTRwt) in individuals remains to be established. METHODS All whole body bone scans performed in individuals ≥ 75 years with no previous clinical suspicion of ATTR were revised in a population-based university hospital over a 7-year period (1509 studies corresponding to 1114 patients; 80.5 ± 4.1 years, 65% males). Positive cardiac uptake was defined according to Perugini score as grade 2 or 3. Heart failure (HF) hospitalizations during the follow-up were obtained from regional administrative databases. RESULTS Thirty-one patients ≥ 75 years (2.78%) showed cardiac uptake; compared with those without uptake, these patients were older (85 ± 5 vs. 80 ± 4, p < 0.001) and predominantly males (90% vs. 64%, p = 0.005). The prevalence of cardiac uptake was 3.88% in males and 0.77% in females, and increased with age, reaching 13.9% in males≥85 years (2.7% among females). The estimated prevalence for the European standard population ≥ 75 years was 4.15% in males, 1.03% in females and 2.59% in the general population. HF hospitalizations rates were 14% in patients without uptake and 29% in those with cardiac uptake (p = 0.034). After adjusting for age and gender, cardiac uptake was associated with a higher risk of HF hospitalization (OR 2.60, 95%CI 1.09-5.74, p = 0.022). CONCLUSIONS Myocardial uptake in bone scan is very prevalent with ageing, mainly affects males and is associated with an increased risk of HF hospitalization. These findings reinforce ATTRwt as a relevant cause of HF in the elderly.
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Affiliation(s)
| | | | - Juan Sanchez-Serna
- Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Álvaro Hernández-Vicente
- Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain; Facultad de Medicina, University of Murcia, Murcia, Spain.
| | - Rafael Reyes-Marle
- Nuclear Medicine Department, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | | - Pablo García-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta del Hierro, Madrid, Spain; Facultad de Ciencias de la Salud, University Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Domingo A Pascual-Figal
- Cardiology Department, University Hospital Virgen de la Arrixaca, Murcia, Spain; Facultad de Medicina, University of Murcia, Murcia, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
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137
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Abstract
Imaging in heart failure (HF) provides data for diagnosis, prognosis and disease monitoring. Both MRI and nuclear imaging techniques have been successfully used for this purpose in HF. Positron Emission Tomography-Cardiac Magnetic Resonance (PET-CMR) is an example of a new multimodality diagnostic imaging technique with potential applications in HF. The threshold for adopting a new diagnostic tool to clinical practice must necessarily be high, lest they exacerbate costs without improving care. New modalities must demonstrate clinical superiority, or at least equivalence, combined with another important advantage, such as lower cost or improved patient safety. The purpose of this review is to outline the current status of multimodality PET-CMR with regard to HF applications, and determine whether the clinical utility of this new technology justifies the cost.
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Affiliation(s)
- Michael A Quail
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520-8017, USA.,Institute of Cardiovascular Science, University College London, London, UK
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, Dana 3, P.O. Box 208017, New Haven, CT, 06520-8017, USA. .,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
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138
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Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis. Eur J Nucl Med Mol Imaging 2018; 45:1945-1955. [PMID: 29687207 DOI: 10.1007/s00259-018-4013-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR. METHODS A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) "amyloid" OR "amyloidosis" AND (b) "TTR" OR "ATTR" OR "transthyretin" AND (c) "scintigraphy" OR "scan" OR "SPECT" OR "SPET" OR "bone" OR "skeletal" OR "skeleton" OR "PYP" OR "DPD" OR "HMDP" OR "MDP" OR "HDP". Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated. RESULTS The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89-95%), specificity 95.4% (95% CI 77-99%), LR+ 7.02 (95% CI 3.42-14.4), LR- 0.09 (95% CI 0.06-0.14), and DOR 81.6 (95% CI 44-153). Mild heterogeneity was found among the selected studies. CONCLUSION Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.
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139
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Tuzovic M, Yang EH, Baas AS, Depasquale EC, Deng MC, Cruz D, Vorobiof G. Cardiac Amyloidosis: Diagnosis and Treatment Strategies. Curr Oncol Rep 2018; 19:46. [PMID: 28528458 DOI: 10.1007/s11912-017-0607-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiac amyloidosis in the United States is most often due to myocardial infiltration by immunoglobulin protein, such as in AL amyloidosis, or by the protein transthyretin, such as in hereditary and senile amyloidosis. Cardiac amyloidosis often portends a poor prognosis especially in patients with systemic AL amyloidosis. Despite better understanding of the pathophysiology of amyloid, many patients are still diagnosed late in the disease course. This review investigates the current understanding and new research on the diagnosis and treatment strategies in patients with cardiac amyloidosis. Myocardial amyloid infiltration distribution occurs in a variety of patterns. Structural and functional changes on echocardiography can suggest presence of amyloid, but CMR and nuclear imaging provide important complementary information on amyloid burden and the amyloid subtype, respectively. While for AL amyloid, treatment success largely depends on early diagnosis, for ATTR amyloid, new investigational agents that reduce production of transthyretin protein may have significant impact on clinical outcomes. Advancements in the non-invasive diagnostic detection and improvements in early disease recognition will undoubtedly facilitate a larger proportion of patients to receive early therapy when it is most effective.
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Affiliation(s)
- Mirela Tuzovic
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Arnold S Baas
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Eugene C Depasquale
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Mario C Deng
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Daniel Cruz
- Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA. .,Cardiovascular Center, 100 Medical Plaza, Suite 545, 100 UCLA Medical Plaza, Los Angeles, CA, 90095, USA.
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Algalarrondo V, Piekarski E, Eliahou L, Le Guludec D, Slama MS, Rouzet F. Can Nuclear Imaging Techniques Predict Patient Outcome and Guide Medical Management in Hereditary Transthyretin Cardiac Amyloidosis? Curr Cardiol Rep 2018; 20:33. [PMID: 29574587 DOI: 10.1007/s11886-018-0976-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Nuclear imaging recently gained a key role in the diagnosis and prognostic assessment of transthyretin (TTR)-related cardiac amyloidosis. This review aims at summarizing the state-of-the art regarding the implementation of nuclear imaging in the management of hereditary mutated TTR-cardiac amyloidosis (mTTR-CA). RECENT FINDINGS Although cardiac uptake of bone tracers is acknowledged as a specific marker of TTR amyloid cardiac burden, recent studies validated the implementation of bone scan in the flow chart for non-invasive diagnosis and follow-up of CA in multicenter trials. Simultaneously, cardiac denervation evidenced by MIBG scintigraphy proved to be a strong and independent prognostic marker of poor outcome in mTTR-CA. By its unique ability to assess both amyloid burden and cardiac denervation, nuclear imaging may prove useful as part of multimodality imaging tools to trigger treatment initiation and monitoring in patients with mTTR-CA.
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Affiliation(s)
- Vincent Algalarrondo
- Cardiology Department, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), UMR-S 1180, University of Paris-Sud, Clamart, France.,French Referral Center for Familial Amyloidotic Polyneuropathy and Other Rare Peripheral Neuropathies (CRMR-NNERF), Bicêtre, France
| | - Eve Piekarski
- Nuclear Medicine Department and DHU FIRE, Bichat Claude Bernard Hospital, AP-HP, University Paris VII, Paris, France.,Inserm UMR-S 1148, Paris, France
| | - Ludivine Eliahou
- Cardiology Department, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), UMR-S 1180, University of Paris-Sud, Clamart, France.,French Referral Center for Familial Amyloidotic Polyneuropathy and Other Rare Peripheral Neuropathies (CRMR-NNERF), Bicêtre, France
| | - Dominique Le Guludec
- Nuclear Medicine Department and DHU FIRE, Bichat Claude Bernard Hospital, AP-HP, University Paris VII, Paris, France.,Inserm UMR-S 1148, Paris, France
| | - Michel S Slama
- Cardiology Department, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), UMR-S 1180, University of Paris-Sud, Clamart, France.,French Referral Center for Familial Amyloidotic Polyneuropathy and Other Rare Peripheral Neuropathies (CRMR-NNERF), Bicêtre, France
| | - François Rouzet
- Nuclear Medicine Department and DHU FIRE, Bichat Claude Bernard Hospital, AP-HP, University Paris VII, Paris, France. .,Inserm UMR-S 1148, Paris, France.
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141
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Piekarski E, Chequer R, Algalarrondo V, Eliahou L, Mahida B, Vigne J, Adams D, Slama MS, Le Guludec D, Rouzet F. Cardiac denervation evidenced by MIBG occurs earlier than amyloid deposits detection by diphosphonate scintigraphy in TTR mutation carriers. Eur J Nucl Med Mol Imaging 2018; 45:1108-1118. [PMID: 29511839 DOI: 10.1007/s00259-018-3963-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/24/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Cardiac involvement in familial transthyretin (TTR) amyloidosis is of major prognostic value, and the development of early-diagnostic tools that could trigger the use of new disease-modifying treatments is crucial. The aim of our study was to compare the respective contributions of 99mTc-diphosphonate scintigraphy (DPD, detecting amyloid deposits) and 123I-MIBG (MIBG, assessing cardiac sympathetic denervation) in patients with genetically proven TTR mutation referred for the assessment of cardiac involvement. METHODS We prospectively studied 75 consecutive patients (classified as symptomatic or asymptomatic carriers), using clinical evaluation, biomarkers (troponin and BNP), echocardiography, and nuclear imaging. Patients were classified as having normal heart-to-mediastinum (HMR) MIBG uptake ratio 4 h after injection (defined by HM4 ≥ 1.85) or abnormal HM4 < 1.85, and positive DPD uptake (grade ≥ 1 of Perugini classification) or negative DPD uptake. RESULTS Among 75 patients, 49 (65%) presented with scintigraphic sympathetic cardiac denervation and 29 (39%) with myocardial diphosphonate uptake. When MIBG was normal, DPD was negative except for two patients. Age was an independent predictor of abnormal scintigraphic result of both MIBG and DPD (HR 1.08 and 1.15 respectively), whereas echocardiographic-derived indicators of increased left ventricular filling pressure (E/e' ratio) was an independent predictor of abnormal MIBG (HR 1.33) and global longitudinal strain of positive DPD (HR 1.45). In asymptomatic patients (n = 31), MIBG was abnormal in 48% (n = 15) among whom 50% had a normal DPD; all those with a normal MIBG (n = 16) had a normal DPD. CONCLUSIONS In TTR mutation carriers, cardiac sympathetic denervation evidenced by decreased MIBG uptake is detected earlier than amyloid burden evidenced by DPD. These results raise the possibility of a diagnostic role for MIBG scintigraphy at an early stage of cardiac involvement in TTR-mutated carriers, in addition to its well-established prognostic value.
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Affiliation(s)
- Eve Piekarski
- Nuclear Medicine Department, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), DHU FIRE, Inserm UMR-S 1148, Paris Diderot University, Paris, France
| | - Renata Chequer
- Nuclear Medicine Department, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), DHU FIRE, Inserm UMR-S 1148, Paris Diderot University, Paris, France
| | - Vincent Algalarrondo
- Cardiology Department, Antoine Béclère Hospital, AP-HP, Paris-Sud University, Clamart, France
- French Referent Center for Rare Diseases for FAP (Familial Amyloid Polyneuropathy) (CRMR-NNERF), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Ludivine Eliahou
- Cardiology Department, Antoine Béclère Hospital, AP-HP, Paris-Sud University, Clamart, France
- French Referent Center for Rare Diseases for FAP (Familial Amyloid Polyneuropathy) (CRMR-NNERF), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Besma Mahida
- Nuclear Medicine Department, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), DHU FIRE, Inserm UMR-S 1148, Paris Diderot University, Paris, France
| | - Jonathan Vigne
- Nuclear Medicine Department, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), DHU FIRE, Inserm UMR-S 1148, Paris Diderot University, Paris, France
| | - David Adams
- French Referent Center for Rare Diseases for FAP (Familial Amyloid Polyneuropathy) (CRMR-NNERF), Bicêtre Hospital, Le Kremlin-Bicêtre, France
- Neurology Department, AP-HP, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Michel S Slama
- Cardiology Department, Antoine Béclère Hospital, AP-HP, Paris-Sud University, Clamart, France
- French Referent Center for Rare Diseases for FAP (Familial Amyloid Polyneuropathy) (CRMR-NNERF), Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Dominique Le Guludec
- Nuclear Medicine Department, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), DHU FIRE, Inserm UMR-S 1148, Paris Diderot University, Paris, France
| | - Francois Rouzet
- Nuclear Medicine Department, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), DHU FIRE, Inserm UMR-S 1148, Paris Diderot University, Paris, France.
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Halatchev IG, Zheng J, Ou J. Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), previously known as senile cardiac amyloidosis: clinical presentation, diagnosis, management and emerging therapies. J Thorac Dis 2018; 10:2034-2045. [PMID: 29707360 DOI: 10.21037/jtd.2018.03.134] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cardiac amyloidosis is thought to be a rare group of diseases caused by extracellular deposition of misfolded proteins in the extracellular cardiac matrix resulting in heart failure with preserved ejection fraction (HFpEF). This review focuses on the similarities and differences between the pathophysiology, clinical presentation and diagnostic tests of wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) compared to immunoglobulin light chain amyloidosis and hereditary cardiac amyloidosis. We address some obstacles to timely diagnosis and opportunities for management of the clinical symptoms as well as possibility of future novel disease modifying therapies.
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Affiliation(s)
- Ilia G Halatchev
- Division of Cardiology, John Cochran Veterans Affairs Medical Center, St. Louis, USA.,Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jingsheng Zheng
- Department of Cardiology, AtlantiCare Regional Medical Center, Pomona, NJ, USA
| | - Jiafu Ou
- Division of Cardiology, John Cochran Veterans Affairs Medical Center, St. Louis, USA.,Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA
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143
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Cappelli F, Gallini C, Costanzo EN, Tutino F, Ciaccio A, Vaggelli L, Bartolini S, Morini S, Martone R, Angelotti P, Frusconi S, Di Mario C, Perfetto F. Lung uptake during 99mTc- hydroxymethylene diphosphonate scintigraphy in patient with TTR cardiac amyloidosis: An underestimated phenomenon. Int J Cardiol 2018; 254:346-350. [DOI: 10.1016/j.ijcard.2017.10.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 09/25/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
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144
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Abstract
The heart, like any organ in the body, is susceptible to amyloid deposition. Although more than 30 types of protein can cause amyloidosis, only two types commonly deposit in the ventricular myocardium: amyloid light chain and amyloid transthyretin. Amyloid cardiomyopathy is usually a major determinant of patient outcomes, and the diagnosis of heart involvement can be often relatively under-diagnosed, owing to nonspecific presenting symptoms and signs at a subclinical stage. The diagnosis of cardiac amyloidosis is usually performed by endomyocardial biopsy; however, the invasive nature and related high-risk complications restrict its wide use in clinical settings. Recently, with the advent of innovative techniques used for evaluating cardiac amyloidosis, noninvasive methods become increasingly important, especially in earlier diagnosis, distinguishing typing, risk prediction and response to treatment. Here, we will review recent developments in the noninvasive methods used in the assessment of cardiac amyloidosis, focused on the laboratory biomarkers and imaging modalities.
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Affiliation(s)
- Lei Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing, Dongcheng district, Beijing, 100730, China.
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Abulizi M, Cottereau AS, Guellich A, Vandeventer S, Galat A, Van Der Gucht A, Plante-Bordeneuve V, Dubois-Randé JL, Bodez D, Rosso J, Damy T, Itti E. Early-phase myocardial uptake intensity of 99mTc-HMDP vs 99mTc-DPD in patients with hereditary transthyretin-related cardiac amyloidosis. J Nucl Cardiol 2018; 25:217-222. [PMID: 27804073 DOI: 10.1007/s12350-016-0707-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study sought to compare the intensity of early-phase myocardial uptake of two phosphonate-based radiotracers, 99mTc-hydroxymethylene diphosphonate (HMDP) and 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD), in patients with hereditary transthyretin-related cardiac amyloidosis (TTR-CA). METHODS Six patients with biopsy-proven diagnosis of TTR-CA and characteristic amyloid fibril composition underwent early-phase 99mTc-HMDP myocardial scintigraphy as part of their routine workup; they were later assessed by 99mTc-DPD scintigraphy after having signed informed written consent. Heart-to-mediastinum-ratio was measured at both time points as well as regional distribution on 17-segment analysis. RESULTS All patients had an H/M ratio >1.28 on both imaging. 99mTc-DPD uptake was slightly higher than 99mTc-HMDP uptake in 3 patients, but no statistical difference was found (P = 0.13). Regional distribution of the two radiotracers was well correlated on bull's eyes analysis, with only slight underestimation of 99mTc-DPD uptake in the anterior/apical segments, compared with 99mTc-HMDP. CONCLUSION 99mTc-HMDP and 99mTc-DPD show comparable myocardial uptake intensity on early-phase scintigraphy and can be used alternatively for the diagnosis of TTR-CA.
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Affiliation(s)
- Mukedaisi Abulizi
- Mondor Amyloidosis Network, 94000, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Hospital, 94000, Créteil, France
| | - Anne-Ségolène Cottereau
- Mondor Amyloidosis Network, 94000, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Hospital, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
| | - Aziz Guellich
- Mondor Amyloidosis Network, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94000, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, 94000, Créteil, France
| | - Stéphanie Vandeventer
- Mondor Amyloidosis Network, 94000, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Hospital, 94000, Créteil, France
| | - Arnault Galat
- Mondor Amyloidosis Network, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94000, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, 94000, Créteil, France
| | - Axel Van Der Gucht
- Mondor Amyloidosis Network, 94000, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Hospital, 94000, Créteil, France
| | - Violaine Plante-Bordeneuve
- Mondor Amyloidosis Network, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, 94000, Créteil, France
- Department of Neurology, AP-HP, Henri Mondor Hospital, 94000, Créteil, France
| | - Jean-Luc Dubois-Randé
- Mondor Amyloidosis Network, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94000, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, 94000, Créteil, France
| | - Diane Bodez
- Mondor Amyloidosis Network, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94000, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, 94000, Créteil, France
| | - Jean Rosso
- Mondor Amyloidosis Network, 94000, Créteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor Hospital, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
| | - Thibaud Damy
- Mondor Amyloidosis Network, 94000, Créteil, France
- DHU ATVB, Paris Est University, 94000, Créteil, France
- Department of Cardiology, AP-HP, Henri Mondor Hospital, 51 Ave. du Mal de Lattre de Tassigny, 94000, Créteil, France
- INSERM U955, GRC Amyloid Research Institute, 94000, Créteil, France
| | - Emmanuel Itti
- Mondor Amyloidosis Network, 94000, Créteil, France.
- Department of Nuclear Medicine, AP-HP, Henri Mondor Hospital, 94000, Créteil, France.
- DHU ATVB, Paris Est University, 94000, Créteil, France.
- INSERM U955, GRC Amyloid Research Institute, 94000, Créteil, France.
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146
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Bhambhvani P, Hage FG. Nuclear imaging of cardiac amyloidosis. 'We've only just begun'. J Nucl Cardiol 2018; 25:191-194. [PMID: 27638743 DOI: 10.1007/s12350-016-0661-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Pradeep Bhambhvani
- Division of Molecular Imaging and Therapeutics, Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Fadi G Hage
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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147
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Pilebro B, Arvidsson S, Lindqvist P, Sundström T, Westermark P, Antoni G, Suhr O, Sörensen J. Positron emission tomography (PET) utilizing Pittsburgh compound B (PIB) for detection of amyloid heart deposits in hereditary transthyretin amyloidosis (ATTR). J Nucl Cardiol 2018; 25:240-248. [PMID: 27645889 DOI: 10.1007/s12350-016-0638-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND DPD scintigraphy has been advocated for imaging cardiac amyloid in ATTR amyloidosis. PET utilizing 11C-Pittsburgh compound B (PIB) is the gold standard for imaging brain amyloid in Alzheimer's disease. PIB was recently shown to identify cardiac amyloidosis in both AL and ATTR amyloidosis. In the ATTR population, two types of amyloid fibrils exist, one containing fragmented and full-length TTR (type A) and the other only full-length TTR (type B). The aim of this study was to further evaluate PIB-PET in patients with hereditary ATTR amyloidosis. METHODS Ten patients with biopsy-proven V30M ATTR amyloidosis and discrete or no signs of cardiac involvement were included. Patients were grouped according to TTR-fragmentation. All underwent DPD scintigraphy, echocardiography, and PIB-PET. A left ventricular PIB-retention index (PIB-RI) was established and compared to five normal volunteers. RESULTS PIB-RI was increased in all patients (P < 0.001), but was significantly higher in type B than in type A (0.129 ± 0.041 vs 0.040 ± 0.006 min-1, P = 0.009). Cardiac DPD uptake was elevated in group A and absent in group B. CONCLUSION PIB-PET, in contrast to DPD scintigraphy, has the potential to specifically identify cardiac amyloid depositions irrespective of amyloid fibril composition. The heart appears to be a target organ for amyloid deposition in ATTR amyloidosis.
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Affiliation(s)
- Björn Pilebro
- Heart Centre, Cardiology, Department of Public Health and Clinical Medicine, Umeå University, 901 85, Umeå, Sweden.
| | - Sandra Arvidsson
- Heart Centre, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå, Sweden
| | - Per Lindqvist
- Heart Centre, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå, Sweden
| | - Torbjörn Sundström
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Per Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Ole Suhr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences, Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
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148
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Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment-A Systematic Review. Radiol Res Pract 2017; 2017:2874902. [PMID: 29270320 PMCID: PMC5705874 DOI: 10.1155/2017/2874902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/02/2017] [Indexed: 12/19/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.
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149
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Non-invasive cardiac imaging in patients with systemic amyloidosis: a practical approach with emphasis on clinical contribution of bone-seeking radiotracers. Clin Transl Imaging 2017. [DOI: 10.1007/s40336-017-0255-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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150
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White JA, Fine NM. Recent Advances in Cardiovascular Imaging Relevant to the Management of Patients with Suspected Cardiac Amyloidosis. Curr Cardiol Rep 2017; 18:77. [PMID: 27319007 DOI: 10.1007/s11886-016-0752-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiac amyloidosis is a form of infiltrative cardiomyopathy typically presenting with progressive heart failure. The clinical presentation and morphological findings often overlap with other cardiovascular diseases, and frequently results in misdiagnosis and consequent under-reporting. Cardiovascular imaging is playing an increasingly important diagnostic and prognostic role in this referral population, and is reducing the reliance on endomyocardial biopsy as a confirmatory testing. Advancements across multiple cardiac imaging modalities, including echocardiography, magnetic resonance imaging, nuclear imaging, and computed tomography, are improving diagnostic accuracy and offering novel approaches to sub-type differentiation and prognostication. This review explores recent advancements in cardiac imaging for the diagnosis, typing, and staging of cardiac amyloidosis, with a focus on new and evolving techniques. Emphasis is also placed on the promise of non-invasive cardiac imaging to provide value across the spectrum of this clinical disease, from early disease identification (prior to the development of increased wall thickness) through to markers of advanced disease associated with early mortality.
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Affiliation(s)
- James A White
- Stephenson Cardiovascular Imaging Center, University of Calgary, Calgary, Alberta, Canada. .,Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada. .,Stephenson Cardiovascular Imaging Center, Foothills Medical Centre Suite #0700, SSB, 1403-29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada.,South Health Campus, 4448 Front Street SE, Calgary, Alberta, T3M 1M4, Canada
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