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Kersting D, Rischpler C, Seifert R. I see, therefore I am? The value of artificial intelligence in nuclear imaging-based identification of cardiac amyloidosis. J Nucl Cardiol 2024; 33:101773. [PMID: 38216411 DOI: 10.1016/j.nuclcard.2023.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/14/2024]
Affiliation(s)
- David Kersting
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Essen, Germany.
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, West German Cancer Center (WTZ), University of Duisburg-Essen, Essen, Germany; Department of Nuclear Medicine, Klinikum Stuttgart, Stuttgart, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Bern, Bern, Switzerland
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Ayers MP, Peruri AV, Bourque JM. Transforming ATTR cardiac amyloidosis into a chronic disease: The enormous potential of quantitative SPECT to improve diagnosis, prognosis, and monitoring of disease progression. J Nucl Cardiol 2021; 28:1846-1850. [PMID: 33851351 DOI: 10.1007/s12350-021-02587-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Michael P Ayers
- Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | - Adithya V Peruri
- Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
| | - Jamieson M Bourque
- Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, VA, USA.
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA.
- Medical Director of Nuclear Cardiology and the Stress Laboratory, Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, 1215 Lee Street, PO Box 800158, Charlottesville, VA, 22908, USA.
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Cappelli F, Zampieri M, Fumagalli C, Nardi G, Del Monaco G, Matucci Cerinic M, Allinovi M, Taborchi G, Martone R, Gabriele M, Ungar A, Moggi Pignone A, Marchionni N, Di Mario C, Olivotto I, Perfetto F. Tenosynovial complications identify TTR cardiac amyloidosis among patients with hypertrophic cardiomyopathy phenotype. J Intern Med 2021; 289:831-839. [PMID: 33615623 DOI: 10.1111/joim.13200] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
UNLABELLED Recent evidence suggests that carpal tunnel syndrome (CTS) and brachial biceps tendon rupture (BBTR) represent red flags for ATTR cardiac amyloidosis (ATTR-CA). The prevalence of upper limb tenosynovial complications in conditions entering differential diagnosis with CA, such as HCM or Anderson-Fabry disease (AFD), and hence their predictive accuracy in this setting, still remains unresolved. OBJECTIVE To investigate the prevalence of CTS and BBTR in a consecutive cohort of ATTR-CA patients, compared with patients with HCM or AFD and with individuals without cardiac disease history. PARTICIPANTS Consecutive patients with a diagnosis of ATTR-CA, HCM and AFD were evaluated. A control group of consecutive patients was recruited among subjects hospitalized for noncardiac reasons and no cardiac disease history. The presence of BBTR, CTS or prior surgery related to these conditions was ascertained. RESULTS 342 patients were prospectively enrolled, including 168 ATTR-CA (141 ATTRwt, 27 ATTRm), 81 with HCM/AFD (N = 72 and 9, respectively) and 93 controls. CTS was present in 75% ATTR-CA patients, compared with 13% and 10% of HCM/AFD and controls (P = 0.0001 for both comparisons). Bilateral CTS was present in 60% of ATTR-CA patients, while it was rare (2%) in the other groups. BBTR was present in 44% of ATTR-CA patients, 8% of controls and 1% in HCM/AFD. CONCLUSIONS CTS and BBTR are fivefold more prevalent in ATTR-CA patients compared with cardiac patients with other hypertrophic phenotypes. Positive predictive accuracy for ATTR-CA is highest when involvement is bilateral. Upper limb assessment of patients with HCM phenotypes is a simple and effective way to raise suspicion of ATTR-CA.
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Affiliation(s)
- F Cappelli
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - M Zampieri
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - C Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
| | - G Nardi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - G Del Monaco
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - M Matucci Cerinic
- Dipartimento di Medicina Sperimentale e Clinica, Careggi University Hospital, Florence, Italy
| | - M Allinovi
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - G Taborchi
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - R Martone
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - M Gabriele
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - A Ungar
- Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
| | - A Moggi Pignone
- IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - N Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Division of General Cardiology, Careggi University Hospital, Florence, Italy
| | - C Di Mario
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - I Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.,IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - F Perfetto
- From the, Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.,Geriatric Medicine Department, Azienda Ospedaliera Careggi, Florence, Italy
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Bartolini S, Baldasseroni S, Fattirolli F, Silverii MV, Piccioli L, Perfetto F, Marchionni N, Di Mario C, Martone R, Taborchi G, Morini S, Vignini E, Cappelli F. Poor right ventricular function is associated with impaired exercise capacity and ventilatory efficiency in transthyretin cardiac amyloid patients. Intern Emerg Med 2021; 16:653-660. [PMID: 32918156 DOI: 10.1007/s11739-020-02474-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/08/2020] [Indexed: 01/09/2023]
Abstract
CardioPulmonary Exercise Test (CPET) is the gold standard to evaluate functional capacity in patients at high risk of heart failure (HF). Few studies with a limited number of subjects and conflicting results, analyzed the role of CPET in patients with systemic amyloidosis. Aims of our study were the assessment of the response to exercise in patients with Transthyretin amyloid (ATTR) cardiomyopathy (CA), and the correlation of clinical, biohumoral and echocardiographic parameters with CPET parameters, such as VO2 peak and VE/VCO2 slope. From February 2018 to March 2019, 72 cardiac ATTR patients were prospectively enrolled and underwent a complete clinical, biohumoral, echocardiographic and CPET assessment. All patients completed the exercise stress test protocol, without any adverse event. At CPET, they achieved a mean VO2 peak of 14 mL/Kg/min and a mean VE/VCO2 slope of 31. The blood pressure response to exercise was inadequate in 26 (36%) patients (flat in 25 and hypotensive in 1), while 49/72 patients (69%) showed an inadequate heart rate recovery. In multivariate analysis, s' tricuspidalic was the only independent predictor of VO2 peak, while in the two test models performed to avoid collinearity, both TAPSE and s' tricuspidalic were the strongest independent predictors of VE/VCO2 slope. Our data demonstrate the role of right ventricular function as an independent predictor of exercise capacity and ventilatory efficiency in ATTR. In CPET evaluation, a significant proportion of patients presented an abnormal arterial pressure response and heart rate variation to exercise.
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Affiliation(s)
- Simone Bartolini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- Cardiology Department, Azienda Sanitaria Firenze (ASF), Florence, Italy
| | | | - Francesco Fattirolli
- Cardiac Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Vittoria Silverii
- Cardiac Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lucrezia Piccioli
- Cardiac Rehabilitation Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, Division of General Cardiology, University of Florence, Careggi University Hospital, Florence, Italy
| | - Carlo Di Mario
- Department of Experimental and Clinical Medicine, Division of General Cardiology, University of Florence, Careggi University Hospital, Florence, Italy
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Raffaele Martone
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Giulia Taborchi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Sofia Morini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Elisa Vignini
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy.
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
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