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Ahluwalia N, Roshankar G, Draycott L, Jimenez-Zepeda V, Fine N, Chan D, Han D, Miller RJH. Diagnostic accuracy of bone scintigraphy imaging for transthyretin cardiac amyloidosis: systematic review and meta-analysis. J Nucl Cardiol 2023; 30:2464-2476. [PMID: 37226006 DOI: 10.1007/s12350-023-03297-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Bone scintigraphy imaging is frequently used to investigate patients with suspected transthyretin cardiac amyloidosis (ATTR-CM). However, the reported accuracy for interpretation approaches has changed over time. We performed a systematic review and meta-analysis to determine the diagnostic accuracy of visual planar grading, heart-to-contralateral (HCL) ratio, and quantitative analysis of SPECT imaging and evaluate reasons for shifts in reported accuracy. METHODS We performed a systematic review to identify studies of the diagnostic accuracy of bone scintigraphy for ATTR-CM from 1990 until February 2023 using PUBMED and EMBASE. Studies were reviewed separately by two authors for inclusion and for risk of bias assessment. Summary receiver operating characteristic curves and operating points were determined with hierarchical modeling. RESULTS Out of a total of 428 identified studies, 119 were reviewed in detail and 23 were included in the final analysis. The studies included a total of 3954 patients, with ATTR-CM diagnosed in 1337 (39.6%) patients and prevalence ranging from 21 to 73%. Visual planar grading and quantitative analysis had higher diagnostic accuracy (.99) than HCL ratio (.96). Quantitative analysis of SPECT imaging had the highest specificity (97%) followed by planar visual grade (96%) and HCL ratio (93%). ATTR-CM prevalence accounted for some of the observed between study heterogeneity. CONCLUSIONS Bone scintigraphy imaging is highly accurate for identifying patients with ATTR-CM, with between study heterogeneity in part explained by differences in disease prevalence. We identified small differences in specificity, which may have important clinical implications when applied to low-risk screening populations.
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Affiliation(s)
- Nanki Ahluwalia
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Golnaz Roshankar
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Logan Draycott
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | | | - Nowell Fine
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada
| | - Denise Chan
- Department of Nuclear Medicine, University of Calgary, Calgary, AB, Canada
| | - Donghee Han
- Departments of Medicine (Division of Artificial Intelligence in Medicine), Imaging and Biomedical Sciences Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J H Miller
- Department of Cardiac Sciences, University of Calgary, GAA08, 3230 Hospital Drive NW, Calgary, AB, T2N 2T9, Canada.
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Miller EJ, Campisi R, Shah NR, McMahon S, Cuddy S, Gallegos-Kattan C, Maurer MS, Damy T, Slart RHJA, Bhatia K, Einstein AJ. Radiopharmaceutical supply disruptions and the use of 99mTc-hydroxymethylene diphosphonate as an alternative to 99mTc-pyrophosphate for the diagnosis of transthyretin cardiac amyloidosis: An ASNC Information Statement. J Nucl Cardiol 2022; 29:2748-2760. [PMID: 35838892 PMCID: PMC9285188 DOI: 10.1007/s12350-022-03059-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Edward J Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Roxana Campisi
- Diagnóstico Maipú and Instituto Argentino de Diagnóstico y Tratamiento S.A, Buenos Aires, Argentina
| | - Nishant R Shah
- Division of Cardiology, Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Sean McMahon
- Hartford HealthCare Heart & Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Sarah Cuddy
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mathew S Maurer
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Thibaud Damy
- Department of Cardiology, Université Paris-Est Créteil Val de Marne, Université Paris, Paris, France
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Centre, University Medical Center Groningen, Groningen, The Netherlands
| | - Ketan Bhatia
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, 622 West 168th Street PH 10-203, New York, NY, 10032, USA.
- Department of Radiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA.
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3
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Zerahn B, Haarmark C. Cardiac CZT-SPECT: More than left ventricular imaging. J Nucl Cardiol 2022; 29:1657-1659. [PMID: 34169478 DOI: 10.1007/s12350-021-02701-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Bo Zerahn
- Department of Nuclear Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Haarmark
- Department of Nuclear Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Tshori S, Livschitz S, Volodarsky I, Goland S, Shimoni S, Fabrikant J, George J. Transthyretin Cardiac Amyloidosis Scintigraphy Using Planar D-SPECT on Dedicated Cardiac CZT Camera. J Nucl Cardiol 2022; 29:1995-2000. [PMID: 33977371 DOI: 10.1007/s12350-021-02651-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bone scintigraphy is a main diagnostic tool in suspected ATTR patients. Almost all literature is based on conventional whole body gamma cameras, and there is very sparse data evaluating the use of dedicated cardiac CZT cameras. The aim of this study was to evaluate the utility of bone scintigraphy in suspected transthyretin cardiac amyloidosis (ATTR-CA) patients on a dedicated cardiac CZT camera. METHODS Seventy-three patients with suspected ATTR-CA underwent planar and SPECT Tc-99 m pyrophosphate scintigraphy using dedicated cardiac CZT camera between May and August 2019. RESULTS Planar D-SPECT image quality was mostly good. Six patients were identified as ATTR-CA positive. Inter-observer agreement based on both Perugini score and on planar D-SPECT H/CL ratio was excellent. CONCLUSIONS ATTR-CA scintigraphy using dedicated cardiac CZT camera was feasible, and yielded planar D-SPECT images with excellent inter-observer agreement.
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Affiliation(s)
- Sagi Tshori
- Heart Center, Kaplan Medical Center, Pasternak St., 1, Rehovot, 7661041, Israel.
- Institute of Medical Research Israel-Canada, The Hebrew University, Jerusalem, Israel.
| | - Shay Livschitz
- Heart Center, Kaplan Medical Center, Pasternak St., 1, Rehovot, 7661041, Israel
| | - Igor Volodarsky
- Heart Center, Kaplan Medical Center, Pasternak St., 1, Rehovot, 7661041, Israel
| | - Sorel Goland
- Heart Center, Kaplan Medical Center, Pasternak St., 1, Rehovot, 7661041, Israel
- The Hebrew University, Jerusalem, Israel
| | - Sara Shimoni
- Heart Center, Kaplan Medical Center, Pasternak St., 1, Rehovot, 7661041, Israel
- The Hebrew University, Jerusalem, Israel
| | - Jacob Fabrikant
- Heart Center, Kaplan Medical Center, Pasternak St., 1, Rehovot, 7661041, Israel
| | - Jacob George
- Heart Center, Kaplan Medical Center, Pasternak St., 1, Rehovot, 7661041, Israel.
- The Hebrew University, Jerusalem, Israel.
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5
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Kudo T, Imakhanova A. Quantification of amyloid deposition using bone scan agents. J Nucl Cardiol 2022; 29:515-518. [PMID: 32940887 DOI: 10.1007/s12350-020-02340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
- Department of Radioisotope Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Aiganym Imakhanova
- Department of Radioisotope Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Zhao H, Hu H, Cui W. Performance of bone tracer for diagnosis and differentiation of transthyretin cardiac amyloidosis: a systematic review and meta-analysis. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:802-810. [PMID: 34792038 DOI: 10.5152/dir.2021.20662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Bone tracers have been validated for many years in detecting transthyretin cardiac amyloidosis (TTR-CA). However, several new studies suggest conflicting results. Our study aimed to systematically evaluate the accuracy of bone radiotracers for diagnosis and differentiation of TTR-CA via a systematic review and meta-analysis. METHODS We retrieved articles assessing the performance of bone tracer in diagnosing and differentiating TTR-CA from PubMed, the Cochrane Library, ScienceDirect, and DOAJ databases, dating up to 10 July 2020. The meta-analysis was conducted through Stata 16 software, and the risk of bias for the included studies was assessed by the QUADAS-2 tool. Moreover, we made a comprehensive review. RESULTS Fourteen articles were included in the systematic review, and 9 in the meta-analysis. The pooled sensitivity was 0.97 (95% confidence interval [95% CI] 0.85-0.99) with heterogeneity (I2=73.5, 95% CI 55.6-91.2), and the specificity was 0.92 (95% CI 0.82-0.96) with heterogeneity (I2=42.0, 95% CI 0.0-86.9). The pooled positive and negative likelihood ratios were 11.49 (95% CI 5.07-26.0) and 0.03 (95% CI 0.01-0.18), respectively. The diagnostic odds ratio was 341 (95% CI 53-2194), and the area under the receiver operating characteristic curve was 0.96 (95% CI 0.94-0.97). CONCLUSION The findings evidence that the bone radiotracer is a valuable noninvasive approach that provides high accuracy for diagnosing TTR-CA and plays a modest role in differentiating TTR-CA from immunoglobulin amyloid light-chain cardiac amyloidosis. 99mTc-HMDP may be more accurate than 99mTc-PYP, 99mTc-DPD, and 18F-NaF in the TTR-CA detecting process, and 18F-NaF is a promising bone tracer to diagnose and differentiate TTR-CA.
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Affiliation(s)
- Hongliang Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China;Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China; Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haijuan Hu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China;Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China
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Ruan D, Sun L. Diagnostic efficacy of bone scintigraphy in transthyretin cardiac amyloidosis: an updated systematic review and Bayesian bivariate meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00471-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Wu Z, Yu C. Diagnostic performance of CMR, SPECT, and PET imaging for the detection of cardiac amyloidosis: a meta-analysis. BMC Cardiovasc Disord 2021; 21:482. [PMID: 34620092 PMCID: PMC8499558 DOI: 10.1186/s12872-021-02292-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background Noninvasive myocardial imaging modalities, such as cardiac magnetic resonance (CMR), single photon emission computed tomography (SPECT), and Positron emission tomography (PET), are well-established and extensively used to detect cardiac amyloid (CA). The purpose of this study is to directly compare CMR, SPECT, and PET scans in the diagnosis of CA, and to provide evidence for further scientific research and clinical decision-making. Methods PubMed, Embase, and Cochrane Library were searched. Studies used CMR, SPECT and/or PET for the diagnosis of CA were included. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR), diagnostic odds ratio (DOR), their respective 95% confidence intervals (CIs) and the area under the summary receiver operating characteristic (SROC) curve (AUC) were calculated. Quality assessment of included studies was conducted. Results A total of 31 articles were identified for inclusion in this meta-analysis. The pooled sensitivities of CMR, SPECT and PET were 0.84, 0.98 and 0.78, respectively. Their respective overall specificities were 0.87, 0.92 and 0.95. Subgroup analysis demonstrated that 99mTc-HMDP manifested the highest sensitivity (0.99). 99mTc-PYP had the highest specificity (0.95). The AUC values of 99mTc-DPD, 99mTc-PYP, 99mTc-HMDP were 0.89, 0.99, and 0.99, respectively. PET scan with 11C-PIB demonstrated a pooled sensitivity of 0.91 and specificity of 0.97 with an AUC value of 0.98. Conclusion Our meta-analysis reveals that SEPCT scans present better diagnostic performance for the identification of CA as compared with other two modalities. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02292-z.
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Affiliation(s)
- Zhaoye Wu
- Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Chunjing Yu
- Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China.
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9
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Wild-type TTR amyloidosis among patients with unexplained heart failure and systolic LV dysfunction. PLoS One 2021; 16:e0254104. [PMID: 34242301 PMCID: PMC8270434 DOI: 10.1371/journal.pone.0254104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/18/2021] [Indexed: 01/15/2023] Open
Abstract
AIM Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure (HF) with preserved left ventricular ejection fraction (LVEF), typically presenting as restrictive cardiomyopathy. The potential co-existence of ATTR-CA with systolic heart failure has not been studied. The aim of this study is to describe the prevalence of ATTR-CA and its clinical characteristics in HF patients with reduced LVEF. METHODS Patients with an unexplained cause of LV systolic dysfunction were screened for ATTR-CA by a 99mTc-PYP planar scintigraphy. Patients in whom presence of ≥ 2 uptake was confirmed by SPECT imaging were included. Their clinical, laboratory and echocardiographic data were collected. RESULTS Out of 75 patients (mean age 65±12 years, LVEF 35.8±7.9%) included in this study, 7 (9.3%) patients (mean age 75±6 years, LVEF 32.0±8.3%) had ATTR-CA. Patients with ATTR-CA were more symptomatic at diagnosis (NYHA FC 3-4 (86% vs 35% (p = 0.03)) and had a more severe clinical course evident by recurrent hospitalizations for HF, and a need for intravenous diuretic treatment (p = 0.04 and p<0.01, respectively) at follow-up, compared with patients with no ATTR-CA. Patients with ATTR-CA had similar LVEF but a clear trend for larger LV mass index (157.1±60.6 g/m2 vs. 121.0±39.5 g/m2, p = 0.07) and a larger proportions of ATTR-CA patients had IVS thickness >13 mm (57.1% vs 13.1%, p = 0.02) as compared to HF patients with no ATTR-CA. CONCLUSION In our study, a meaningful percentage of patients with unexplained LV dysfunction had a co-existing ATTR-CA indicating that the clinical heterogeneity of ATTR-CA is much broader than previously thought.
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Huang YH, Lin YH, Yen RF, Hou CJY, Wang SY, Tsai SC, Ho KC, Lin MH, Tsao CH, Chang CY, Huang JL, Cheng MF, Wu YW. 2021 Advocacy Statements for the Role of 99mTc-Pyrophosphate Scintigraphy in the Diagnosis of Transthyretin Cardiac Amyloidosis: A Report of the Taiwan Society of Cardiology and the Society of Nuclear Medicine of the Republic of China. ACTA CARDIOLOGICA SINICA 2021; 37:221-231. [PMID: 33976505 PMCID: PMC8107701 DOI: 10.6515/acs.202105_37(3).20210420a] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure with preserved ejection fraction. Favorable prognosis depends on early diagnosis and correct treatment strategy. Among patients for whom there is a high clinical suspicion of cardiac amyloidosis, 99mTc-labeled bone avid scintigraphy including 99mTc-pyrophosphate (PYP) scintigraphy may be of diagnostic and prognostic importance. Various international guidelines support the non-biopsy diagnosis of ATTR-CM using 99mTc-PYP scintigraphy, yet emphasize the gap in standardization of acquisition and imaging analysis protocols, as well as the appropriateness of its clinical use. Therefore, a joint expert consensus has been reached by the Taiwan Society of Cardiology and the Society of Nuclear Medicine of the Republic of China, to advocate for the application of 99mTc-PYP scintigraphy in the diagnosis of ATTR-CM. This article aims to highlight the recommendations on image acquisition, qualitative and quantitative assessments of cardiac 99mTc-PYP uptake, and diagnostic algorithms. We hope the implementation of these recommendations in Taiwan will facilitate the process and enhance the diagnostic rate of ATTR-CM.
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Affiliation(s)
- Yih-Hwen Huang
- Department of Nuclear Medicine, National Taiwan University Hospital
| | - Yen-Hung Lin
- National Taiwan University College of Medicine
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital
- National Taiwan University College of Medicine
| | - Charles Jia-Yin Hou
- Mackay Medical College, New Taipei City
- Cardiovascular Center, MacKay Memorial Hospital, Taipei
| | - Shan-Ying Wang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei
| | - Shih-Chuan Tsai
- Department of Nuclear Medicine, Taichung Veterans General Hospital
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung
| | - Kung-Chu Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan
| | - Ming-Hsien Lin
- National Taiwan University College of Medicine
- Division of Nuclear Medicine, Department of Nuclear Medicine, Cheng Hsin General Hospital, Taipei
| | - Chin-Ho Tsao
- Department of Nuclear Medicine, Mackay Memorial Hospital
| | - Chih-Yung Chang
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei
| | - Jin-Long Huang
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- Heart Failure Division, Cardiovascular Center, Education Department, Taichung Veterans General Hospital, Taichung
| | - Mei-Fang Cheng
- Department of Nuclear Medicine, National Taiwan University Hospital
- National Taiwan University College of Medicine
| | - Yen-Wen Wu
- Department of Nuclear Medicine, National Taiwan University Hospital
- National Taiwan University College of Medicine
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
- Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City
- National Yang Ming Chiao Tung University, School of Medicine, Faculty of Medicine, Taipei
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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11
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Picken MM. The Pathology of Amyloidosis in Classification: A Review. Acta Haematol 2020; 143:322-334. [PMID: 32392555 DOI: 10.1159/000506696] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The amyloidoses are a rare and heterogeneous group of disorders that are characterized by the deposition of abnormally folded proteins in tissues ultimately leading to organ damage. The deposits are mainly extracellular and are recognizable by their affinity for Congo red and their yellow-green birefringence under polarized light. Current classification of amyloid in medical practice is based on the amyloid protein type. To date, 36 proteins have been identified as being amyloidogenic in humans. SUMMARY in clinical practice, it is critical to distinguish between treatable versus non-treatable amyloidoses. Moreover, amyloidoses with a genetic component must be distinguished from the sporadic types and systemic amyloidoses must be distinguished from the localized forms. Among the systemic amyloidoses, AL continues to be the most common amyloid diagnosis in the developed world; other clinically significant types include AA, ALECT2, and ATTR. The latter is emerging as an underdiagnosed type in both the hereditary and wild-type setting. Other hereditary amyloidoses include AFib, several amyloidoses derived from apolipoproteins, AGel, ALys, etc. In a dialysis setting, systemic amyloid derived from β2 microglobulin (Aβ2M) should be considered, although a very rare hereditary variant has also been reported; several amyloidoses may be typically associated with aging and several iatrogenic types have also emerged. Determination of the amyloid protein type is imperative before specific therapy can be implemented and the current methods are briefly summarized. A brief overview of the target organ involvement by amyloid type is also included. Key Messages: (1) Early diagnosis of amyloidosis continues to pose a significant challenge and requires the participation of many clinical and laboratory specialties. (2) Determination of the protein type is imperative before specific therapy can be implemented. (3) While mass spectrometry has emerged as the preferred method of amyloid typing, careful application of immune methods is still clinically useful but caution and experience, as well as awareness of the limitations of each method, are necessary in their interpretation. (4) While the spectrum of amyloidoses continues to expand, it is critical to distinguish between those that are currently treatable versus those that are untreatable and avoid causing harm by inappropriate treatment.
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Affiliation(s)
- Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA,
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12
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Campisi R, Traverso SS. Diagnosis of transthyretin cardiac amyloidosis with cadmium zinc telluride cameras: Is it feasible? J Nucl Cardiol 2020; 27:381-385. [PMID: 32086742 DOI: 10.1007/s12350-020-02071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Roxana Campisi
- Departments of Nuclear Medicine and Cardiovascular Imaging, Diagnóstico Maipú, Av. Maipú 1668, B1602ABQ, Vicente López, Buenos Aires, Argentina.
- Department of Nuclear Medicine, Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina.
| | - Sonia S Traverso
- Department of Nuclear Medicine, Instituto Argentino de Diagnóstico y Tratamiento, Buenos Aires, Argentina
- Departments of SPECT/CT and PET/CT, Fundación Centro Diagnóstico Nuclear, Buenos Aires, Argentina
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