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Role of Diphosphonates Bone Scintigraphy in Correlation with Biomarkers for a Personalized Approach to ATTR Cardiac Amyloidosis in North-Eastern Romania. Diagnostics (Basel) 2022; 13:diagnostics13010083. [PMID: 36611375 PMCID: PMC9818064 DOI: 10.3390/diagnostics13010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Transthyretin cardiac amyloidosis (ATTR) is a rare cardiac protein deposition disease characterized by progressive thickening of both ventricles, the inter-atrial-ventricular septum and the atrioventricular valves. The gold standard method for diagnosing this rare pathology is endomyocardial biopsy. If this method cannot be used, the alternative is a mixture of clinical and paraclinical tests. Over the course of five years, we examined 58 patients suspected of cardiac amyloidosis based on electrocardiography and ultrasonography criteria, who had been sent for bone scintigraphy in order to determine the presence of ATTR cardiac amyloidosis. However, the final diagnosis was set by correlating the bone scan with genetic testing, free light chain dosage or soft tissue biopsy. Based on the final diagnosis we analyzed the patients' predominant biomarkers in order to determine a possible correlation between them. This analysis is designed to help the general practitioner set a possible cardiac amyloidosis diagnosis.
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Chamling B, Drakos S, Bietenbeck M, Klingel K, Meier C, Yilmaz A. Diagnosis of Cardiac Involvement in Amyloid A Amyloidosis by Cardiovascular Magnetic Resonance Imaging. Front Cardiovasc Med 2021; 8:757642. [PMID: 34646875 PMCID: PMC8502966 DOI: 10.3389/fcvm.2021.757642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Diagnosis of cardiac involvement in amyloid A (AA) amyloidosis is challenging since AA amyloidosis is a rare disease and cardiac involvement even less frequent. The diagnostic yield of currently available non-invasive imaging methods is not well-studied and rather limited, and invasive endomyocardial biopsy (EMB) is rarely performed due to the potential risk of this procedure. Cardiovascular magnetic resonance (CMR)-based myocardial tissue characterization by late-gadolinium-enhancement (LGE) imaging and novel-mapping approaches may increase the diagnostic yield in AA amyloidosis. Methods: Two patients with AA amyloidosis in whom cardiac involvement was suspected based on CMR findings and subsequently proven by biopsy work-up are presented. CMR studies were performed on a 1.5-T system and comprised a cine steady-state free precession pulse sequence for ventricular function and a late-gadolinium-enhancement (LGE) sequence for detection of myocardial pathology. Moreover, a modified Look-Locker inversion recovery (MOLLI) T1-mapping sequence was applied in basal, mid and apical short-axes prior to contrast agent administration and ~20 min thereafter to determine native T1 and ECV values. Results: Both patients showed slightly dilated left ventricles (LV) with mild to moderate LV hypertrophy and preserved systolic function. Only a very subtle pattern of LGE was observed in both patients with AA amyloidosis. However, markedly elevated native T1 (max. 1,108 and 1,112 ms, respectively) and extracellular volume fraction (ECV) values (max. 39 and 48%, respectively) were measured in the myocardium suggesting the presence of cardiac involvement - with subsequent EMB-based proof of AA amyloidosis. Conclusion: We recommend a multi-parametric CMR approach in patients with AA amyloidosis comprising both LGE-based contrast-imaging and T1-mapping-based ECV measurement of the myocardium for non-invasive work-up of suspected cardiac involvement. The respective CMR findings may be used as gatekeeper for additional invasive procedures (such as EMB) and as a non-invasive monitoring tool regarding assessment and modification of ongoing treatments.
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Affiliation(s)
- Bishwas Chamling
- Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Münster, Albert Schweitzer Campus 1, Münster, Germany
| | - Stefanos Drakos
- Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Münster, Albert Schweitzer Campus 1, Münster, Germany
| | - Michael Bietenbeck
- Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Münster, Albert Schweitzer Campus 1, Münster, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Claudia Meier
- Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Münster, Albert Schweitzer Campus 1, Münster, Germany
| | - Ali Yilmaz
- Division of Cardiovascular Imaging, Department of Cardiology I, University Hospital Münster, Albert Schweitzer Campus 1, Münster, Germany
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Ionescu TM, Jalloul W, Stolniceanu CR, Iacob R, Grecu LP, Stătescu AM, Grierosu I, Guțu M, Gavrilescu A, Daniela C, Petriș A, Ciocoiu M, Ungureanu C, Ștefănescu C. Transthyretin cardiac amyloidosis: a review of the nuclear imaging findings with emphasis on the radiotracers mechanisms. Ann Nucl Med 2021; 35:967-993. [PMID: 34275068 DOI: 10.1007/s12149-021-01650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
Cardiac amyloidosis is a protein deposition disease characterized by the infiltration of the myocardium and coronary arteries resulting in a progressive thickening of both ventricles, interatrial septum and atrioventricular valves, eventually leading to organ failure. It is a disease hard to diagnose, due to the lack of diagnostic investigations. However, development of new and more accurate examinations is undergoing. Endomyocardial biopsy is the gold standard investigation for this disease, but it has its limitations (invasive and not widely available). Other investigations may be able to detect the presence of cardiac amyloidosis but cannot specify the type involved. To that end, nuclear medicine through bone scanning offers a simple, non-invasive solution to detect, differentiate and diagnose transthyretin cardiac amyloidosis (ATTR) from other types of cardiac amyloidosis. In order to demonstrate the importance of bone scanning we will present a few methods of image processing based on literature and a personalized method, followed by a few important examples of positive cases. The aim of this review was to present the current methods of ATTR detection with emphasis on nuclear medicine bone scanning and its important place in the decision algorithm of the cardiologist for a personalized approach to this pathology.
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Affiliation(s)
- Teodor M Ionescu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania.
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania.
| | - Wael Jalloul
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Cati R Stolniceanu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Roxana Iacob
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Laura P Grecu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Ana-Maria Stătescu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Irena Grierosu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Mihai Guțu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Adrian Gavrilescu
- Cardiology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Crișu Daniela
- Cardiology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Antoniu Petriș
- Cardiology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Manuela Ciocoiu
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
| | - Cristina Ungureanu
- Endocrinology Department, County Emergency Hospital "Sf. Spiridon", Iași, Romania
| | - Cipriana Ștefănescu
- Nuclear Medicine Laboratory, County Emergency Hospital "Sf. Spiridon", Iași, Romania
- University of Medicine and Pharmacy U.M.F "Grigore T. Popa", Iași, Romania
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Lelli D, Pedone C, Leosco D, Antonelli Incalzi R. Cardiac amyloidosis awareness among residents/specialists in Geriatrics: an Italian national survey. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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