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Besson FL, Treglia G, Bucerius J, Anagnostopoulos C, Buechel RR, Dweck MR, Erba PA, Gaemperli O, Gimelli A, Gheysens O, Glaudemans AWJM, Habib G, Hyafil F, Lubberink M, Rischpler C, Saraste A, Slart RHJA. A systematic review for the evidence of recommendations and guidelines in hybrid nuclear cardiovascular imaging. Eur J Nucl Med Mol Imaging 2024; 51:2247-2259. [PMID: 38221570 PMCID: PMC11178580 DOI: 10.1007/s00259-024-06597-x] [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: 11/05/2023] [Accepted: 01/01/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVES This study aimed to evaluate the level of evidence of expert recommendations and guidelines for clinical indications and procedurals in hybrid nuclear cardiovascular imaging. METHODS From inception to August 2023, a PubMed literature analysis of the latest version of guidelines for clinical hybrid cardiovascular imaging techniques including SPECT(/CT), PET(/CT), and PET(/MRI) was performed in two categories: (1) for clinical indications for all-in primary diagnosis; subgroup in prognosis and therapy evaluation; and for (2) imaging procedurals. We surveyed to what degree these followed a standard methodology to collect the data and provide levels of evidence, and for which topic systematic review evidence was executed. RESULTS A total of 76 guidelines, published between 2013 and 2023, were included. The evidence of guidelines was based on systematic reviews in 7.9% of cases, non-systematic reviews in 47.4% of cases, a mix of systematic and non-systematic reviews in 19.7%, and 25% of guidelines did not report any evidence. Search strategy was reported in 36.8% of cases. Strengths of recommendation were clearly reported in 25% of guidelines. The notion of external review was explicitly reported in 23.7% of cases. Finally, the support of a methodologist was reported in 11.8% of the included guidelines. CONCLUSION The use of evidence procedures for developing for evidence-based cardiovascular hybrid imaging recommendations and guidelines is currently suboptimal, highlighting the need for more standardized methodological procedures.
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Affiliation(s)
- Florent L Besson
- Department of Nuclear Medicine-Molecular Imaging, DMU SMART IMAGING, Hôpitaux Universitaires Paris-Saclay, AP-HP, CHU Bicêtre, Le Kremlin Bicetre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicetre, France
- Commissariat À L'énergie Atomique Et Aux Énergies Alternatives (CEA), Centre National de La Recherche Scientifique (CNRS), Inserm, BioMaps, Université Paris-Saclay, Le Kremlin-Bicetre, France
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6501, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900, Lugano, Switzerland
| | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Universitätsmedizin Göttingen, Gottingen, Germany
| | | | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Paula A Erba
- Department of Medicine and Surgery, University of Milan Bicocca, and Nuclear Medicine Unit ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Institut Roi Albert II, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - 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
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
| | - Fabian Hyafil
- Department of Nuclear Medicine, DMU IMAGINA, Georges-Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, F75015, Paris, France
| | - Mark Lubberink
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - 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.
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
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2
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Gotuzzo I, Slart RHJA, Gimelli A, Ashri N, Anagnostopoulos C, Bucerius J, Buechel RR, Gaemperli O, Gheysens O, Glaudemans AWJM, Habib G, Hyafil F, Lubberink M, Saraste A, Podlesnikar T, Dweck MR, Erba PA. Nuclear medicine practice for the assessment of cardiac sarcoidosis and amyloidosis. A survey endorsed by the EANM and EACVI. Eur J Nucl Med Mol Imaging 2024; 51:1809-1815. [PMID: 38679624 DOI: 10.1007/s00259-024-06727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Irene Gotuzzo
- Department of Medicine and Surgery, Nuclear Medicine Unit, University of Milan Bicocca, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, the Netherlands
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Nabila Ashri
- European Association of Nuclear Medicine (EANM), Vienna, Austria
| | | | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | | | - Olivier Gheysens
- Department of Nuclear Medicine, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, 1200, Belgium
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, the Netherlands
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
| | - Fabian Hyafil
- Department of Nuclear Medicine, DMU IMAGINA, Georges-Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, F75015, France
| | - Mark Lubberink
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tomaz Podlesnikar
- Department of Cardiac Surgery, University Medical Centre Maribor, Maribor, Slovenia
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Paola A Erba
- Department of Medicine and Surgery, Nuclear Medicine Unit, University of Milan Bicocca, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy.
- Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, PO Box 30.001, Groningen, 9700 RB, the Netherlands.
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3
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Bawaskar P, Thomas N, Ismail K, Guo Y, Chhikara S, Athwal PSS, Ranum A, Jadhav A, Mendez AH, Nadkarni I, Frerichs D, Velangi P, Ergando T, Akram H, Kanda A, Shenoy C. Nonischemic or Dual Cardiomyopathy in Patients With Coronary Artery Disease. Circulation 2024; 149:807-821. [PMID: 37929565 PMCID: PMC10951941 DOI: 10.1161/circulationaha.123.067032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Randomized trials in obstructive coronary artery disease (CAD) have largely shown no prognostic benefit from coronary revascularization. Although there are several potential reasons for the lack of benefit, an underexplored possible reason is the presence of coincidental nonischemic cardiomyopathy (NICM). We investigated the prevalence and prognostic significance of NICM in patients with CAD (CAD-NICM). METHODS We conducted a registry study of consecutive patients with obstructive CAD on coronary angiography who underwent contrast-enhanced cardiovascular magnetic resonance imaging for the assessment of ventricular function and scar at 4 hospitals from 2004 to 2020. We identified the presence and cause of cardiomyopathy using cardiovascular magnetic resonance imaging and coronary angiography data, blinded to clinical outcomes. The primary outcome was a composite of all-cause death or heart failure hospitalization, and secondary outcomes were all-cause death, heart failure hospitalization, and cardiovascular death. RESULTS Among 3023 patients (median age, 66 years; 76% men), 18.2% had no cardiomyopathy, 64.8% had ischemic cardiomyopathy (CAD+ICM), 9.3% had CAD+NICM, and 7.7% had dual cardiomyopathy (CAD+dualCM), defined as both ICM and NICM. Thus, 16.9% had CAD+NICM or dualCM. During a median follow-up of 4.8 years (interquartile range, 2.9, 7.6), 1116 patients experienced the primary outcome. In Cox multivariable analysis, CAD+NICM or dualCM was independently associated with a higher risk of the primary outcome compared with CAD+ICM (adjusted hazard ratio, 1.23 [95% CI, 1.06-1.43]; P=0.007) after adjustment for potential confounders. The risks of the secondary outcomes of all-cause death and heart failure hospitalization were also higher with CAD+NICM or dualCM (hazard ratio, 1.21 [95% CI, 1.02-1.43]; P=0.032; and hazard ratio, 1.37 [95% CI, 1.11-1.69]; P=0.003, respectively), whereas the risk of cardiovascular death did not differ from that of CAD+ICM (hazard ratio, 1.15 [95% CI, 0.89-1.48]; P=0.28). CONCLUSIONS In patients with CAD referred for clinical cardiovascular magnetic resonance imaging, NICM or dualCM was identified in 1 of every 6 patients and was associated with worse long-term outcomes compared with ICM. In patients with obstructive CAD, coincidental NICM or dualCM may contribute to the lack of prognostic benefit from coronary revascularization.
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Affiliation(s)
- Parag Bawaskar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Nicholas Thomas
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Khaled Ismail
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Yugene Guo
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Sanya Chhikara
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Pal Satyajit Singh Athwal
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Alison Ranum
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Achal Jadhav
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Abel Hooker Mendez
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ishan Nadkarni
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Dominic Frerichs
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Pratik Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Tesfatsiyon Ergando
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Hassan Akram
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Adinan Kanda
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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4
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Ruberg FL, Maurer MS. Cardiac Amyloidosis Due to Transthyretin Protein: A Review. JAMA 2024; 331:778-791. [PMID: 38441582 PMCID: PMC11167454 DOI: 10.1001/jama.2024.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Importance Systemic amyloidosis from transthyretin (ATTR) protein is the most common type of amyloidosis that causes cardiomyopathy. Observations Transthyretin (TTR) protein transports thyroxine (thyroid hormone) and retinol (vitamin A) and is synthesized predominantly by the liver. When the TTR protein misfolds, it can form amyloid fibrils that deposit in the heart causing heart failure, heart conduction block, or arrhythmia such as atrial fibrillation. The biological processes by which amyloid fibrils form are incompletely understood but are associated with aging and, in some patients, affected by inherited variants in the TTR genetic sequence. ATTR amyloidosis results from misfolded TTR protein deposition. ATTR can occur in association with normal TTR genetic sequence (wild-type ATTR) or with abnormal TTR genetic sequence (variant ATTR). Wild-type ATTR primarily manifests as cardiomyopathy while ATTR due to a genetic variant manifests as cardiomyopathy and/or polyneuropathy. Approximately 50 000 to 150 000 people in the US have heart failure due to ATTR amyloidosis. Without treatment, heart failure due to ATTR amyloidosis is associated with a median survival of approximately 5 years. More than 130 different inherited genetic variants in TTR exist. The most common genetic variant is Val122Ile (pV142I), an allele with an origin in West African countries, that is present in 3.4% of African American individuals in the US or approximately 1.5 million persons. The diagnosis can be made using serum free light chain assay and immunofixation electrophoresis to exclude light chain amyloidosis combined with cardiac nuclear scintigraphy to detect radiotracer uptake in a pattern consistent with amyloidosis. Loop diuretics, such as furosemide, torsemide, and bumetanide, are the primary treatment for fluid overload and symptomatic relief of patients with ATTR heart failure. An ATTR-directed therapy that inhibited misfolding of the TTR protein (tafamidis, a protein stabilizer), compared with placebo, reduced mortality from 42.9% to 29.5%, reduced hospitalizations from 0.7/year to 0.48/year, and was most effective when administered early in disease course. Conclusions and Relevance ATTR amyloidosis causes cardiomyopathy in up to approximately 150 000 people in the US and tafamidis is the only currently approved therapy. Tafamidis slowed progression of ATTR amyloidosis and improved survival and prevented hospitalization, compared with placebo, in people with ATTR-associated cardiomyopathy.
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Affiliation(s)
- Frederick L Ruberg
- Section of Cardiovascular Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston Medical Center, Boston, Massachusetts
- Amyloidosis Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Mathew S Maurer
- Cardiac Amyloidosis Program, Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, and NewYork-Presbyterian Hospital, New York
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5
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Yu A, Chen Y, Tsai C, Wu YA, Su M, Chou C, Shun C, Hsueh H, Juang JJ, Lee M, Tseng P, Hsu C, Hsieh S, Ko C, Cheng M, Chao C, Lin Y. Use of Technetium-99m-Pyrophosphate Single-Photon Emission Computed Tomography/Computed Tomography in Monitoring Therapeutic Changes of Eplontersen in Patients With Hereditary Transthyretin Amyloid Cardiomyopathy. J Am Heart Assoc 2024; 13:e030512. [PMID: 38214277 PMCID: PMC10926803 DOI: 10.1161/jaha.123.030512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/13/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Hereditary transthyretin amyloid cardiomyopathy (hATTR-CM) is a progressive and fatal disease. Recent evidence indicates that bone scintigraphy may serve as a tool to monitor the effectiveness of hATTR-CM treatment. The objective of this study was to examine how eplontersen therapy influences the semiquantitative uptake of technetium-99m-pyrophosphate in individuals diagnosed with hATTR-CM. METHODS AND RESULTS We retrospectively analyzed a prospective cohort from the NEURO-TTRansform trial, including patients with hATTR-CM receiving eplontersen (45 mg/4 weeks). A control group comprised patients with hATTR-CM who had not received eplontersen, inotersen, tafamidis, or patisiran. Technetium-99m-pyrophosphate single-photon emission computed tomography/computed tomography was conducted at baseline and during follow-up. Thirteen patients with hATTR-CM were enrolled, with 6 receiving eplontersen and 7 serving as the control group. The median follow-up time was 544 days. The eplontersen group exhibited a significant decrease in volumetric heart and lung ratio (3.774 to 2.979, P=0.028), whereas the control group showed no significant change (4.079 to 3.915, P=0.237). Patients receiving eplontersen demonstrated a significantly greater reduction in volumetric heart and lung ratio compared with the control group (-20.7% versus -3.4%, P=0.007). CONCLUSIONS The volumetric heart and lung ratio used to quantify technetium-99m-pyrophosphate uptake showed a significant reduction subsequent to eplontersen treatment in individuals diagnosed with hATTR-CM. These findings suggest the potential efficacy of eplontersen in treating hATTR-CM and highlight the value of technetium-99m-pyrophosphate single-photon emission computed tomography/computed tomography as a tool for monitoring therapeutic effectiveness.
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Affiliation(s)
- An‐Li Yu
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital Hsin‐Chu BranchHsinchuTaiwan
| | - Yi‐Chieh Chen
- Department of Nuclear MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Cheng‐Hsuan Tsai
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
- National Taiwan University College of MedicineGraduate Institute of Clinical MedicineTaipeiTaiwan
| | - Yuan‐Kun Aden Wu
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Mao‐Yuan Su
- Department of Medical ImagingNational Taiwan University HospitalTaipeiTaiwan
- Department of Medical Imaging and Radiological TechnologyYuanpei University of Medical TechnologyHsinchuTaiwan
| | - Chia‐Hung Chou
- Department of Obstetrics and GynecologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Chia‐Tung Shun
- Department of Forensic Medicine and PathologyNational Taiwan University HospitalTaipeiTaiwan
| | - Hsueh‐Wen Hsueh
- Department of NeurologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Jimmy Jyh‐Ming Juang
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Ming‐Jen Lee
- Department of NeurologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Ping‐Huei Tseng
- Department of Internal Medicine, Division of GastroenterologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Chia‐Hua Hsu
- Department of NeurologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Sung‐Tsang Hsieh
- Department of NeurologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Chi‐Lun Ko
- Department of Nuclear MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Mei‐Fang Cheng
- Department of Nuclear MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
- Institute of Environmental and Occupational Health SciencesNational Taiwan UniversityTaipeiTaiwan
| | - Chi‐Chao Chao
- Department of NeurologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
| | - Yen‐Hung Lin
- Department of Internal Medicine, Division of CardiologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
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Chen J, Chen H, Zhou L, Liu D, Du F, Xiang H. Strong positive light chain immunostaining in a patient with transthyretin amyloidosis. Hematology 2023; 28:2244315. [PMID: 37551718 DOI: 10.1080/16078454.2023.2244315] [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: 05/07/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
The two most common systemic amyloidosis types are immunoglobulin light chain (AL) and amyloid transthyretin (ATTR) amyloidosis, in which the precursor proteins responsible for amyloidosis are light chain and transthyretin, respectively. Identification of precursor proteins is paramount to determine the type of amyloidosis, given that both amyloidosis types lack specificity in clinical presentation. Congo red staining followed by immunohistochemistry or immunofluorescence using fibril protein-specific antibodies is crucial for the diagnosis of amyloidosis. Here we describe a patient who was initially diagnosed with AL amyloidosis due to strong positive kappa light chain staining results. However, the diagnosis was corrected to hereditary ATTR amyloidosis using mass spectrometry and gene sequencing, confirming the important role of mass spectrometry in identifying the amyloid precursor protein and ruling out false-positive result from immunohistochemistry.
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Affiliation(s)
- Jiao Chen
- Department of Hematology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, People's Republic of China
| | - Haifei Chen
- Department of Hematology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, People's Republic of China
| | - Lingyun Zhou
- Department of Hematology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, People's Republic of China
| | - Danbo Liu
- Department of Hematology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, People's Republic of China
| | - Fang Du
- Department of Hematology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, People's Republic of China
| | - Hongxian Xiang
- Department of Hematology, Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, People's Republic of China
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7
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Abstract
Cardiac amyloidosis (CA) occurs when the insoluble fibrils formed by misfolded precursor proteins deposit in cardiac tissues. The early clinical manifestations of CA are not evident, but it is easy to progress to refractory heart failure with an inferior prognosis. Echocardiography is the most commonly adopted non-invasive modality of imaging to visualize cardiac structures and functions, and the preferred modality in the evaluation of patients with cardiac symptoms and suspected CA, which plays a vital role in the diagnosis, prognosis, and long-term management of CA. The present review summarizes the echocardiographic manifestations of CA, new echocardiographic techniques, and the application of multi-parametric echocardiographic models in CA diagnosis.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China
| | - Zhiyue Liu
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China
| | - Qian Li
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China
| | - Wenfeng He
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, No. 37 GuoXue Alley, Chengdu, 610041, China.
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8
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Timóteo AT, Rosa SA, Brás PG, Ferreira MJV, Bettencourt N. Multimodality imaging in cardiac amyloidosis: State-of-the-art review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1084-1096. [PMID: 36218201 DOI: 10.1002/jcu.23271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
Amyloidosis is a systemic disease, characterized by deposition of amyloid fibrils in various organs, including the heart. For the diagnosis of cardiac amyloidosis (CA) it is required a high level of clinical suspicion and in the presence of clinical, laboratorial, and electrocardiographic red flags, a comprehensive multimodality imaging evaluation is warranted, including echocardiography, magnetic resonance, scintigraphy, and computed tomography, that will confirm diagnosis and define the CA subtype, which is of the utmost importance to plan a treatment strategy. We will review the use of multimodality imaging in the evaluation of CA, including the latest applications, and a practical flow-chart will sum-up this evidence.
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Affiliation(s)
- Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | - Silvia Aguiar Rosa
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
- Heart Center, Hospital Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Pedro Garcia Brás
- Cardiology Department, Santa Marta Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Maria João Vidigal Ferreira
- Faculty of Medicine, Coimbra Institute for Biomedical Imaging and Translational Research, Coimbra University, Coimbra, Portugal
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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9
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Mekritthikrai R, Gomez-Valencia J, Malhotra S. What is this image? 2022 image 1 result: radiologic improvement of transthyretin cardiac amyloidosis after treatment with tafamidis. J Nucl Cardiol 2022; 29:1500-1502. [PMID: 35715715 DOI: 10.1007/s12350-022-03026-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Javier Gomez-Valencia
- Division of Cardiology, Cook County Health, Chicago, IL, USA
- Division of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Saurabh Malhotra
- Division of Cardiology, Cook County Health, Chicago, IL, USA.
- Division of Cardiology, Rush Medical College, Chicago, IL, USA.
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10
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Jung MH, Chang S, Han EJ, Youn JC. Multimodal Imaging and Biomarkers in Cardiac Amyloidosis. Diagnostics (Basel) 2022; 12:627. [PMID: 35328180 PMCID: PMC8946926 DOI: 10.3390/diagnostics12030627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/12/2022] [Accepted: 01/28/2022] [Indexed: 01/15/2023] Open
Abstract
Amyloidosis is a progressive infiltrative disease instigated by the extracellular deposition of amyloid fibrils in various organs such as the heart, kidney, and peripheral nerves. Cardiac amyloid deposits cause restrictive cardiomyopathy, leading to a poor prognosis in systemic amyloidosis. The most common etiologies of cardiac amyloidosis (CA) are immunoglobulin light chain deposits (AL-CA) and misfolded transthyretin deposits (ATTR-CA). In recent years, many developments have been accomplished in the field of diagnosis and treatment of CA. At present, ATTR-CA can be noninvasively diagnosed if the following two conditions are fulfilled in the setting of typical echocardiographic/cardiac MRI findings: (1) grade 2 or 3 myocardial uptake in bone scintigraphy confirmed by SPECT and (2) absence of monoclonal protein confirmed by serum-free light chain assay, and serum/urine protein electrophoresis with immunofixation test. Effective therapies are evolving in both types of CA (tafamidis for ATTR-CA and immunologic treatments for AL-CA). Thus, early suspicion and prompt diagnosis are crucial for achieving better outcomes. In this review, we have summarized the role of multimodal imaging (e.g., echocardiography, cardiac MRI, and bone scintigraphy) and biomarkers (e.g., troponin, BNP) in the diagnosis, risk stratification, and treatment monitoring of CA.
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Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Suyon Chang
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Eun Ji Han
- Division of Nuclear Medicine, Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jong-Chan Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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11
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Santangelo G, Rossi A, Toriello F, Badano LP, Messika Zeitoun D, Faggiano P. Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging. J Clin Med 2021; 10:jcm10163745. [PMID: 34442039 PMCID: PMC8396987 DOI: 10.3390/jcm10163745] [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: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
Aortic stenosis is the most common heart valve disease necessitating surgical or percutaneous intervention. Imaging has a central role for the initial diagnostic work-up, the follow-up and the selection of the optimal timing and type of intervention. Referral for aortic valve replacement is currently driven by the severity and by the presence of aortic stenosis-related symptoms or signs of left ventricular systolic dysfunction. This review aims to provide an update of the imaging techniques and seeks to highlight a practical approach to help clinical decision making.
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Affiliation(s)
- Gloria Santangelo
- San Paolo Hospital, Division of Cardiology, Department of Health Sciences, University of Milan, 20142 Milan, Italy;
| | - Andrea Rossi
- Division of Cardiology, Azienda Ospedaliero Universitaria Verona, 37126 Verona, Italy;
| | - Filippo Toriello
- Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Division of Cardiology, Department of Internal Medicine, University of Milan, 20122 Milan, Italy;
| | - Luigi Paolo Badano
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Milan, Italy;
- Department of Cardiac, Metabolic and Neural Sciences, Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy
| | - David Messika Zeitoun
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada;
| | - Pompilio Faggiano
- Fondazione Poliambulanza, Cardiovascular Disease Unit, Via Leonida Bissolati, 57, 25100 Brescia, Italy
- Correspondence:
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12
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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. Circ Cardiovasc Imaging 2021; 14:e000029. [PMID: 34196223 DOI: 10.1161/hci.0000000000000029] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sharmila Dorbala
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Japan
| | - Sabahat Bokhari
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, NY
| | - Angela Dispenzieri
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Rodney H Falk
- Cardiac Amyloidosis Program, Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor A Ferrari
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Marianna Fontana
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | - Olivier Gheysens
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Julian D Gillmore
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mazen A Hanna
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Bouke P C Hazenberg
- Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center 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, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mathew S Maurer
- Columbia University Medical Center/New York Presbyterian Hospital, Columbia University, NY
| | - 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, Italy
| | - Edward J Miller
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - James C Moon
- National Amyloidosis Centre, Division of Medicine, University College London, London, United Kingdom
| | | | - C Cristina Quarta
- National Amyloidosis Centre, Division of Medicine, 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, MA
| | - Sanjiv J Shah
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hein J Verberne
- Division of Hematology, Division of Cardiovascular Diseases, and Department of Radiology, Division of Nuclear Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Jamieson M Bourque
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Molecular Medicine, University of Pavia, Italy
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13
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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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