Nuclear Cardiology Surrogate Biomarkers in Clinical Trials

The Accuracy of Technetium-99 m Pyrophosphate Imaging in Diagnosing Transthyretin Cardiac Amyloidosis and Its Impact on Patient Management

PURPOSE OF REVIEW

This review evaluates recent advancements in Technetium-99 m pyrophosphate (99mTc-PYP) imaging for transthyretin amyloid cardiomyopathy (ATTR-CM). We summarize the advantages of single-photon emission computed tomography (SPECT) over planar imaging, the potential impact of quantitative methods, and emerging data for quantifying response to therapy.

RECENT FINDINGS

The current literature demonstrates the superior diagnostic accuracy of SPECT compared with planar imaging in 99mTc-PYP studies. Emerging quantitative methods, using hybrid SPECT/CT and artificial intelligence, show promise for enhancing diagnostic precision and risk assessment. Recent studies have also highlighted the potential of 99mTc-PYP quantification for monitoring treatment response. 99mTc-PYP SPECT imaging has exceptional diagnostic accuracy for ATTR-CM. Quantitative techniques, which can be facilitated by artificial intelligence, improve risk stratification and may aid in treatment monitoring. Future research should focus on clarifying the clinical role and optimal approach for quantification.