Abstract
Background
Quantitation of myocardial 99m Tc-pyrophosphate activity may have high diagnostic accuracy, but its correlation with disease burden is unknown. We examined the relationship between 99m Tc-pyrophosphate quantitation and cardiac magnetic resonance (CMR) measures in patients with suspected transthyretin cardiac amyloidosis (ATTR-CM) or light chain cardiac amyloidosis (AL-CM).
Methods
Consecutive patients who underwent 99mTc-pyrophosphate imaging and CMR were included. ATTR-CM and AL-CM were diagnosed using standard criteria. 99mTc-pyrophosphate images were assessed with standard parameters and quantified with cardiac pyrophosphate activity (CPA) and volume of involvement (VOI). We assessed the association between 99mTc-pyrophosphate image interpretation and CMR tissue characteristics.
Results
Seventy patients were identified, mean age 70.4 ± 11.4 years, with ATTR-CM and AL-CM diagnosed in 22 (31%) and 11 (16%) patients, respectively. In patients with ATTR-CM, there were significant correlations between CPA (r2 = 0.509, P < 0.001) and VOI (r2 = 0.586, P < 0.001) with native myocardial T1 mapping values. Additionally, CPA (adjusted hazard ratio (aHR) 1.04, P = 0.016), VOI (aHR 1.12, P = 0.034), and average myocardial T1 (aHR 1.12, P = 0.025) were associated with incidence of heart failure hospitalization or death.
Conclusion
CPA and VOI were correlated with CMR measures of myocardial fibrosis in patients with ATTR-CM. 99mTc-pyrophosphate quantitation may have a role in ATTR-CM disease staging, guiding treatment, or following response to therapy.
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Abbreviations
- AL:
-
Light chain cardiac amyloidosis
- CMR:
-
Cardiovascular magnetic resonance
- CPA:
-
Cardiac pyrophosphate activity
- ECV:
-
Extracellular volume
- HCL:
-
Heart/contralateral ratio
- IQR:
-
Interquartile range
- LGE:
-
Late gadolinium enhancement
- LV:
-
Left ventricle
- LVBP:
-
Left ventricular blood pool
- PET:
-
Positron emission tomography
- PSIR:
-
Phase-sensitive inversion recovery
- ROI:
-
Region of interest
- SD:
-
Standard deviation
- SPECT:
-
Single photon emission computed tomography
- Tc:
-
Technetium
- ATTR-CM:
-
Transthyretin cardiac amyloidosis
- VOI:
-
Volume of involvement
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Disclosures
This research was supported in part by NIH Grant R01-HL135557. Dr. Fine reports research and consulting support from Pfizer, Akcea, Ionis, Alnylam, and Eidos. Dr. White receives funding from the Calgary Health Trust and Siemens Healthineers and is a shareholder in Cohesic Inc. Dr. Miller reports consulting support from Alnylam and Pfizer. The other authors have no other relevant disclosures.
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This research was supported in part by NIH Grant R01-HL135557.
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Roshankar, G., White, G.C., Cadet, S. et al. Quantitative technetium pyrophosphate and cardiovascular magnetic resonance in patients with suspected cardiac amyloidosis. J. Nucl. Cardiol. 29, 2679–2690 (2022). https://doi.org/10.1007/s12350-021-02806-4
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DOI: https://doi.org/10.1007/s12350-021-02806-4