Regional Variation in Technetium Pyrophosphate Uptake in Transthyretin Cardiac Amyloidosis and Impact on Mortality

JACC-CARDIOVASCULAR IMAGING

卷:11

Article

Sperry, Brett W.¹  Vranian, Michael N.¹  Tower-Rader, Albree¹  Hachamovitch, Rory¹  Hanna, Mazen¹  Brunken, Richard^1,2  Phelan, Dermot¹  Cerqueira, Manuel D.^1,2  Jaber, Wael A.^1,2 

[1] Cleveland Clin Fdn, Dept Cardiovasc Med, 9500 Euclid Ave, Cleveland, OH 44195 USA

[2] Cleveland Clin Fdn, Dept Nucl Med, 9500 Euclid Ave, Cleveland, OH 44195 USA

关键词: advanced cardiac imaging;    heart failure with preserved ejection fraction;    infiltrative cardiomyopathies;    nuclear cardiac imaging;   

DOI  :  10.1016/j.jcmg.2017.06.020

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to investigate the regional uptake of technetium 99m-pyrophosphate (TcPYP) in transthyretin cardiac amyloidosis (ATTR) and its association with mortality. BACKGROUND TcPYP nuclear scintigraphy is a diagnostic and prognostic tool in ATTR. Echocardiography has identified a pattern of regional variation in longitudinal strain (LS) with a gradient of improved strain from base to apex in ATTR. METHODS Consecutive patients with ATTR were evaluated who underwent TcPYP nuclear scintigraphy with planar and attenuation corrected single-photon emission computed tomography (SPECT). Heart-to-contralateral lung (H/CL) ratio was calculated on planar images, and left ventricular (LV) uptake was determined in each of the 17 segments using SPECT. A measure of apical-sparing of myocardial TcPYP uptake, termed the apical-sparing ratio (ASR), was calculated as basal + mid / apical counts. RESULTS Overall, 54 patients with ATTR (age 78 +/- 9 years, 76% male, 31% hereditary ATTR) were analyzed. There was increased TcPYP uptake in basal and mid relative to apical LV segments, and an apical-sparing LS pattern on echocardiography. The right ventricle similarly showed greater uptake in basal segments. There were 26 deaths over 1.8 years median follow-up. The ASR of TcPYP uptake was associated with age-adjusted all-cause mortality (p = 0.013) with worse prognosis seen at levels < 2.75. Global LS was also prognostic (p = 0.01), whereas H/CL ratio and total LV uptake indexed to blood pool were not (p = 0.772 and p = 0.850, respectively). The prognostic utility of the ASR persisted in multivariable modeling (p = 0.003), whereas global LS did not. CONCLUSIONS There is decreased TcPYP uptake in apical as compared to mid and basal segments in the LV, mimicking apical-sparing LS seen on echocardiography. Regional distribution of LV TcPYP uptake is associated with mortality, whereas overall amount of uptake as measured by H/CL ratio and indexed LV SPECT uptake is not. (C) 2018 by the American College of Cardiology Foundation.

【 授权许可】

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