Addendum to 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

Abstract

There are 2 primary reasons for an addendum. The first is that the document reviewer list is being updated to include Dr Richard Cheng and Dr Roy John, who have critically reviewed the document, but were inadvertently not listed as reviewers. In addition, since the publication of this document and the introduction of approved therapies for transthyretin cardiac amyloidosis, the clinical use of bone tracer cardiac scintigraphy has been extended to populations with a lower prevalence of transthyretin cardiac amyloidosis. Numerous observations have raised concerns about (1) incorrect diagnosis of transthyretin cardiac amyloidosis based on 99mTc-pyrophosphate (PYP) planar imaging and heart-to-contralateral lung (H/CL) ratio without confirmation of diffuse myocardial uptake on single photon emission computed tomography (SPECT) imaging at some sites; (2) excess blood pool activity on the 1-hour planar and SPECT images being interpreted as positive scans; and (3) missed diagnosis of light chain amyloidosis, as serum-free light chain studies and serum and urine immunofixation electrophoresis studies may not be recommended in the 99mTc-PY P/-3,3-diphosphono-1,2-propanodicarboxylic acid/hydroxymethylene diphosphonate (99mTc-PYP/DPD/HMDP) report. Incorrect diagnosis leads to inappropriate therapy and worse patient outcomes. SPECT and planar imaging performed at 3-hour maximize specificity. 1 Sperry B.W. Burgett E. Bybee K.A. McGhie A.I. O’ Keefe J.H. Saeed I.M. et al. Technetium pyrophosphate nuclear scintigraphy for cardiac amyloidosis: imaging at I vs 3 hours and planar vs SPECT/CT. J Nucl Cardiol. 2020; 27: 1802—7https://doi.org/10.1007/s12350-020-02139-8 Crossref Scopus (20) Google Scholar , 2 Masri A. Bukhari S. Ahmad S. Nieves R. Eisele Y.S. Follansbee W. et al. Efficient 1-hour technetium-99m pyrophosphate imaging protocol for the diagnosis of transthyretin cardiac amyloidosis. Circ Cardiovasc Imaging. 2020; 13e010249https://doi.org/10.1161/CIRCIMAGING.119.010249 Crossref Scopus (27) Google Scholar , 3 Castano A. Haq M. Narotsky D.L. Goldsmith J. Weinberg R.L. Morgenstern R. et al. Multicenter study of planar technetium 99m pyrophosphate cardiac imaging: predicting survival for patients with ATTR cardiac amyloidosis. JAMA Cardiol. 2016; 1: 880-889https://doi.org/10.1001/jamacardio.2016.2839 Crossref PubMed Scopus (211) Google Scholar Additionally, technical parameters have been updated. 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 ImagingJournal of Cardiac FailureVol. 25Issue 11PreviewCardiac amyloidosis is a form of restrictive infiltrative cardiomyopathy that confers significant mortality. Because of the relative rarity of cardiac amyloidosis, clinical and diagnostic expertise in the recognition and evaluation of individuals with suspected amyloidosis is mostly limited to a few expert centers. Electrocardiography, echocardiography, and radionuclide imaging have been used for the evaluation of cardiac amyloidosis for over 40 years.1–3 Although cardiovascular magnetic resonance (CMR) has also been in clinical practice for several decades, it was not applied to cardiac amyloidosis until the late 1990s. Full-Text PDF