Prognostic value of 99mTc-HMDP scintigraphy in elderly patients with chronic heart failure

Abstract

Abstract Background Bone scintigraphy is an accurate modality for diagnosis of transthyretin amyloidosis (ATTR). Purpose We evaluated the prevalence and prognostic significance of cardiac ATTR in elderly heart failure population. Methods Our retrospective study included 335 patients aged over 70 years with diagnosed heart failure who underwent 99mTc-hydroxymethylenediphosphonate (99mTc-HMDP) scintigraphy due to non-cardiac indications. A Perugini grade >2 and heart-to-contralateral ratio (H/CL) of >1.30 was considered positive for ATTR. Results There were a total of 234 deaths of which 70 were classified as cardiovascular during a median follow-up of 3±2 years. ATTR was diagnosed in 17 patients using H/CL ratio (5.1%). Patients with ATTR were older (85±5 vs. 80±5 years, p=0.002) and had higher N-terminal pro-brain natriuretic peptide (Nt-ProBNP) levels (6692±5694 vs. 3285±5233 ng/l, p=0.02). Age, presence of bone metastasis and GFR were independent predictors of overall mortality. Age, GFR, ≥grade 2 visual cardiac uptake and H/CL ratio were independent predictors of cardiovascular mortality. Conclusions ATTR was found in 5% of elderly patients with heart failure. The presence of cardiac uptake on bone scintigraphy did not convey independent prognostic value on overall mortality but was associated with cardiovascular mortality. Funding Acknowledgement Type of funding sources: None.