Simultaneous mechanical clot fragmentation and pharmacologic thrombolysis in acute massive pulmonary embolism

Abstract

that technetium pyrophosphate scintigraphy has a very low sensitivity for cardiac amyloidosis. Our results suggest that none of the noninvasive parameters evaluated in this study for diagnosis of cardiac amyloidosis are highly sensitive. Thus, low voltage had a sensitivity of 80%, myocardial sparkling 45%, and technetium-99m-pyrophosphate uptake 23%. This low sensitivity, coupled with the previously mentioned low specificity, makes these findings unattractive for diagnosis of amyloidosis. An alternative approach to noninvasive diagnosis of cardiac amyloidosis was suggested by Carrol et al’ who noted that patients with cardiac amyloidosis tend to have low electrocardiographic voltages and high echocardiographic estimates of left ventricular mass. When the voltage/mass relation for cardiac amyloid patients is compared with that for patients with aortic valve (high voltage, high mass) or pericardial (low voltage, low mass) disease, clear differences emerge. Plotting voltage/mass relations for the patients in this study on a diagram developed by Carrol et al (Figure 1) would place 12 patients (80%) in a cardiac amyloid range (voltage 10 cm2/m2). This result makes the voltage/mass relation an attractive approach for diagnosis of cardiac amyloidosis. However, there are no reliable estimates of specificity for this technique. In conclusion, the present study examined several frequently used findings obtained by noninvasive techniques with regard to their sensitivity for diagnosis of cardiac amyloidosis. Our results suggest that the sensitivity ‘of both myocardial technetium uptake and echocardiographic observation of sparkling are low. However, voltage/mass relation diagrams appear to be a very promising technique for noninvasive diagnosis of these patients. The use and specificity of this technique need further study.