Abstract
PurposeWild-type transthyretin-related amyloidosis cardiomyopathy (ATTRwt-CM) is an increasingly recognized cause of heart failure especially in elderly patients. The purpose of the present study was to determine retrospectively whether the quantitative indices of 99mTc-pyrophosphate (PYP) SPECT/CT help to predict the prognosis of ATTRwt-CM patients when compared with other clinical parameters.Materials and methodsSixty-eight patients with biopsy-proven ATTRwt-CM who underwent PYP SPECT/CT were enrolled. Baseline clinical characteristics, echocardiographic parameters, and qualitative and/or quantitative indices of planar and SPECT/CT imaging in PYP scintigraphy for each patient were included. For quantitative analysis of SPECT/CT, the accumulation ratio of PYP in the septum, posterior, anterior, lateral, and apex walls to the cavity pool was calculated as the septal wall-to-cavity ratio (Se/C), lateral wall-to-cavity ratio (La/C), anterior wall-to-cavity ratio (An/C), inferior wall-to-cavity ratio (In/C), and apical wall-to-cavity ratio (Ap/C), respectively. Endpoints for prognostic accuracy evaluation were cardiac death or hospitalization due to heart failure. Event-free survival rate was evaluated through Cox proportional hazards regression analysis, providing estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and Kaplan–Meier curves.ResultsHigh-sensitivity cardiac troponin T (hs-cTnT), La/C, age, interventricular septal thickness in diastole, and E/e′ ratio in the septal wall were significantly associated with event-free survival (P < 0.05). For a multivariable Cox proportional hazards analysis, hs-cTnT (HR 1.153; 95% CI 1.034–1.286; P < 0.01), La/C (HR 2.091; 95% CI 1.012–4.322; P = 0.046), and age (HR 1.116; 95% CI 1.007–1.238; P = 0.037) were significant independent prognostic factors.ConclusionThis study indicated that the quantitative indices of PYP SPECT/CT can help to predict the prognosis of ATTRwt-CM patients.
Highlights
Wild-type transthyretin-related amyloidosis cardiomyopathy (ATTRwt-CM) is associated with heart failure in a considerable number of elderly patients [1]
International scientific literature agrees on the usefulness of boneavid compounds for the accurate identification of transthyretin [5], and PYP scintigraphy can be beneficial in identifying amyloid deposition in the myocardium of patients with ATTR cardiomyopathy (ATTR-CM), and the scintigraphy constitutes a valuable method for the noninvasive diagnosis of ATTR-CM [6, 7]
high-sensitivity cardiac troponin T (Hs-cTnT), lateral wall-to-cavity ratio (La/C), age, IVSTd, and E/eseptal were significantly associated with event-free survival (P < 0.05); the hazard ratios (HRs) was 1.137 for High-sensitivity cardiac troponin T (hs-cTnT), 2.297 for La/C, 1.085 for age, 1.177 for IVSTd, and 1.064 for E/eseptal
Summary
Wild-type transthyretin-related amyloidosis cardiomyopathy (ATTRwt-CM) is associated with heart failure in a considerable number of elderly patients [1]. An autopsy study revealed that at least 25% of individuals aged > 80 years had histological evidence of amyloid deposits in their cardiac tissue [2]. Another study reported that 13% of patients with heart failure with preserved ejection fraction (HFpEF) with left ventricular (LV) hypertrophy (> 12 mm) had been diagnosed with ATTRwt-CM [1]. Bone-avidity, phosphate-based isotopes, including 99mTcpyrophosphate (PYP) and 99mTc-3,3-diphosphono-1,2-propanodiacarboxylic acid (DPD), show specific features for transthyretin-related amyloidosis (ATTR) deposits. International scientific literature agrees on the usefulness of boneavid compounds for the accurate identification of transthyretin [5], and PYP scintigraphy can be beneficial in identifying amyloid deposition in the myocardium of patients with ATTR cardiomyopathy (ATTR-CM), and the scintigraphy constitutes a valuable method for the noninvasive diagnosis of ATTR-CM [6, 7]
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