Regional Variation in Technetium Pyrophosphate Uptake in Transthyretin Cardiac Amyloidosis and Impact on Mortality
| Autor: | Michael N. Vranian, Wael A. Jaber, Rory Hachamovitch, Mazen Hanna, Dermot Phelan, Manuel D. Cerqueira, Brett W. Sperry, Albree Tower-Rader, Richard C. Brunken |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Technetium Tc 99m Pyrophosphate Heart Ventricles chemistry.chemical_element 030204 cardiovascular system & hematology Technetium Ventricular Function Left 030218 nuclear medicine & medical imaging 03 medical and health sciences Basal (phylogenetics) 0302 clinical medicine Predictive Value of Tests Humans Medicine Radiology Nuclear Medicine and imaging Aged Retrospective Studies Aged 80 and over Tomography Emission-Computed Single-Photon Amyloid Neuropathies Familial Lung medicine.diagnostic_test biology business.industry Reproducibility of Results Prognosis Transthyretin medicine.anatomical_structure Cardiac amyloidosis chemistry Ventricle Ventricular Function Right biology.protein Female Radiopharmaceuticals Cardiomyopathies Cardiology and Cardiovascular Medicine business Heart failure with preserved ejection fraction Nuclear medicine Emission computed tomography |
| Zdroj: | JACC: Cardiovascular Imaging. 11:234-242 |
| ISSN: | 1936-878X |
| DOI: | 10.1016/j.jcmg.2017.06.020 |
| Popis: | This study sought to investigate the regional uptake of technetium 99m-pyrophosphate (TcPYP) in transthyretin cardiac amyloidosis (ATTR) and its association with mortality.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.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.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.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. |
| Databáze: | OpenAIRE |
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