99mTc-DPD scintigraphy in immunoglobulin light chain (AL) cardiac amyloidosis

Autor: Sajitha Sachchithanantham, Ashutosh D. Wechalekar, Claudio Rapezzi, Jiexin Zheng, Candida Cristina Quarta, Marianna Fontana, Shameem Mahmood, David F. Hutt, Carol J. Whelan, Philip N. Hawkins, Helen J. Lachmann, Richa Manwani, Liza Chacko, Simona F. Grigore, Julian D. Gillmore, Ana Martinez-Naharro
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Cardiac function curve
medicine.medical_specialty
medicine.drug_class
diagnosis
Cardiomyopathy
030204 cardiovascular system & hematology
Scintigraphy
Gastroenterology
NO
03 medical and health sciences
0302 clinical medicine
Internal medicine
AL amyloidosis
medicine
Natriuretic peptide
Humans
Prealbumin
99mTc-DPD scintigraphy
Radiology
Nuclear Medicine and imaging
AcademicSubjects/MED00200
amyloidosis
cardiomyopathy
light chain
prognosis
Radionuclide Imaging
Amyloid Neuropathies
Familial
biology
medicine.diagnostic_test
business.industry
Amyloidosis
General Medicine
Organotechnetium Compounds
Original Articles
medicine.disease
Transthyretin
Cardiac amyloidosis
030220 oncology & carcinogenesis
biology.protein
cardiovascular system
Immunoglobulin Light Chains
Cardiology and Cardiovascular Medicine
business
Cardiomyopathies
Zdroj: European Heart Journal Cardiovascular Imaging
Popis: Aims Technetium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD scintigraphy) is recognized as highly accurate for the non-invasive diagnosis of transthyretin (ATTR) cardiac amyloidosis (CA). A proportion of patients with immunoglobulin light chain (AL) CA have also been reported to show cardiac 99mTc-DPD uptake. Herein, we assessed the frequency and degree of cardiac 99mTc-DPD uptake and its clinical significance among patients with AL CA. Methods and results Between 2010 and 2017, 292 consecutive patients with AL CA underwent 99mTc-DPD scintigraphy and were included in this study: 114 (39%) had cardiac 99mTc-DPD uptake: grade 1 in 75%, grade 2 in 17%, and grade 3 in 8% of cases. Patients with cardiac 99mTc-DPD uptake had poorer cardiac systolic function and higher N-terminal pro-brain natriuretic peptide. No differences were noted in cardiac magnetic resonance parameters between patients with and without cardiac 99mTc-DPD uptake (N = 19 and 42, respectively). Patients with cardiac 99mTc-DPD uptake showed a trend to worse survival than those with no uptake (log-rank P = 0.056). Among 22 patients who underwent serial 99mTc-DPD scintigraphy, 5 (23%) showed reduction in the grade of cardiac uptake. Conclusions In this large cohort of patients with AL CA, 99mTc-DPD scintigraphy ∼40% of cases showed cardiac uptake, including grade 2–3 in 10% of all patients (25% of those with cardiac 99mTc-DPD uptake). Cardiac 99mTc-DPD uptake was associated with poorer cardiac function and outcomes. These data highlight the critical importance of ruling out AL amyloidosis in all patients with cardiac 99mTc-DPD uptake to ensure such patients are not assumed to have ATTR CA.
Databáze: OpenAIRE
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