Author + information
- Received March 31, 2017
- Revision received June 12, 2017
- Accepted June 16, 2017
- Published online February 5, 2018.
- Brett W. Sperry, MDa,∗ (, )
- Michael N. Vranian, MDa,
- Albree Tower-Rader, MDa,
- Rory Hachamovitch, MSc, MDa,
- Mazen Hanna, MDa,
- Richard Brunken, MDa,b,
- Dermot Phelan, MD, PhDa,
- Manuel D. Cerqueira, MDa,b and
- Wael A. Jaber, MDa,b
- aDepartment of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- bDepartment of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Brett W. Sperry, Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Heart and Vascular Institute, 9500 Euclid Avenue, Desk J1-5, Cleveland, Ohio 44195.
Objectives This study sought to investigate the regional uptake of technetium 99m-pyrophosphate (TcPYP) in transthyretin cardiac amyloidosis (ATTR) and its association with mortality.
Background 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.
Methods 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.
Results 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.
Conclusions 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.
- advanced cardiac imaging
- heart failure with preserved ejection fraction
- infiltrative cardiomyopathies
- nuclear cardiac imaging
Dr. Cerqueira is a consultant and on the speakers board at Astellas Pharma USA. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 31, 2017.
- Revision received June 12, 2017.
- Accepted June 16, 2017.
- 2018 American College of Cardiology Foundation