Regional Variation in Technetium Pyrophosphate Uptake in Transthyretin Cardiac Amyloidosis and Impact on Mortality

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 
Source: Journal of the American College of Cardiology: Cardiovascular Imaging - Category: Radiology Authors: Tags: Original Research Source Type: research

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AbstractBackgroundTechnetium-based bone scintigraphy is rapidly becoming the most common non-invasive imaging tool in the diagnosis of Transthyretin cardiac amyloidosis (ATTR). Skeletal muscle uptake has been described with technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid (TcDPD), and may account for masking of bony uptake. We sought to investigate skeletal muscle uptake of technetium-99m-pyrophosphate (TcPYP) in patients with ATTR.Methods and ResultsThis was a retrospective analysis of 57 patients diagnosed with ATTR who underwent TcPYP scintigraphy. Cardiac uptake was assessed on whole-body planar imaging usin...
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
PMID: 29199249 [PubMed - as supplied by publisher]
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
AbstractCardiac amyloidosis is a form of restrictive cardiomyopathy resulting in heart failure and potential risk on arrhythmia, due to amyloid infiltration of the nerve conduction system and the myocardial tissue. The prognosis in this progressive disease is poor, probably due the development of cardiac arrhythmias. Early detection of cardiac sympathetic innervation disturbances has become of major clinical interest, because its occurrence and severity limits the choice of treatment. The use of iodine-123 labelled metaiodobenzylguanidine ([I-123]MIBG), a chemical modified analogue of norepinephrine, is well established in...
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
Authors: Wall JS, Kennel SJ, Martin EB Abstract Amyloidosis is associated with a number of rare diseases and is characterized by the deposition, in abdominothoracic organs and peripheral nerves, of extracellular protein fibrils, which leads to dysfunction and severe morbidity. Effective clinical evaluation and management of patients with systemic amyloidosis are hampered by the lack of a noninvasive, quantitative method for detecting whole-body amyloid load. We have used a battery of assays including dual-energy SPECT imaging and comparative effectiveness studies in support of translation of a synthetic polybasic p...
Source: Molecular Imaging - Category: Radiology Tags: Mol Imaging Source Type: research
Conclusion: These results showed the potential of NaF-PET/MR to diagnose cardiac amyloidosis and to differentiate ATTR and AL forms, confirming our preliminary published results (Trivieri et al. J Am Coll Cardiol 2016). Research Support: This work was supported by National Institutes of Health (NIH) grants NIH/NHLBI R01HL071021 (to Dr. Fayad) and NIH 5T32HL007824-18 (to Dr. Trivieri), and by British Heart Foundation grants SS/CH/09/002/26360, FS/13/77/30488, SS/CH/09/002/2636, FS/14/78/31020, CH/09/002 (to Dr. Dweck).
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: The ' New Cardiomyopathies: Sarcoid, Amyloid, and Chemotherapy Source Type: research
35Objectives: The current gold standard for diagnosis of amyloid cardiomyopathy (A-CM) is endomyocardial biopsy (EMB). Bone radiotracer based scintigraphy has re-emerged as an effective non-invasive procedure for diagnosing A-CM, specifically transthyretin amyloid cardiomyopathy (ATTR-CM). The purpose of our study was to evaluate the diagnostic accuracy of a new combined single-photon emission computed tomography and computed tomography (SPECT-CT) (3-D imaging) based quantitative method for diagnosing ATTR-CM and compare it with the current standard planar scintigraphy (2-D imaging) method, the heart-to-contralateral side ...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Young Investigator Award Symposium Source Type: research
ConclusionsModification of amyloid-targeting peptides using D-amino acids should be performed cautiously due to the introduction of unexpected secondary pharmacologic effects. Peptides that adopt a helical structure, to align charged amino acid side chains along one face, exhibit specific reactivity with amyloid; however, polybasic peptides with a propensity for β-sheet conformation are also amyloid-reactive and may yield a novel class of amyloid-targeting agents for imaging and therapy.
Source: Molecular Imaging and Biology - Category: Molecular Biology Source Type: research
In this study, the researchers examined the diagnostic accuracy of the Tc 99m PYP test for ATTR-CA in a retrospective study of 179 amyloidosis patients (121 with ATTR and 50 with other types). The researchers found that the imaging test was able to correctly identify ATTR in 91 percent of those diagnosed with the disease, and was able to rule out ATTR-CA in 92 percent of those with other forms of amyloidosis or no amyloidosis. Link: http://newsroom.cumc.columbia.edu/blog/2016/08/24/amyloid-related-heart-failure-now-detectable-with-imaging-test/
Source: Fight Aging! - Category: Research Authors: Tags: Daily News Source Type: blogs
Conclusion [ 99m Tc]p5  + 14 is a specific and stable radiotracer for systemic amyloid in mice and may provide a convenient and inexpensive alternative to imaging of peripheral amyloidosis in patients.
Source: Molecular Imaging and Biology - Category: Molecular Biology Source Type: research
Abstract Nuclear cardiology is one of the major fields of nuclear medicine practice. Myocardial perfusion studies using single-photon emission computed tomography (SPECT) have played a crucial role in the management of coronary artery diseases. Positron emission tomography (PET) has also been considered an important tool for the assessment of myocardial viability and perfusion. However, the recent development of computed tomography (CT)/magnetic resonance imaging (MRI) technologies and growing concerns about the radiation exposure of patients remain serious challenges for nuclear cardiology. In response to these c...
Source: Nuclear Medicine and Molecular Imaging - Category: Nuclear Medicine Source Type: research
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