TTR vs AL Cardiac Amyloidosis: Don't Rely on Imaging Alone TTR vs AL Cardiac Amyloidosis: Don't Rely on Imaging Alone

Drs Acharya, Grogan and Abou-Ezzeddine from Mayo discuss amyloid and TTR cardiac amyloidosis, with particular focus on diagnostic challenges and use of the pyrophosphate (PYP) scan.Mayo Clinic
Source: Medscape Cardiology Headlines - Category: Cardiology Tags: Cardiology Roundtable Source Type: news

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Systemic amyloidosis is a group of diseases that develops as the result of protein misfolding, formation, and deposition of amyloid into the organs.1 The organs involved depend, in part, on the type of amyloid and innate property of the individual proteins that remains incompletely understood. Patients with wild-type transthyretin (wtATTR) amyloidosis typically have predominately heart involvement, whereas those with mutant transthyretin (mATTR) amyloidosis have involvement of the heart, nerves, and eyes, while all organs except the brain can be involved in immunoglobulin light chain (AL) amyloidosis.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Editorial Source Type: research
ConclusionAmyloid PET tracers such as18F-flutemetamol could be a promising tool in diagnosing and in therapy response assessment for patients with cardiac amyloidosis.
Source: Annals of Nuclear Medicine - Category: Nuclear Medicine Source Type: research
Authors: De Vito C, Papathomas G T, Pedica F, Kane P, Amir A, Heaton N, Quaglia A Abstract Systemic symptoms such as fever and fatigue are non-specific manifestations spanning from inflammation to neoplasia. Here we report the case of a 34 year-old man who presented with systemic symptoms for four months. CT-scan and MRI revealed a 3.4 cm arterialized hepatic lesion and a 7 cm paraduodenal mass. Surgical resection of both lesions and histological examination revealed an inflammatory hepatocellular adenoma and a unicentric plasma cell type of Castleman disease. Moreover, a diffuse AA amyloid deposition in the liver ...
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
AbstractPurposeCardiac amyloidosis (CA) is a rare cause of heart failure with frequently delayed diagnosis, because specific early signs or symptoms are missing. Recently, direct amyloid imaging using positron emission tomography/computed tomography (PET/CT) has emerged.The aim of this study was to examine the performance of18F-florbetaben-PET/CT in detection of CA, and compare it to echocardiography (echo), cardiac MRI (CMR) and scintigraphy. Additionally, the use of18F-florbetaben-PET/CT for quantification of amyloid burden and monitoring of treatment response was assessed.MethodsTwenty-two patients with proven (n&thinsp...
Source: European Journal of Nuclear Medicine and Molecular Imaging - Category: Nuclear Medicine Source Type: research
DISCUSSION: Our results encourage an independent validation cohort study to confirm the indication that the plasma Aβ1-40/Aβ1-42 ratio, assessed via Simoa, may improve future standard of care and clinical trial design. PMID: 31113759 [PubMed - as supplied by publisher]
Source: The Journal of Alzheimers Association - Category: Psychiatry Tags: Alzheimers Dement Source Type: research
53Aim: Immunmodulatory treatment with the PPAR agonist Pioglitazone shows heterogeneous results in Alzheimer`s disease (AD). We aimed to apply longitudinal in-vivo PET monitoring combined with terminal cognitive assessment to investigate PET as a tool for longitudinal monitoring of treatment effects and to establish efficacy determinants. Methods: PS2APP (TG) mice and C57Bl/6 (WT) mice were randomly stratified in Pioglitazone (N=13 TG, N=8 WT) and placebo treatment (N=10 TG, N=7 WT) at the age of 8 months. Therapy was conducted for 5 months (mo). All mice received amyloid-PET (Aβ-PET) scans (F-18-Florbetaben) at basel...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Brain Imaging Council YIA Symposium Source Type: research
Conclusions: While the results of this pilot study suggest that 18F-NaF PET/CT demonstrates good diagnostic accuracy for ATTR, particularly when using quantitative analysis, its sensitivity is less than the reported sensitivity of established nuclear medicine studies with PYP or DPD. Further studies with direct comparisons to PYP or DPD SPECT are recommended.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Posters Source Type: research
1451Purpose: Cardiac amyloidosis (CA) is a progressive cardiomyopathy for which new therapies are now available. Non-invasive imaging like 99mTc-DPD scintigraphy can aid in the diagnostic workup. While Perugini qualitative-score is a recognized useful tool to identify CA, still a more quantitative and less subjective approach would be desirable. We aimed at validating a semiquantitative parameter able to improve the diagnostic accuracy in patients with suspected CA. The additional value of morphological parameters derived from trans-thoracic echocardiography (TTE) was also tested. Materials and Methods: 59 Patients were re...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Posters Source Type: research
Conclusions: 11C-PIB PET/MR may be valuable in the noninvasive diagnosis of CA. Further study with a larger cohort of patients would be needed to confirm it.
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular YIA Symposium Source Type: research
Conclusions: SPECT imaging can improve the diagnostic accuracy of planar scans. Blood pool increases visual score and heart-to-contralateral ratio on planar images. This could be responsible for a large portion (36%) of questionable visual scores and result in possible false positives (4%). Future studies should investigate the ability of delayed imaging to clear blood pool in these cases. Another 36% of questionable visual scores showed presence of PYP on SPECT not evident on planar, which may implicate expanded use of PYP imaging. Focal uptake of PYP can represent prior myocardial damage, which SPECT can better identify....
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Hermann Blumgart Award Lecture Source Type: research
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