My Approach to Imaging Cardiac Amyloidosis: Role of Bone-Seeking Tracers Scintigraphy

Abstract

Amyloidosis is a systemic infiltrative disease characterized by the extracellular deposition of amyloid fibrils. Heart involvement is common and associated with a poor prognosis. The most predominant types of cardiac amyloidosis (CA) are amyloid immunoglobulin light chain (AL) and amyloid transthyretin (ATTR). Diagnosis of CA and differentiation between the types are important for prognosis, therapy, and genetic counseling. ATTR-CA is an under - diagnosed cause of heart failure. However, great accomplishments in non-invasive imaging methods, as well as the possibility of effective clinical treatment, have shifted ATTR-CA from a rare and untreatable disease to a condition that clinicians should consider on a daily basis. The advent of scintigraphy imaging with bone-seeking tracers has allowed the early diagnosis of ATTR-CA with high accuracy once monoclonal gammopathies have been excluded. Interpretation of cardiac scintigraphy with bone-seeking tracers requires expertise, and we propose a step-by-step guide to performing this exam in clinical practice according to the most recent guidelines. Moreover, we reviewed some crucial points that we believe