The diagnostic yield of non-invasive testing features in cardiac amyloidosis.

IF 0.6 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Domagoj Kustić, Josipa Vukšić, Dražen Huić
{"title":"The diagnostic yield of non-invasive testing features in cardiac amyloidosis.","authors":"Domagoj Kustić, Josipa Vukšić, Dražen Huić","doi":"10.5603/nmr.103627","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardiac amyloidosis (CA) is a progressive disease in which amyloid fibrils infiltrate the heart muscle. This study aimed to identify features from cardiac biomarkers, electrocardiography (ECG), and echocardiography that may distinguish between transthyretin amyloidosis (ATTR) scintigraphy-positive and negative patients.</p><p><strong>Material and methods: </strong>Seventy-eight consecutive patients, median age 69 years (range 34-81), with suspected CA, negative serum free light chains, and negative serum and urine protein electrophoresis with immunofixation, referred to cardiac scintigraphy between 2021 and 2024, were retrospectively enrolled. Cardiac uptake was assessed by Perugini grades. Troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and various ECG and echocardiographic features were compared between ATTR scintigraphy-positive and negative participants using the t-test, Mann-Whitney U-test, and χ2-test as appropriate. Multivariable stepwise logistic regression created the prediction model for ATTR-positive scintigraphy. The significance level was 0.05.</p><p><strong>Results: </strong>Scintigraphy was ATTR-positive in 24 participants (30.77%). The variables significantly connected with ATTR-positive testing were atrial fibrillation (p = 0.010), first- or second-degree atrioventricular block (p = 0.041), left ventricle (LV) end-diastolic dimension (p = 0.018), LV global longitudinal strain (GLS) (p = 0.040), a restrictive transmitral inflow pattern (p = 0.025), LV posterior wall thickness (p < 0.001), interventricular septum (IVS) thickness (p < 0.001), QRS voltages (p < 0.001), the pseudo- infarct pattern (p < 0.001), and relative apical sparing of the GLS ratio (p < 0.001). The latter four were incorporated into the prediction model for ATTR-positive scintigraphy.</p><p><strong>Conclusions: </strong>ECG and echocardiography remain the essential diagnostic procedures that raise the suspicion of CA and trigger further diagnostics. Low QRS voltages, the pseudo-infarct pattern, IVS thickness, and relative apical sparing of the GLS ratio are sensitive predictors of ATTR-positive scintigraphy findings.</p>","PeriodicalId":44718,"journal":{"name":"NUCLEAR MEDICINE REVIEW","volume":"28 0","pages":"1-8"},"PeriodicalIF":0.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"NUCLEAR MEDICINE REVIEW","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5603/nmr.103627","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Cardiac amyloidosis (CA) is a progressive disease in which amyloid fibrils infiltrate the heart muscle. This study aimed to identify features from cardiac biomarkers, electrocardiography (ECG), and echocardiography that may distinguish between transthyretin amyloidosis (ATTR) scintigraphy-positive and negative patients.

Material and methods: Seventy-eight consecutive patients, median age 69 years (range 34-81), with suspected CA, negative serum free light chains, and negative serum and urine protein electrophoresis with immunofixation, referred to cardiac scintigraphy between 2021 and 2024, were retrospectively enrolled. Cardiac uptake was assessed by Perugini grades. Troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and various ECG and echocardiographic features were compared between ATTR scintigraphy-positive and negative participants using the t-test, Mann-Whitney U-test, and χ2-test as appropriate. Multivariable stepwise logistic regression created the prediction model for ATTR-positive scintigraphy. The significance level was 0.05.

Results: Scintigraphy was ATTR-positive in 24 participants (30.77%). The variables significantly connected with ATTR-positive testing were atrial fibrillation (p = 0.010), first- or second-degree atrioventricular block (p = 0.041), left ventricle (LV) end-diastolic dimension (p = 0.018), LV global longitudinal strain (GLS) (p = 0.040), a restrictive transmitral inflow pattern (p = 0.025), LV posterior wall thickness (p < 0.001), interventricular septum (IVS) thickness (p < 0.001), QRS voltages (p < 0.001), the pseudo- infarct pattern (p < 0.001), and relative apical sparing of the GLS ratio (p < 0.001). The latter four were incorporated into the prediction model for ATTR-positive scintigraphy.

Conclusions: ECG and echocardiography remain the essential diagnostic procedures that raise the suspicion of CA and trigger further diagnostics. Low QRS voltages, the pseudo-infarct pattern, IVS thickness, and relative apical sparing of the GLS ratio are sensitive predictors of ATTR-positive scintigraphy findings.

无创检查对心脏淀粉样变性的诊断率。
背景:心脏淀粉样变性(CA)是一种淀粉样原纤维浸润心肌的进行性疾病。本研究旨在确定心脏生物标志物、心电图(ECG)和超声心动图的特征,这些特征可以区分甲状腺转蛋白淀粉样变性(ATTR)扫描阳性和阴性患者。材料和方法:回顾性入选2021 - 2024年间连续78例疑似CA、血清游离轻链阴性、免疫固定血清和尿蛋白电泳阴性的心脏造影患者,中位年龄69岁(范围34-81岁)。采用Perugini分级评估心脏摄取。采用T检验、Mann-Whitney u检验和χ2检验,比较ATTR显像阳性和阴性受试者肌钙蛋白T、n端前b型利钠肽(NT-proBNP)及各种心电图和超声心动图特征。多变量逐步逻辑回归建立了atr阳性显像的预测模型。显著性水平为0.05。结果:24例(30.77%)患者显像呈atr阳性。心房颤动(p = 0.010)、一度或二度房室传导阻滞(p = 0.041)、左心室舒张末期尺寸(p = 0.018)、左心室总纵向应变(GLS) (p = 0.040)、限制性透射血流模式(p = 0.025)、左心室后壁厚度(p < 0.001)、室间隔(IVS)厚度(p < 0.001)、QRS电压(p < 0.001)、假性梗死模式(p < 0.001)、GLS比的相对根尖保留(p < 0.001)。后4例纳入atr阳性闪烁成像预测模型。结论:心电图和超声心动图仍然是必要的诊断程序,引起怀疑CA和触发进一步的诊断。低QRS电压、伪梗死模式、IVS厚度和GLS的相对根尖保留比是atr阳性显像结果的敏感预测因子。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
NUCLEAR MEDICINE REVIEW
NUCLEAR MEDICINE REVIEW RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
1.40
自引率
0.00%
发文量
53
审稿时长
24 weeks
期刊介绍: Written in English, NMR is a biannual international periodical of scientific and educational profile. It is a journal of Bulgarian, Czech, Hungarian, Macedonian, Polish, Romanian, Russian, Slovak, Ukrainian and Yugoslav Societies of Nuclear Medicine. The periodical focuses on all nuclear medicine topics (diagnostics as well as therapy), and presents original experimental scientific papers, reviews, case studies, letters also news about symposia and congresses. NMR is indexed at Index Copernicus (7.41), Scopus, EMBASE, Index Medicus/Medline, Ministry of Education 2007 (4 pts.).
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信