{"title":"Non-invasive Imaging Findings of Wild-type Transthyretin Amyloid Cardiomyopathy in Women: A Retrospective Study.","authors":"Fumihiro Yoshimura, Seitaro Oda, Masafumi Kidoh, Shinpei Yamaguchi, Seiji Takashio, Naoto Kuyama, Tetsuya Oguni, Hiroki Usuku, Yasuhiro Izumiya, Yasunori Nagayama, Takeshi Nakaura, Kenichi Tsujita, Toshinori Hirai","doi":"10.1016/j.acra.2025.03.009","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale and objectives: </strong>Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) predominantly affects males; however, female patients can also develop this condition. This study assessed the non-invasive imaging features of ATTRwt-CM in female patients.</p><p><strong>Materials and methods: </strong>In this study, 106 consecutive patients diagnosed with ATTRwt-CM were retrospectively analyzed, evaluating sex-related differences in imaging features, including echocardiography, cardiac magnetic resonance (CMR), and <sup>99m</sup>Tc-labeled pyrophosphate (<sup>99m</sup>Tc-PYP) scintigraphy.</p><p><strong>Results: </strong>12 of 106 patients (11.3%) were female. They were significantly older at diagnosis (75 years [interquartile range, 71-79 years] vs. 79 years [77-83 years]; p<0.01). The proportion of female patients increased with age, from 7.5% (6/80) in those aged <80 years to 23.1% (6/26) in those aged ≥80 years. CMR-measured left ventricular ejection fraction (LVEF) was significantly higher in female patients (50.0% [42.0-61.0%] vs. 59.5% [44.3-72.3%]; p=0.04). No significant sex-related differences in LV mass and global longitudinal strain were observed. In T1 mapping, no significant difference in native T1 was observed; however, the extracellular volume fraction (ECV) was significantly lower in female patients (54.2% [46.5-66.0%] vs. 50.4% [42.0-55.0%]; p=0.04). Furthermore, no significant difference in myocardial T2 value was observed. Late gadolinium enhancement was more extensively observed in males than in females. The heart-to-contralateral ratio in <sup>99m</sup>Tc-PYP scintigraphy was significantly lower among female patients (1.88 [1.70-2.04] vs. 1.64 [1.58-1.74]; p=0.02).</p><p><strong>Conclusion: </strong>CMR findings revealed that females exhibited higher LVEF, lower ECV, and weaker cardiac uptake on <sup>99m</sup>Tc-PYP scintigraphy, indicating a milder myocardial amyloid burden. No significant sex-related differences in echocardiographic parameters or other CMR indices were observed.</p>","PeriodicalId":50928,"journal":{"name":"Academic Radiology","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acra.2025.03.009","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Rationale and objectives: Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) predominantly affects males; however, female patients can also develop this condition. This study assessed the non-invasive imaging features of ATTRwt-CM in female patients.
Materials and methods: In this study, 106 consecutive patients diagnosed with ATTRwt-CM were retrospectively analyzed, evaluating sex-related differences in imaging features, including echocardiography, cardiac magnetic resonance (CMR), and 99mTc-labeled pyrophosphate (99mTc-PYP) scintigraphy.
Results: 12 of 106 patients (11.3%) were female. They were significantly older at diagnosis (75 years [interquartile range, 71-79 years] vs. 79 years [77-83 years]; p<0.01). The proportion of female patients increased with age, from 7.5% (6/80) in those aged <80 years to 23.1% (6/26) in those aged ≥80 years. CMR-measured left ventricular ejection fraction (LVEF) was significantly higher in female patients (50.0% [42.0-61.0%] vs. 59.5% [44.3-72.3%]; p=0.04). No significant sex-related differences in LV mass and global longitudinal strain were observed. In T1 mapping, no significant difference in native T1 was observed; however, the extracellular volume fraction (ECV) was significantly lower in female patients (54.2% [46.5-66.0%] vs. 50.4% [42.0-55.0%]; p=0.04). Furthermore, no significant difference in myocardial T2 value was observed. Late gadolinium enhancement was more extensively observed in males than in females. The heart-to-contralateral ratio in 99mTc-PYP scintigraphy was significantly lower among female patients (1.88 [1.70-2.04] vs. 1.64 [1.58-1.74]; p=0.02).
Conclusion: CMR findings revealed that females exhibited higher LVEF, lower ECV, and weaker cardiac uptake on 99mTc-PYP scintigraphy, indicating a milder myocardial amyloid burden. No significant sex-related differences in echocardiographic parameters or other CMR indices were observed.
期刊介绍：
Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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