Prognostic value of 99mtechnetium-pyrophosphate single-photon emission computed tomography visual grade in patients with transthyretin cardiac amyloidosis on stabilization therapy.
Ardel J Romero Pabón, Olivier F Clerc, Sarah A M Cuddy, Shilpa Vijayakumar, Zhou Lan, Hanna K Gaggin, Marcelo F Di Carli, Rodney H Falk, Sharmila Dorbala
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引用次数: 0
Abstract
Background: The aim of our study was to evaluate the prognostic value of amyloid burden estimated by technetium-pyrophosphate single-photon emission computed tomography (99mTc-PYP-SPECT) visual grade in patients with transthyretin (ATTR) amyloid cardiomyopathy (ATTR-CM) receiving TTR stabilization therapy.
Methods: Our retrospective cohort study included 344 ATTR-CM participants receiving TTR stabilization therapy. 99mTc-PYP-SPECT myocardial uptake was graded as 0, 1, 2, or 3, based on myocardial uptake that was absent, less than, equal to, or greater than rib uptake, respectively. National Amyloidosis Center (NAC) stage was defined by N-terminal pro B-type natriuretic peptide (≤3000 pg/mL) and estimated glomerular filtration rate (≥45 mL/min/1.73 m2) levels. The primary outcome was all-cause mortality. Kaplan-Meier survival and multivariable Cox regression analyses were performed.
Results: Of the 344 participants (median age: 80 years), 88% were men and 98% had a 99mTc-PYP-SPECT visual grade uptake of 2 or 3. Seventy-six participants (22.1%) died during follow-up (median: 27 months). In the Cox regression analysis adjusted for age, NAC stage, New York Heart Association (NYHA) class, left ventricular (LV) mass index, LV ejection fraction, and 99mTc-PYP-SPECT visual grade, only NAC stage (hazard ratio [HR]: 4.01, P value <.001) and NYHA class (HR: 5.22, P value = .011) strongly predicted mortality.
Conclusions: In patients with ATTR-CM receiving TTR stabilization therapy, organ dysfunctions evidenced by NAC stage and NYHA class, but not by amyloid burden on 99mTc-PYP-SPECT visual grade, are strong predictors of mortality. Our results support a revision to 99mTc-PYP visual grading 2 and 3 into a single grade (positive). Future work is needed to evaluate whether amyloid burden measured by quantitative 99mTc-PYP-SPECT offers prognostic value in ATTR-CM.
期刊介绍：
Journal of Nuclear Cardiology is the only journal in the world devoted to this dynamic and growing subspecialty. Physicians and technologists value the Journal not only for its peer-reviewed articles, but also for its timely discussions about the current and future role of nuclear cardiology. Original articles address all aspects of nuclear cardiology, including interpretation, diagnosis, imaging equipment, and use of radiopharmaceuticals. As the official publication of the American Society of Nuclear Cardiology, the Journal also brings readers the latest information emerging from the Society''s task forces and publishes guidelines and position papers as they are adopted.
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