生物标志物预测可疑甲状腺转蛋白淀粉样变性患者的异常锝-99m焦磷酸盐扫描。

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology Pub Date : 2025-01-01 DOI:10.1016/j.jaccao.2024.10.013

Laura De Michieli MD , Omar F. AbouEzzeddine MDCM, MS , Muhannad A. Abbasi MD , Daniel R. Davies MD , Christopher G. Scott MS , Eli Muchtar MD , Angela Dispenzieri MD , Martha Grogan MD , Margaret M. Redfield MD , Allan S. Jaffe MD

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引用次数: 0

摘要

背景：锝Tc 99m焦磷酸盐闪烁成像（99mTc PYP成像）是甲状腺转蛋白淀粉样心肌病（atr - cm）的诊断工具。心脏生物标志物，特别是高敏感性心肌肌钙蛋白（hs-cTn）和n端前b型利钠肽（NT-proBNP），可能有助于识别atr - cm的低风险或高风险患者。目的：作者试图评估hs-cTnT和NT-proBNP在美国大型队列中接受99mTc PYP成像的疑似atr - cm患者中的预测价值。方法：这是一项回顾性研究，研究对象为2013年5月至2022年9月期间接受99mTc PYP成像的患者，包括在扫描后6个月内至少进行1次hs-cTnT测量的患者。结果：1442例患者中有427例（29.6%）诊断为atr - cm。结论：在接受99mTc PYP影像学检查疑似atr - cm的患者中，尽管在一小部分患者中，非常低的hs-cTnT水平可以有效地排除诊断。更高的阈值会增加假阴性的风险。NT-proBNP和联合生物标志物策略显示出类似的趋势，hs-cTnT和NT-proBNP在疾病诊断中的效用有限。

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Biomarkers to Predict Abnormal Technetium-99m Pyrophosphate Scans in Patients With Suspected Transthyretin Amyloidosis

Background

Technetium Tc 99m pyrophosphate scintigraphy (^99mTc PYP imaging) is a diagnostic tool for transthyretin amyloid cardiomyopathy (ATTR-CM). Cardiac biomarkers, particularly high-sensitivity cardiac troponin (hs-cTn) and N-terminal pro–B-type natriuretic peptide (NT-proBNP), may help identify patients at low or high risk for ATTR-CM.

Objectives

The authors sought to evaluate the predictive value of hs-cTnT and NT-proBNP in patients undergoing ^99mTc PYP imaging for suspected ATTR-CM in a large U.S. cohort.

Methods

This was a retrospective study of patients who underwent ^99mTc PYP imaging between May 2013 and September 2022, including those with at least 1 hs-cTnT measurement within 6 months of the scan.

Results

ATTR-CM was diagnosed in 427 of 1,442 patients (29.6%). A hs-cTnT level <6 ng/L (n = 50, 3.5%) showed a negative predictive value of 100% (95% CI: 93%-100%) and sensitivity of 100% (95% CI: 99%-100%) for ruling out ATTR-CM. As the hs-cTnT threshold increased, the number of patients who could be ruled out also increased, but false negatives emerged. The positive predictive value for ruling in ATTR-CM remained low. NT-proBNP showed similar results (n = 1,378). The combination of hs-cTnT <14 ng/L and NT-proBNP <60 ng/L identified 45 patients (3.3%) without ATTR-CM.

Conclusions

In patients undergoing ^99mTc PYP imaging for suspected ATTR-CM, very low hs-cTnT levels can effectively rule out the diagnosis, although in a small subset of patients. Higher thresholds increase the risk of false negatives. NT-proBNP and combined biomarker strategies showed similar trends, the utility of hs-cTnT and NT-proBNP for ruling in the disease is limited.

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来源期刊

Jacc: Cardiooncology Multiple-

CiteScore

12.50

自引率

6.30%

发文量

106

期刊介绍： JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.