Yousuf Razvi, Aldostefano Porcari, David F Hutt, Jonathan Lazari, Adam Ioannou, Rishi K Patel, Muhammad Umaid Rauf, Tamer Rezk, Oliver Hague, Stefano Filisetti, Helen J Lachmann, Ashutosh D Wechalekar, Aviva Petrie, Carol J Whelan, Lucia Venneri, Ana Martinez-Naharro, Janet A Gilbertson, Dorota Rowczenio, William E Moody, Richard Steeds, Jennifer H Pinney, Philip N Hawkins, Marianna Fontana, Julian D Gillmore
{"title":"经治疗的转甲状腺素淀粉样心肌病的一系列骨显像表现的临床相关性尚不确定。","authors":"Yousuf Razvi, Aldostefano Porcari, David F Hutt, Jonathan Lazari, Adam Ioannou, Rishi K Patel, Muhammad Umaid Rauf, Tamer Rezk, Oliver Hague, Stefano Filisetti, Helen J Lachmann, Ashutosh D Wechalekar, Aviva Petrie, Carol J Whelan, Lucia Venneri, Ana Martinez-Naharro, Janet A Gilbertson, Dorota Rowczenio, William E Moody, Richard Steeds, Jennifer H Pinney, Philip N Hawkins, Marianna Fontana, Julian D Gillmore","doi":"10.1016/j.jcmg.2025.03.014","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Technetium-99m-labeled 3,3-diphosphono-1,2-propanodicarboxylic acid (<sup>99m</sup>Tc-DPD) scintigraphy is a critical part of the validated nonbiopsy diagnostic algorithm for transthyretin amyloid cardiomyopathy (ATTR-CM). With the advent of novel disease-modifying therapies for ATTR-CM, there is intense interest in establishing the utility of DPD scans as an indicator of treatment response.</p><p><strong>Objectives: </strong>The authors conducted a retrospective multimodality imaging study to determine the utility of <sup>99m</sup>Tc-DPD to track treatment response in ATTR-CM.</p><p><strong>Methods: </strong>ATTR-CM patients from the United Kingdom National Amyloidosis Centre who were receiving amyloid-specific disease-modifying therapy (DMT) and underwent pre- and post-treatment <sup>99m</sup>Tc-DPD/single-photon emission computed tomography-computed tomography scans were included. Myocardial percentage injected dose (PID), a proposed scintigraphic indicator of cardiac amyloid burden, was measured at baseline and follow-up. Change from baseline in this variable was compared with that of other validated biomarkers of disease severity.</p><p><strong>Results: </strong>A total of 66 patients with ATTR-CM who received DMT underwent serial <sup>99m</sup>Tc-DPD scans. At follow-up, with a median time between <sup>99m</sup>Tc-DPD scans of 27.5 months (Q1-Q3: 21.9-33.1 months), there was a mean reduction from pre-DMT myocardial PID on <sup>99m</sup>Tc-DPD scintigraphy of 1.5 ± 1.5%. No statistically significant correlation between the change in PID at follow-up and change in echocardiographic, biochemical, or cardiac magnetic resonance parameters was identified. Discordance in which there was an improvement on follow-up <sup>99m</sup>Tc-DPD scintigraphy despite disease progression was observed in 28/66 patients (42.4%).</p><p><strong>Conclusions: </strong>Our study indicates a poor correlation between reduction in <sup>99m</sup>Tc-DPD uptake at follow-up and numerous established biomarkers of ATTR-CM treatment response. Changes in DPD uptake in ATTR-CM patients receiving DMT should be interpreted with caution.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":12.8000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Uncertain Clinical Relevance of Serial Bone Scintigraphy Findings in Treated Transthyretin Amyloid Cardiomyopathy.\",\"authors\":\"Yousuf Razvi, Aldostefano Porcari, David F Hutt, Jonathan Lazari, Adam Ioannou, Rishi K Patel, Muhammad Umaid Rauf, Tamer Rezk, Oliver Hague, Stefano Filisetti, Helen J Lachmann, Ashutosh D Wechalekar, Aviva Petrie, Carol J Whelan, Lucia Venneri, Ana Martinez-Naharro, Janet A Gilbertson, Dorota Rowczenio, William E Moody, Richard Steeds, Jennifer H Pinney, Philip N Hawkins, Marianna Fontana, Julian D Gillmore\",\"doi\":\"10.1016/j.jcmg.2025.03.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Technetium-99m-labeled 3,3-diphosphono-1,2-propanodicarboxylic acid (<sup>99m</sup>Tc-DPD) scintigraphy is a critical part of the validated nonbiopsy diagnostic algorithm for transthyretin amyloid cardiomyopathy (ATTR-CM). With the advent of novel disease-modifying therapies for ATTR-CM, there is intense interest in establishing the utility of DPD scans as an indicator of treatment response.</p><p><strong>Objectives: </strong>The authors conducted a retrospective multimodality imaging study to determine the utility of <sup>99m</sup>Tc-DPD to track treatment response in ATTR-CM.</p><p><strong>Methods: </strong>ATTR-CM patients from the United Kingdom National Amyloidosis Centre who were receiving amyloid-specific disease-modifying therapy (DMT) and underwent pre- and post-treatment <sup>99m</sup>Tc-DPD/single-photon emission computed tomography-computed tomography scans were included. Myocardial percentage injected dose (PID), a proposed scintigraphic indicator of cardiac amyloid burden, was measured at baseline and follow-up. Change from baseline in this variable was compared with that of other validated biomarkers of disease severity.</p><p><strong>Results: </strong>A total of 66 patients with ATTR-CM who received DMT underwent serial <sup>99m</sup>Tc-DPD scans. At follow-up, with a median time between <sup>99m</sup>Tc-DPD scans of 27.5 months (Q1-Q3: 21.9-33.1 months), there was a mean reduction from pre-DMT myocardial PID on <sup>99m</sup>Tc-DPD scintigraphy of 1.5 ± 1.5%. No statistically significant correlation between the change in PID at follow-up and change in echocardiographic, biochemical, or cardiac magnetic resonance parameters was identified. Discordance in which there was an improvement on follow-up <sup>99m</sup>Tc-DPD scintigraphy despite disease progression was observed in 28/66 patients (42.4%).</p><p><strong>Conclusions: </strong>Our study indicates a poor correlation between reduction in <sup>99m</sup>Tc-DPD uptake at follow-up and numerous established biomarkers of ATTR-CM treatment response. Changes in DPD uptake in ATTR-CM patients receiving DMT should be interpreted with caution.</p>\",\"PeriodicalId\":14767,\"journal\":{\"name\":\"JACC. Cardiovascular imaging\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":12.8000,\"publicationDate\":\"2025-06-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. 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Uncertain Clinical Relevance of Serial Bone Scintigraphy Findings in Treated Transthyretin Amyloid Cardiomyopathy.
Background: Technetium-99m-labeled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy is a critical part of the validated nonbiopsy diagnostic algorithm for transthyretin amyloid cardiomyopathy (ATTR-CM). With the advent of novel disease-modifying therapies for ATTR-CM, there is intense interest in establishing the utility of DPD scans as an indicator of treatment response.
Objectives: The authors conducted a retrospective multimodality imaging study to determine the utility of 99mTc-DPD to track treatment response in ATTR-CM.
Methods: ATTR-CM patients from the United Kingdom National Amyloidosis Centre who were receiving amyloid-specific disease-modifying therapy (DMT) and underwent pre- and post-treatment 99mTc-DPD/single-photon emission computed tomography-computed tomography scans were included. Myocardial percentage injected dose (PID), a proposed scintigraphic indicator of cardiac amyloid burden, was measured at baseline and follow-up. Change from baseline in this variable was compared with that of other validated biomarkers of disease severity.
Results: A total of 66 patients with ATTR-CM who received DMT underwent serial 99mTc-DPD scans. At follow-up, with a median time between 99mTc-DPD scans of 27.5 months (Q1-Q3: 21.9-33.1 months), there was a mean reduction from pre-DMT myocardial PID on 99mTc-DPD scintigraphy of 1.5 ± 1.5%. No statistically significant correlation between the change in PID at follow-up and change in echocardiographic, biochemical, or cardiac magnetic resonance parameters was identified. Discordance in which there was an improvement on follow-up 99mTc-DPD scintigraphy despite disease progression was observed in 28/66 patients (42.4%).
Conclusions: Our study indicates a poor correlation between reduction in 99mTc-DPD uptake at follow-up and numerous established biomarkers of ATTR-CM treatment response. Changes in DPD uptake in ATTR-CM patients receiving DMT should be interpreted with caution.
期刊介绍：
JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography.
JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy.
In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.
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