99mtc焦磷酸盐摄取对可疑甲状腺素转甲状腺素型心脏淀粉样变性患者的预后价值。

IF 2.7 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Nuclear Cardiology Pub Date : 2025-09-01 DOI:10.1016/j.nuclcard.2025.102452

Tomohi Ajima MD , Tadao Aikawa MD, PhD , Toshinori Saitou RT , Yuya Matsue MD, PhD , Shinichiro Fujimoto MD, PhD , Kazunori Omote MD, PhD , Tohru Minamino MD, PhD

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引用次数: 0

摘要

背景：本研究旨在评估心肌99mtc -焦磷酸（PYP）摄取对疑似甲状腺素型心脏淀粉样变性（atr - ca）患者行PYP影像学检查的预后价值。方法：回顾性分析301例连续行PYP影像学检查疑似atr - ca的患者。心肌PYP摄取使用Perugini分级目视分级（0-3级），并通过心脏与对侧肺摄取（H/CL）比量化。主要终点是合并心源性死亡和记录的致命性室性心律失常(室性颤动（ventricular fibrillation， VF）和持续室性心动过速（ventricular tach心动过速，VT），持续时间为30秒。结果：301例患者中，90例SPECT心肌PYP摄取阳性。在中位随访668天（四分位数范围186-868天）期间，36例患者死亡，包括13例心脏死亡。6例患者发生致死性室性心律失常（2例室性心动过速流产，4例持续室性心动过速）。主要结局发生在211例PYP SPECT阴性患者中的8例（4%）和90例PYP SPECT阳性患者中的10例（11%）。Kaplan-Meier分析显示，PYP SPECT阳性患者的主要转归发生率显著高于阴性患者（P= 0.018）。相比之下，两组的全因死亡率无显著差异（P= 0.36）。多变量Cox比例风险回归分析显示，PYP SPECT阳性是疑似atr - ca患者主要预后的独立预测因子（校正风险比：2.86[95%置信区间：1.10-7.41];P = 0.031）。结论：在疑似atr - ca患者中，显著的心肌PYP摄取与不良心脏事件风险增加相关。

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Prognostic value of 99mTc-pyrophosphate uptake in patients with suspected transthyretin cardiac amyloidosis

Background

This study aimed to evaluate the prognostic value of myocardial ^99mTc-pyrophosphate (PYP) uptake in patients undergoing PYP imaging for suspected transthyretin cardiac amyloidosis (ATTR-CA).

Methods

A retrospective analysis of 301 consecutive patients who underwent PYP imaging for suspected ATTR-CA was performed. Myocardial PYP uptake was graded visually using the Perugini classification (grade 0-3) and quantified by the heart-to-contralateral lung uptake (H/CL) ratio. The primary outcome was combined cardiac death and documented fatal ventricular arrhythmias (ventricular fibrillation [VF] and sustained ventricular tachycardia [VT] lasting >30 seconds).

Results

Among the 301 patients, 90 had positive myocardial PYP uptake on SPECT. During a median follow-up of 668 days (interquartile range, 186-868 days), 36 patients died, including 13 cardiac deaths. Fatal ventricular arrhythmias were documented in 6 patients (2 aborted VF and 4 sustained VT). The primary outcome occurred in 8 of 211 (4%) patients with negative PYP SPECT and in 10 of 90 (11%) patients with positive PYP SPECT. Kaplan–Meier analyses showed a significantly higher incidence of the primary outcome in patients with positive PYP SPECT than in those without (P=.018). In contrast, all-cause mortality did not differ significantly between the two groups (P=.36). Multivariable Cox proportional hazards regression analyses showed that PYP SPECT positivity was an independent predictor of the primary outcome in patients with suspected ATTR-CA (adjusted hazard ratio: 2.86 [95% confidence interval: 1.10-7.41]; P =.031).

Conclusions

Significant myocardial PYP uptake was associated with an increased risk of adverse cardiac events in patients with suspected ATTR-CA.

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来源期刊

Journal of Nuclear Cardiology 医学-核医学

CiteScore

5.30

自引率

20.80%

发文量

249

审稿时长

4-8 weeks

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.