Wild type cardiac amyloidosis: is it time to order a nuclear technetium pyrophosphate SPECT imaging study?
Wild type cardiac amyloidosis: is it time to order a nuclear technetium pyrophosphate SPECT imaging study?
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DOI：
10.1007/s10554-022-02692-y
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发表时间：
2023-01
影响因子：
2.1
通讯作者：
Srivastava, Ajay, V
中科院分区：
文献类型：
--
作者：
Shen, Christine P.;Vanichsarn, Christopher T.;Pandey, Amitabh C.;Billick, Kristen;Rubenson, David S.;Mohan, Rajeev C.;Heywood, James Thomas;Srivastava, Ajay, V
转甲状腺激素(Attr)淀粉样变性是一种衰弱的全身性疾病，常与有症状的心脏受累有关。随着~(99)Tm焦磷酸盐(TC-PYP)单光子发射计算机断层扫描(SPECT)的出现，诊断发生了巨大的变化。随着非侵入性诊断ATTR淀粉样变性和提供新的治疗方法的能力，确定哪些患者应该被转介进行这种测试变得越来越重要。超声心动图上相对心尖节段性纵向应变可用于筛查此类患者。我们试图描述99mTC-PYP显像非侵入性诊断的ATTR淀粉样变性患者的心电图和超声心动图(TTE)表现，包括纵向应变的相对心尖保留。这是一项单中心的回顾性研究，研究对象为2016年6月至2019年2月间接受99mTC-PYP显像的患者。根据左心室纵向应变(LV LS)值计算相对心尖纵向应变。在99mTC-PYP阳性患者中，没有任何心电图参数与其有意义相关。99mTC-PYP阳性组与阴性组的左心室重量指数(p = 0.001)、室间隔内径(p <； 0.001)、左心室收缩末期内径(<； 0.001)均有非常显著差异。99mTC-PYP阳性患者的LV LS相对心尖节段性较高(p <； 0.001)，而99mTC-PYP阴性患者的 >； 比值均为1.0。纵向应变的相对心尖保留的发现可以可靠地指导临床医生对患者进行分类，考虑使用99mTC-PYP显像对野生型心脏淀粉样变性进行无创性诊断。具有临床提示特征且LV LS相对心尖节约率 >； 为0.8的患者可考虑进行99mTC-PYP显像以评估ATTR型心脏淀粉样变性。
Transthyretin (ATTR) amyloidosis is a debilitating systemic disease often associated with symptomatic cardiac involvement. Diagnosis has dramatically changed with the advent of Technetium-99 m pyrophosphate (Tc-PYP) single-photon emission computed tomography (SPECT). With the ability to diagnose ATTR amyloidosis noninvasively and offer newer therapies, it is increasingly important to identify which patients should be referred for this testing. Relative apical sparing of longitudinal strain on echocardiogram can be potentially used to screen such patients. We sought to describe electrocardiogram (ECG) and echocardiogram (TTE) findings, including relative apical sparing of longitudinal strain, in ATTR amyloidosis patients diagnosed non-invasively with 99mTc-PYP imaging. This was a single-center, retrospective study with 64 patients who underwent 99mTc-PYP imaging between June 2016 and February 2019. Relative apical longitudinal strain was calculated from left ventricular longitudinal strain (LV LS) values. No ECG parameters were meaningfully associated with of 99 m Tc-PYP positive patients. LV mass index (p = 0.001), IVSd (p < 0.001), and LVPWd (< 0.001) demonstrated a highly significant difference between positive and negative 99mTc-PYP groups. 99mTc-PYP positive patients had a higher relative apical sparing of LV LS (p < 0.001), and notably, no 99mTc-PYP negative patient had a ratio > 1.0. The finding of relative apical sparing of longitudinal strain can reliably guide clinicians in triaging which patients to consider ordering 99mTc-PYP imaging for the noninvasive diagnosis of wild type cardiac amyloidosis. A patient with clinically suggestive features and an LV LS relative apical sparing ratio > 0.8 can be considered for 99mTc-PYP imaging to evaluate for ATTR cardiac amyloidosis.
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影响因子：
39.3
作者：
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通讯作者：
Garcia-Pavia, Pablo
影响因子：
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作者：
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影响因子：
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影响因子：
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作者：
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通讯作者：
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影响因子：
2.7
作者：
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Kristen AV