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- Title
Apical sparing pattern of left ventricular myocardial <sup>99m</sup>Tc-HMDP uptake in patients with transthyretin cardiac amyloidosis.
- Authors
Van Der Gucht, Axel; Cottereau, Anne-Ségolène; Abulizi, Mukedaisi; Guellich, Aziz; Blanc-Durand, Paul; Israel, Jean-Marc; Galat, Arnault; Plante-Bordeneuve, Violaine; Dubois-Randé, Jean-Luc; Bodez, Diane; Rosso, Jean; Damy, Thibaud; Itti, Emmanuel
- Abstract
<bold>Background: </bold>A decreased longitudinal strain in basal segments with a base-to-apex gradient has been described in patients with cardiac amyloidosis (CA).<bold>Objectives: </bold>Aim was to investigate the left ventricular (LV) regional distribution of early-phase 99mTc-Hydroxymethylene diphosphonate (99mTc-HMDP) uptake in patients with transthyretin-related cardiac amyloidosis (TTR-CA).<bold>Methods: </bold>All patients underwent a whole-body planar 99mTc-HMDP scintigraphy acquired at 10-min post-injection (early-phase) followed by a thorax SPECT/CT. The segmental uptake (expressed as % of maximal myocardial HMDP uptake) was investigated on the AHA 17-segment model and 3-segment model (basal, mid-cavity, apical).<bold>Results: </bold>Sixty-one TTR-CA patients were included of whom 29 were wild-type (wt-TTR-CA) and 32 had hereditary TTR-CA (m-TTR-CA). Early myocardial 99mTc-HMDP uptake occurred in all TTR-CA. In all patients, segmental analysis of the LV myocardial distribution of 99mTc-HMDP uptake showed an increased median uptake (interquartile range) in basal/mid-cavity segments compared to the lowest median uptake of apical segments (respectively, 79% [72%-86%] vs. 72% [64%-81%]; P < 10-6). This pattern was similar in wt-TTR-CA group (78% [70%-84%] vs. 70% [61%-81%]; P < 10-6), in m-TTR-CA group (80% [74%-86%] vs. 73 [66%-82%]; P < 10-7) and remained constant independently of the TTR mutation subtype with P ranging 10-5 to 0.03.<bold>Conclusions: </bold>Early-phase myocardial scintigraphy identified regional distribution of 99mTc-HMDP uptake characterized by a base-to-apex gradient, corroborating echocardiographic, and cardiac magnetic resonance findings. This apical sparing pattern was similar across TTR-CA and TTR mutation subtypes.
- Subjects
CARDIAC amyloidosis; MYOCARDIAL perfusion imaging; AMYLOIDOSIS
- Publication
Journal of Nuclear Cardiology, 2018, Vol 25, Issue 6, p2072
- ISSN
1071-3581
- Publication type
journal article
- DOI
10.1007/s12350-017-0894-z