Key result
99mTc-HMDP uptake measures higher in ATTR versus AL amyloidosis and decreases after tafamidis treatment.
Why the study?
The diagnostic performance of 99mTc-HMDP imaging for cardiac amyloidosis and its ability to demonstrate changes in cardiac uptake after tafamidis treatment required evaluation.
Does 99mTc-HMDP imaging accurately diagnose cardiac ATTR and evaluate changes after tafamidis treatment in patients with suspected cardiac amyloidosis?
Observational (n=75)
No
Does 99mTc-HMDP imaging accurately diagnose cardiac ATTR and evaluate changes after tafamidis treatment in patients with suspected cardiac amyloidosis?
p-value: p=0.003
99mTc-HMDP imaging, particularly myocardial SUVpeak, is useful for diagnosing cardiac ATTR and monitoring changes in cardiac uptake after tafamidis treatment.
99mTc-HMDP parameters may aid ATTR diagnosis and tafamidis monitoring; leaves open prospective validation before clinical adoption.
OBJECTIVE: This study aimed to evaluate the diagnostic performance of 99m Tc-hydroxymethylene diphosphonate ( 99m Tc-HMDP) imaging for cardiac amyloidosis and to demonstrate changes in cardiac uptake of 99m Tc-HMDP after tafamidis treatment. METHODS: Seventy-five patients with suspected cardiac amyloidosis who underwent 99m Tc-HMDP imaging were included. We compared visual Perugini grades and semiquantitative heart-to-contralateral (H/CL) area ratios, myocardial maximum standardized uptake value (SUVmax), and peak of SUV (SUVpeak) between cardiac transthyretin amyloidosis (ATTR) and amyloid light-chain amyloidosis (AL). Comparison of interobserver reproducibility between H/CL ratios and myocardial SUVmax/SUVpeak was performed. H/CL ratio of 99m Tc-HMDP and myocardial SUVmax/SUVpeak were compared before and after tafamidis administration for cardiac wild-type ATTR. RESULTS: Among 75 patients, 20 patients (26.7%) were visually positive based on Perugini grade. Fifteen and three patients were pathologically identified as cardiac ATTR and AL, respectively. ATTR group ( n = 15) had significantly higher H/CL ratios of 99m Tc-HMDP than AL group ( n = 3) ( P = 0.003). ATTR group ( n = 15) had significantly higher myocardial SUVmax/SUVpeak of 99m Tc-HMDP than AL group ( n = 2) ( P = 0.015). Myocardial SUVmax/SUVpeak had better interobserver reproducibility than H/CL ratios. After tafamidis treatment for cardiac wild-type ATTR, the decrease in myocardial SUVpeak was significant but not in H/CL ratios and myocardial SUVmax. CONCLUSION: H/CL ratio and SUVmax/SUVpeak in 99m Tc-HMDP imaging were useful for diagnosing cardiac ATTR. Myocardial SUVpeak may be useful for monitoring changes in cardiac uptake after tafamidis treatment for cardiac ATTR.
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Egi et al. (2024) conducted an observational in Suspected cardiac amyloidosis (n=75). 99mTc-HMDP imaging and tafamidis treatment vs. AL amyloidosis (for diagnosis) / baseline (for treatment) was evaluated on Heart-to-contralateral (H/CL) area ratios of 99mTc-HMDP between ATTR and AL groups (p=0.003). 99mTc-HMDP imaging parameters were significantly higher in cardiac ATTR compared to AL amyloidosis (P=0.003 for H/CL ratio), and myocardial SUVpeak significantly decreased after tafamidis treatment.
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