Key result
Positive myocardial PYP uptake on SPECT was associated with an increased risk of combined cardiac death and fatal ventricular arrhythmias compared to negative uptake (HR 2.86; 95% CI 1.10-7.41; P=0.031).
Why the study?
Does positive myocardial PYP uptake predict adverse cardiac events in patients with suspected ATTR-CA?
Cohort (n=301)
Does positive myocardial PYP uptake predict adverse cardiac events in patients with suspected ATTR-CA?
Hazard Ratio: 2.86 (95% CI 1.1–7.41)
Absolute Event Rate: 11% vs 4%
p-value: p=0.031
Significant myocardial PYP uptake is associated with an increased risk of adverse cardiac events, including cardiac death and fatal ventricular arrhythmias, in patients with suspected ATTR-CA.
PYP uptake may aid risk stratification in suspected ATTR-CA; leaves open prospective validation before guiding management.
BACKGROUND: Tc-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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Ajima et al. (2025) conducted a cohort in Suspected transthyretin cardiac amyloidosis (ATTR-CA) (n=301). Positive myocardial PYP uptake on SPECT vs. Negative PYP SPECT was evaluated on Combined cardiac death and documented fatal ventricular arrhythmias (HR 2.86, 95% CI 1.10-7.41, p=0.031). Positive myocardial PYP uptake on SPECT was associated with an increased risk of combined cardiac death and fatal ventricular arrhythmias compared to negative uptake (HR 2.86; 95% CI 1.10-7.41; P=0.031).
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