Why the study?
The prognostic significance of incidental suspected transthyretin amyloidosis (ATTR) on routine bone scintigraphy in elderly patients was not previously described.
Cohort (n=2,000)
Yes
Hazard Ratio: 2.73 (95% CI 1.67–4.45)
Absolute Event Rate: 35% vs 8%
p-value: p=<.0001
A 65-year-old man with known bone metastases from prostate cancer and no cardiac history attended for a restaging bone scan (BS). Diffuse increased Tc-HDP activity in the heart was noted, new since a BS 3 months earlier. A restaging contrast-enhanced CT scan on the same day showed reduced myocardial perfusion in the anterior, apical, and septal walls. On direct questioning, he described an episode of severe exertional chest pain the day before. Myocardial infarction was confirmed and treated with primary percutaneous coronary intervention. New cardiac uptake on BS, raising the possibility of myocardial infarction, is a red alert for clinicians.
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Panagiotidis et al. (2013) conducted a cohort in Incidental cardiac uptake (suspected ATTR) on bone scintigraphy (n=2,000). Incidental suspected cardiac ATTR (Perugini grade ≥2 cardiac uptake) vs. Mild or no cardiac uptake (Perugini grade ≤1) was evaluated on Cardiovascular mortality (HR 2.73, 95% CI 1.67-4.45, p=<.0001).
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