In patients with wild-type transthyretin cardiac amyloidosis, a higher lateral wall-to-cavity ratio on PYP SPECT/CT was an independent predictor of cardiac death or heart failure hospitalization (HR 2.091).
Cohort (n=68)
No
Does quantitative 99mTc-pyrophosphate SPECT/CT predict the prognosis of patients with wild-type transthyretin cardiac amyloidosis?
Quantitative indices from 99mTc-PYP SPECT/CT, specifically the lateral wall-to-cavity ratio, provide independent prognostic value in patients with wild-type transthyretin cardiac amyloidosis.
Hazard Ratio: 2.091 (95% CI 1.012–4.322)
p-value: p=0.046
PURPOSE: Tc-pyrophosphate (PYP) SPECT/CT help to predict the prognosis of ATTRwt-CM patients when compared with other clinical parameters. MATERIALS AND METHODS: Sixty-eight patients with biopsy-proven ATTRwt-CM who underwent PYP SPECT/CT were enrolled. Baseline clinical characteristics, echocardiographic parameters, and qualitative and/or quantitative indices of planar and SPECT/CT imaging in PYP scintigraphy for each patient were included. For quantitative analysis of SPECT/CT, the accumulation ratio of PYP in the septum, posterior, anterior, lateral, and apex walls to the cavity pool was calculated as the septal wall-to-cavity ratio (Se/C), lateral wall-to-cavity ratio (La/C), anterior wall-to-cavity ratio (An/C), inferior wall-to-cavity ratio (In/C), and apical wall-to-cavity ratio (Ap/C), respectively. Endpoints for prognostic accuracy evaluation were cardiac death or hospitalization due to heart failure. Event-free survival rate was evaluated through Cox proportional hazards regression analysis, providing estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and Kaplan-Meier curves. RESULTS: High-sensitivity cardiac troponin T (hs-cTnT), La/C, age, interventricular septal thickness in diastole, and E/e' ratio in the septal wall were significantly associated with event-free survival (P < 0.05). For a multivariable Cox proportional hazards analysis, hs-cTnT (HR 1.153; 95% CI 1.034-1.286; P < 0.01), La/C (HR 2.091; 95% CI 1.012-4.322; P = 0.046), and age (HR 1.116; 95% CI 1.007-1.238; P = 0.037) were significant independent prognostic factors. CONCLUSION: This study indicated that the quantitative indices of PYP SPECT/CT can help to predict the prognosis of ATTRwt-CM patients.
Ogasawara et al. (Sat,) conducted a cohort in Wild-type transthyretin cardiac amyloidosis (ATTRwt-CM) (n=68). Lateral wall-to-cavity ratio (La/C) on PYP SPECT/CT vs. Lower La/C was evaluated on Cardiac death or hospitalization due to heart failure (HR 2.091, 95% CI 1.012-4.322, p=0.046). In patients with wild-type transthyretin cardiac amyloidosis, a higher lateral wall-to-cavity ratio on PYP SPECT/CT was an independent predictor of cardiac death or heart failure hospitalization (HR 2.091).
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