Role of Cardiac Scintigraphy With ^99mTc-DPD in the Differentiation of Cardiac Amyloidosis Subtype

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• 作者：F. Javier De Haro-Del Moral^a ; ^{fjdeharo.hpth@salud.madrid.org} ; Alicia Sá ; nchez-Lajusticia^a ; Manuel Gó ; mez-Bueno^b ; Pablo Garcí ; a-Paví ; a^b ; Clara Salas-Antó ; n^c ; Javier Segovia-Cubero^b
• 关键词：CA ; cardiac amyloidosis ; CA-AL ; monoclonal immunoglobulin light chain cardiac amyloidosis ; CA-TTR ; transthyretin-related cardiac amyloidosis
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2012
• 出版时间：May, 2012
• 年：2012
• 卷：65
• 期：5
• 页码：440-446
• 全文大小：1255 K

文摘

Introduction and objectives

We investigated the diagnostic accuracy of technetium-99m-3,3-diphosphono-1,2 propanodicarboxylic acid (^99mTc-DPD) scintigraphy in differentiating between monoclonal immunoglobulin light chain and transthyretin-related cardiac amyloidosis.

Methods

Nineteen patients with documented cardiac amyloidosis were included: 8 with transthyretin-related amyloidosis (group A) and 11 with light chain amyloidosis (group B). All the patients underwent scintigraphy with ^99mTc-DPD and technetium-99m-methylene diphosphonate (^99mTc-MDP).

Results

On visual scoring, cardiac ^99mTc-DPD uptake could be characterized as moderate to severe (scores of 2-3), with ventricular or biventricular distribution, in all group A patients (transthyretin-related cardiac amyloidosis), and was absent or mild (scores of 0-1) and diffusely distributed in all group B patients (monoclonal immunoglobulin light chain cardiac amyloidosis). ^99mTc-DPD uptake was also absent (score of 0) among unaffected controls and in 2 unaffected relatives of patients with hereditary transthyretin-related amyloidosis who harbor a mutation in the transthyretin gene. With ^99mTc-MDP, all the patients had a myocardial uptake score of 0-1. In our series, selective myocardial uptake of ^99mTc-DPD provided 100 % accuracy (95 % CI, 97.37 % -100 % ) for the differentiation between transthyretin-related and light chain cardiac amyloidosis.

Conclusions

We conclude that ^99mTc-DPD scintigraphy is a useful test for the differential diagnosis of transthyretin versus light chain etiology in patients with cardiac amyloidosis.