Noninvasive Risk Stratification of Patients With Transthyretin Amyloidosis

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• 作者：Arnt V. Kristen ; MD^&lowast ; ; ^{Arnt.Kristen@med.uni-heidelberg.de" class="auth_mail} ; Katrin Scherer ; MS^&lowast ; ; Sebastian Buss ; MD^&lowast ; ; Fabian aus dem Siepen ; MS^&lowast ; ; Sabine Haufe ; MD^&dagger ; ; Ralf Bauer ; MD^&lowast ; ; Katrin Hinderhofer ; PhD^&Dagger ; ; Evangelos Giannitsis ; MD^&lowast ; ; Stefan Hardt ; MD^&lowast ; ; Uwe Haberkorn ; MD^&dagger ; ; Hugo A. Katus ; MD^&lowast ; ; Henning Steen ; MD^&lowast ;
• 关键词：cardiac magnetic resonance ; echocardiography ; skeletal scintigraphy ; survival ; transthyretin amyloidosis
• 刊名：JACC: Cardiovascular Imaging
• 出版年：May 2014
• 年：2014
• 卷：7
• 期：5
• 页码：502-510
• 全文大小：510 K

文摘

We sought to evaluate noninvasive parameters by electrocardiography, echocardiography, technetium-99m–3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD) scintigraphy, and cardiac magnetic resonance for the prediction of all-cause mortality in patients with cardiac transthyretin amyloidosis (ATTR).

absSec_2">Background

abspara0015">ATTR may present with highly variable symptoms, including polyneuropathy and cardiomyopathy, the latter being associated with a poor outcome. However, data on noninvasive risk stratification of ATTR are limited.

absSec_3">Methods

abspara0020">A total of 70 patients with ATTR were evaluated by echocardiography, cardiac biomarkers, and ^99mTc-DPD scintigraphy. Cardiac magnetic resonance was performed in 30 patients. Echocardiographic findings and plasma levels of biomarkers were correlated with results of quantitative analysis of scintigraphy using a region-of-interest technique (whole-body as well as heart tracer retention). Receiver-operating characteristic (ROC) analysis was performed to calculate a cutoff value of ^99mTc-DPD scintigraphy for heart retention for the diagnosis of cardiac amyloid involvement with the highest sensitivity and specificity. Univariate and multivariate analyses were performed in patients with cardiac involvement (n = 60) to determine noninvasive predictors of all-cause mortality.

absSec_4">Results

abspara0025">Scintigraphy findings correlated with morphological (interventricular septum thickness, left ventricular hypertrophy index) as well as functional (mitral annular systolic velocity, mitral/tricuspid annular plane systolic excursion) findings, cardiac biomarkers, renal function, and late gadolinium enhancement. The ROC-derived cutoff for the detection of cardiac amyloidosis by scintigraphic heart tracer retention was 4.8%. Univariate Cox regression revealed N-terminal pro–B-type natriuretic peptide, troponin T, mitral annular plane systolic excursion, and left ventricular hypertrophy index as predictors of all-cause mortality. However, on multivariate analysis, troponin T remained the only independent predictor of survival. The ROC-derived cutoff value of troponin T predicting all-cause mortality with the highest sensitivity (80.0%) and specificity (68.7%) was 0.0375 ng/l.

absSec_5">Conclusions

abspara0030">Quantitative analysis of tracer retention is capable of characterizing the severity of cardiac involvement in ATTR. By multivariate analysis, troponin T remained the only independent predictor of survival.