technetium-tc-99m-pyrophosphate and Cardiomyopathies

Topics: Amyloidosis; Cardiomyopathies; Disease Progression; Early Diagnosis; Echocardiography; Humans; Magnetic Resonance Imaging, Cine; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Diphosphonates; Humans; Prealbumin; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Cardiac amyloidosis, once considered untreatable, is now gaining well-deserved attention due to advances in imaging and the recent approval of targeted breakthrough therapies. In this paper, we discuss the role of radionuclide imaging in the evaluation and management of patients with the most common form of amyloidosis-cardiac transthyretin amyloidosis (ATTR). We provide a comprehensive summary of the literature interspersed with our institutional experience as appropriate, to deliver our perspective.

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Bone and Bones; Cardiomyopathies; Heart; Humans; Prealbumin; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The two most common types of cardiac amyloidosis are caused by fibril deposits of immunoglobulin light chains (AL) and transthyretin (TTR), each with distinct prognosis and clinical management. Cardiac amyloidosis is under-recognized among heart failure patients with preserved ejection fraction (HFpEF). Bone-seeking tracers like. The clinical scope of cardiac amyloidosis among HFpEF patients and current literature supporting the use of bone-seeking tracers for TTR cardiac amyloidosis are presented. The differences of imaging techniques for cardiac amyloid and bone disease evaluation, bone tracer pharmacodynamics, and imaging interpretation criteria for cardiac amyloidosis diagnosis are discussed. Finally, a diagnostic algorithm to use bone scintigraphy in cardiac amyloidosis diagnosis among HFpEF patients is proposed. Bone scintigraphy with

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Echocardiography; Heart; Heart Failure; Humans; Radionuclide Imaging; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate

Amyloidosis is a heterogeneous group of diseases characterized by localized or systemic deposition of insoluble extracellular fibrillary proteins in organs and tissues. Several types of amyloid can infiltrate the heart resulting in a restrictive cardiomyopathy, heart failure, and atrial and ventricular arrhythmias. Scintigraphy is a noninvasive method that may facilitate early diagnosis, distinguish various forms of cardiac amyloid, and may be useful in following disease burden. The amyloid-specific tracers presented in this article have been used with planar imaging and/or single-photon emission computed tomography. To date, there are no approved cardiac amyloid tracers although investigational tracers are currently under examination. This article serves to review the current nuclear imaging modalities available in the detection of cardiac amyloid.

Topics: 3-Iodobenzylguanidine; Amyloidosis; Cardiomyopathies; Diphosphonates; Disease Progression; Heart Diseases; Humans; Iodine Radioisotopes; Organotechnetium Compounds; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

We report the fourth case of transthyretin amyloidosis (ATTR) Ser23Asn in a 41-year-old Ecuadorian male. He has a pedigree that spans seven generations and involves 24 family members who suffered early cardiac death. Salient presenting symptoms were fatigue, shortness of breath, and peripheral neuropathy. The diagnosis of cardiac amyloid was confirmed by immunohistochemical staining of an endomyocardial biopsy, genotyping and by technetium pyrophosphate ((99m)Tc-PYP) scintigraphy, which remains to be established as a reliable tool to visualize myocardial amyloid involvement in patients with the Ser23Asn transthyretin (TTR) variant. The patient underwent successful combined heart and liver transplant. We add to the current ATTR literature that in patients with the rare Ser23Asn mutation, peripheral nerve in addition to cardiac involvement can occur and (99m)Tc-PYP scintigraphy can be used as an imaging modality to visualize myocardial amyloid.

Topics: Adult; Amyloid Neuropathies, Familial; Cardiomyopathies; Heart; Heart Transplantation; Humans; Liver Transplantation; Male; Mutation, Missense; Myocardium; Pedigree; Prealbumin; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Topics: Age Factors; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Angina Pectoris; Angina, Unstable; Animals; Breast Neoplasms; Cardiomyopathies; Coronary Disease; Diagnosis, Differential; Diphosphates; Dogs; Electric Countershock; Humans; Myocardial Infarction; Radionuclide Imaging; Rats; Rib Fractures; Technetium; Technetium Tc 99m Pyrophosphate

We compared Takotsubo cardiomyopathy (transient left ventricular apical ballooning) with acute myocardial infarction (AMI) using two-dimensional echocardiography, 99mTc-tetrofosmin, 99mTc-PYP, 123I-BMIPP and 123I-MIBG myocardial SPECT.. We examined 7 patients with Takotsubo cardiomyopathy and 7 with AMI at the time of emergency admission (acute phase), and 2-14 days (subacute phase), one month (chronic phase), and 3 months (chronic II phase) after the attack. The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored according to five grades from normal (0) to severely abnormal (4).. Coronary angiography showed the absence of stenotic regions in patients with Takotsubo cardiomyopathy, and severely stenotic and/or occlusive lesions in patients with AMI. The total ST segment elevation on electrocardiograms (mm) was 7.8 +/- 3.7 in those with Takotsubo cardiomyopathy, and 7.3 +/- 3.9 in patients with AMI. Abnormal wall motion scores on echocardiograms were 14.2 +/- 4.6, 4.7 +/- 4.0, 1.7 +/- 2.0 and 0.5 +/- 0.4 during the acute, subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 14.0 +/- 4.3, 11.4 +/- 3.9, 8.8 +/- 3.6 and 5.2 +/- 4.8 in those with AMI. Abnormal myocardial perfusion scores on 99mTc-tetrofosmin images were 11.8 +/- 3.5, 3.2 +/- 3.0, 0.5 +/- 1.2 and 0.2 +/- 0.4 during the acute, subacute, chronic and chronic II phases, in patients with Takotsubo cardiomyopathy, and 16.2 +/- 4.3, 13.9 +/- 4.6, 7.9 +/- 4.6 and 5.0 +/- 4.5, respectively, in those with AMI. Abnormal myocardial fatty acid scores on 123I-BMIPP images were 12.6 +/- 3.7, 6.8 +/- 3.2 and 0.4 +/- 0.6 during the subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 16.5 +/- 5.1, 14.7 +/- 4.8 and 7.5 +/- 4.5 in those with AMI. Abnormal myocardial sympathetic nerve function scores on 123I-MIBG images were 14.8 +/- 4.0, 8.8 +/- 4.0 and 0.4 +/- 0.6 during the subacute, chronic, chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 18.6 +/- 6.5, 16.8 +/- 6.8 and 12.9 +/- 5.2 in those with AMI. Myocardial 99mTc-PYP uptake was abnormal not only in patients with AMI but also in those with Takotsubo cardiomyopathy during the acute phase.. Takotsubo cardiomyopathy might represent a stunned myocardium caused by a disturbance of the coronary microcirculation.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Cardiomyopathies; Diagnosis, Differential; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Syndrome; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

Pyrophosphate (PYP) imaging has a high diagnostic accuracy for transthyretin cardiac amyloidosis (ATTR-CA). Indeterminate findings are often reported due to persistent blood pool activity, presumed to be from low cardiac output. We evaluated the relationship between blood pool activity on PYP imaging and echocardiographic indices of cardiac function.. Clinical and imaging data of 189 patients referred for PYP scintigraphy were evaluated. All patients underwent planar imaging and SPECT (diagnostic standard). Among those with a negative PYP SPECT, persistent left ventricular blood pool activity on planar images was inferred by a visual score ≥2 or a heart-to-contralateral (HCL) ratio ≥ 1.5. Absence of blood pool activity was inferred when both visual score was < 2 and HCL was < 1.5. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), stroke volume index (SVi), and left atrial pressure (LAP) were calculated from standard transthoracic echocardiograms.. ATTR-CA was present in 43 (23%) patients. Among those with a negative PYP SPECT, 11 patients had significant blood pool activity. Patients with ATTR-CA had a lower LVEF, SVi, and GLS, with a higher LAP, compared to those without ATTR-CA. Among those without ATTR-CA, there were no significant differences in these parameters.. Approximately 8% of patients with a negative PYP SPECT have significant blood pool activity. Measures of cardiac function are not different among those with and without blood pool activity. PYP SPECT should be routinely performed in all patients to avoid false image interpretation.

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Echocardiography; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

Transthyretin amyloidosis (ATTR) proteins can infiltrate skeletal muscle and infrequently cause a myopathy.. Radioisotope uptake in the deltoid muscles of patients with ATTR was compared to uptake in control subjects without amyloidosis in a retrospective study.. Tracer uptake was significantly higher over the deltoids and heart but not the CC, in patients with ATTR than in control subjects. MC values were 120.1 ± 43.7 (mean ± SD) in ATTR patients and 78.9 ± 20.4 in control subjects over the heart (p = 0.005), 73.3± 21.0 and 63.5 ± 14.4 over CC (p = 0.09), and 37.0 ± 11.7 and 26.0 ± 7.1 averaged over both deltoid muscles (p = 0.014).

Topics: Amyloid Neuropathies, Familial; Biomarkers; Cardiomyopathies; Diphosphates; Humans; Muscle, Skeletal; Prealbumin; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Data were reviewed for 318 patients with suspected ATTR who underwent PYP SPECT/CT. Myocardial-to-blood pool count (MBP) ratios were computed and repeated independently > 1 month later. A physician independently scored LV myocardial-to-rib uptake on SPECT/CT as: 0 (negative), 1 < rib (equivocal), 2 = rib (positive) or 3 > rib (positive), and the image quality as: 1 (poor), 2 (adequate), and 3 (good). SPECT-only MBP ratios and visual scores were assessed separately for a subgroup of the first sequential 191 patients.. 25% of patients had positive myocardial uptake (myocardial-to-rib uptake score of ≥ 2). SPECT/CT MBP ratios were reproducible (1.35 ± .68 vs 1.33 ± .74, p = .09) and corresponded with visual scores ≥ 2 (ROC AUC = 99 ± 1%) more accurately than SPECT-only MBPs (93 ± 3%, p = .02). SPECT/CT image quality was better than that of SPECT-only (2.7 ± .5 vs 2.1 ± .5, p < .0001) with fewer equivocal results (2.6% vs 22.5%, p < .0001).. SPECT/CT produces MBP ratios that are reproducible and accurately identify a positive scan, with better image quality and fewer equivocal cases than SPECT-only.

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Humans; Reproducibility of Results; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to examine the diagnostic value of planar. PYP images of 109 consecutive patients with suspected ATTR-CA were retrospectively reviewed. The myocardial PYP uptake was visually graded on a scale of 0 to 3 and quantified with the heart-to-contralateral (H/CL) ratio in accordance with the current expert consensus recommendations. The diagnostic value of planar images for identifying positive PYP SPECT was assessed by a receiver-operating characteristic curve analysis with the area under the curve (AUC). The uptake ratios of the ascending and descending aorta, left atrium, and trapezius muscle divided by the liver uptake were measured on SPECT images and compared to the renal function.. A total of 41 patients (38%) had myocardial PYP uptake on SPECT images. In comparison with the visual scores on 1-h anterior planar images, those on 3-h anterior planar images had lower sensitivity (80.5% vs. 97.6%) and higher specificity (86.8% vs. 55.9%) for identifying positive PYP SPECT. The ROC analysis showed that the combination of visual scores on both 1-h and 3-h anterior planar images had significantly higher AUC values in comparison with 1-h anterior planar images alone (0.90 [95% CI 0.83-0.94] vs. 0.83 [95% CI 0.75-0.88]; P < 0.001), which was comparable to the AUC values on 3-h anterior planar images alone (0.88 [95% CI 0.80-0.92]; P = 0.071). In comparison with visual scores on 1-h or 3-h anterior planar images alone, the combination of visual scores and H/CL ratio did not significantly improve the diagnostic value for identifying positive PYP SPECT (P = 0.73 and P = 0.50, respectively). The uptake ratios of ascending aorta/liver, descending aorta/liver, left atrium/liver, and trapezius muscle/liver were not significantly associated with the serum creatinine level or estimated glomerular filtration rate (P > 0.05 for all).. In the assessment of ATTR-CA using PYP imaging, visual scores on 3-h anterior planar images for identifying positive PYP SPECT had lower sensitivity and higher specificity in comparison with those on 1-h anterior planar images. The diagnostic value of the visual scores on 1-h and 3-h anterior planar images was not improved by adding the H/CL ratio. Blood pool activity of PYP was not significantly associated with renal dysfunction.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Kidney Diseases; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

99mTc-pyrophosphate (99mTc-PYP) uptake in the skeletal muscles is minimal in patients with transthyretin cardiac amyloidosis (ATTR-CA) when assessed qualitatively and quantitatively. We previously demonstrated moderate- to high-grade 99mTc-PYP uptake in the subcutaneous abdominal fat of some patients with ATTR-CA and showed that this abnormal finding could reflect the regional amyloid burden of this tissue. We aimed to investigate the frequency of 99mTc-PYP uptake in skeletal trunk muscles of patients with ATTR-CA.. Chest- and abdomen-centered 99mTc-PYP scintigraphy images were obtained 2 hours after IV injections of the tracer (20 mCi) in 36 patients with ATTR-CA. The frequency of 99mTc-PYP uptake in the following 11 skeletal trunk muscles was investigated: pectoralis major, deltoid, subscapularis, infraspinatus, trapezius, latissimus dorsi, erector spinae, psoas major, abdominal oblique, rectus abdominis, and the gluteus muscles.. Ten of the 11 muscles were involved in patients with the highest number of 99mTc-PYP uptake in the skeletal trunk muscles examined, whereas no muscle was involved in a patient with the least uptake. The muscle with the highest rate of 99mTc-PYP uptake, observed in 34 of 36 patients (94.4%), was the abdominal oblique. No tracer uptake was observed in the psoas major. The frequency of radiotracer uptake in the remaining examined muscles was between those of abdominal oblique and psoas major muscles.. Radiotracer uptake was often detectable in some skeletal trunk muscles of ATTR-CA, although the muscles of patients examined and the skeletal trunk muscles of 1 patient showed heterogeneity in the uptake of 99mTc-PYP.

Topics: Amyloidosis; Cardiomyopathies; Humans; Muscle, Skeletal; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Transthyretin (ATTR) amyloidosis is a debilitating systemic disease often associated with symptomatic cardiac involvement. Diagnosis has dramatically changed with the advent of Technetium-99 m pyrophosphate (Tc-PYP) single-photon emission computed tomography (SPECT). With the ability to diagnose ATTR amyloidosis noninvasively and offer newer therapies, it is increasingly important to identify which patients should be referred for this testing. Relative apical sparing of longitudinal strain on echocardiogram can be potentially used to screen such patients. We sought to describe electrocardiogram (ECG) and echocardiogram (TTE) findings, including relative apical sparing of longitudinal strain, in ATTR amyloidosis patients diagnosed non-invasively with

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Cardiomyopathies; Diphosphates; Heart; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The optimal heart-to-contralateral chest (H/CL) ratio threshold for non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) using Tc. Using myocardial PYP retention by SPECT as the reference standard, we evaluated the diagnostic performance of different semi-quantitative and quantitative (H/CL chest ratio) planar parameters obtained from 3-hour PYP imaging in a prospectively recruited cohort of minority older adults with heart failure and increased LV wall thickness.. Of 229 patients, 14 were found to have ATTR-CA (6.1%). No PYP uptake (grade 0) was observed in 77% of scans, all grade 3 scans were ATTR-CA, and only 4 of 11 (36%) grade 2 scans were ATTR-CA. An H/CL threshold of ≥ 1.4 maximized specificity (99%) and positive predictive value (93%) but resulted in decreased sensitivity (93%), compared to the ≥ 1.3 threshold which had 100% sensitivity.. Among patients with a low pretest likelihood of ATTR-CA, planar interpretation, while useful to exclude disease, must be interpreted with caution. H/CL ratio threshold of ≥ 1.3 resulted in clinically important misclassifications. These data suggest that quantitative planar imaging thresholds may not be appropriate to apply in low pretest likelihood populations being evaluated for ATTR-CA.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

Tafamidis has been used for treatment of transthyretin cardiac amyloidosis (ATTR-CA). However, Tc-99 m pyrophosphate (PYP) cardiac scan for follow-up after tafamidis therapy has not been reported.. From May 2017 to March 2022, five patients with or without tafamidis therapy had received two Tc-99 m PYP cardiac scans. Tc-99 m PYP cardiac scan was performed with planar image and single photon emission computed tomography/computed tomography (SPECT/CT) 3 h after administration of Tc-99 m PYP. Perugini grading system was applied to determine positive or negative result of the scan. Heart to contralateral lung (H/CL) ratio as well as the difference of H/CL ratio between first and second Tc-99 m PYP cardiac scans (ΔH/CL ratio) was calculated.. In the five patients participated in this study, three received tafamidis therapy and H/CL ratio was significantly decreased (p = 0.02) after tafamidis therapy. Besides, the ΔH/CL ratio was larger in patients with tafamidis therapy than that in those without tafamidis therapy, albeit not reaching statistical significance (p = 0.2).. A decrease in H/CL ratio was found after tafamidis therapy in patients with ATTR-CA, albeit the magnitude of changes in the H/CL ratio (ΔH/CL ratio) was not significantly different from that of patients without tafamidis therapy. Future study with larger population might be required to further clarify the effect of tafamidis therapy on myocardial uptake of Tc-99 m PYP.. No clinical trial was conducted in our retrospective study.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Follow-Up Studies; Humans; Prealbumin; Retrospective Studies; Technetium Tc 99m Pyrophosphate

SPECT improves diagnostic specificity of Technetium-99m pyrophosphate (PYP) scintigraphy. Diagnostic performance of PYP data, reconstructed as either chest or cardio-focal SPECT is not known.. In this quality assurance study, blinded evaluation of PYP SPECT/CT data from 102 Caucasian patients (mean age 76 ± 11 years, 67% men) was performed by two readers. Reader 1 reviewed planar and PYP chest SPECT, while reader 2 reviewed planar and cardio-focal PYP SPECT. Demographic, clinical, and other testing data were obtained from the electronic medical records.. A total of 41 patients (40%) were considered positive based on myocardial uptake on chest PYP SPECT. Of these, 98% of the patients had a Perugini score ≥ 2 on planar imaging. There was good agreement between the two readers for visual score ≥ 2 (k = .88, P < .001) and excellent agreement for myocardial uptake on tomographic imaging (98%, P < .001). Only one study was categorized as false negative by cardio-focal SPECT reconstruction. Non-diffuse myocardial uptake was identified in 22% of those with a positive PYP SPECT.. When read by experienced readers, chest and cardio-focal reconstruction of PYP SPECT have comparable diagnostic performance. A substantial proportion of patients with a positive PYP SPECT have a non-diffuse distribution of PYP. Given the possibility of misclassification of non-diffuse myocardial uptake on cardio-focal reconstruction alone, chest reconstruction of PYP scintigraphy should be strongly considered.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Prealbumin; Quality Assurance, Health Care; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Gastrointestinal Tract; Humans; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Myocardial imaging with bone agents such as Tc-99 m PYP and HMDP has assumed a central role in the evaluation of patients with suspected transthyretin (TTR) amyloidosis. Visual scoring (VS) (0-3 +) and the heart to contralateral lung ratio (HCL) classify many patients as equivocal when mediastinal uptake is apparent but cannot be further differentiated into myocardial uptake versus blood pool. SPECT imaging has been recommended but current reconstruction protocols frequently produce amorphous mediastinal activity that also fails to discriminate between myocardial activity and blood pool. We hypothesized that interactive filtering interactively using a deconvolving filter would improve this.. We identified 176 sequential patients referred for TTR amyloid imaging. All patients had planar imaging, 101 had planar imaging with a large field of view camera that allowed HCL measurements. SPECT imaging was performed on a 3-headed digital camera with lead fluorescence attenuation correction. One study was excluded for technical reasons. We created software to allow interactive filtering while reconstructing the images then overlay them on attenuation mu maps to assist localization of myocardial/mediastinal uptake. Conventional Butterworth and an interactive inverse Gaussian filters were employed to differentiate myocardial uptake from residual blood pool. We defined "clean blood pool" (CBP) as recognizable blood pool with no activity in the surrounding myocardium. A scan was determined diagnostic if it showed CBP, positive uptake or no identifiable mediastinal uptake.. 76/175 (43%) were equivocal (1 +) by visual uptake. Of these 22 (29%) were diagnostic by Butterworth but 71 (93%) were by inverse gaussian (p < .0001). 71/101 (70%) were equivocal by HCL (1-1.5). Of these, 25 (35%) were diagnostic by Butterworth but 68 (96%) were diagnostic by inverse gaussian (p < .0001). This was driven by a greater than threefold increase in the identification of CBP by inverse gaussian filtering.. CBP can be identified in the vast majority of patients with equivocal PYP scans using optimized reconstruction and can greatly reduce the number of equivocal scans.

Topics: Amyloidosis; Cardiomyopathies; Heart; Humans; Prealbumin; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Technetium-labeled bone-avid radiotracers can be used to diagnose transthyretin cardiac amyloidosis (ATTR-CA). Extracardiac uptake of technetium pyrophosphate (Tc-99m PYP) in this context has not been extensively explored and its significance is not well characterized. We assessed extracardiac Tc-99m PYP uptake in individuals undergoing nuclear scintigraphy and the extent of clinically actionable findings.. The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study utilizes Tc-99m PYP imaging to identify ATTR-CA in self-identified Black and Caribbean Hispanic participants ≥ 60 years old with heart failure. We characterized the distribution of extracardiac uptake, including stratification of findings by timing of scan (1 hour vs 3 hours after Tc-99m PYP administration) and noted any additional testing in these subjects.. Of 379 participants, 195 (51%) were male, 306 (81%) Black race, and 120 (32%) Hispanic ethnicity; mean age was 73 years. Extracardiac Tc-99m PYP uptake was found in 42 subjects (11.1%): 21 with renal uptake only, 14 with bone uptake only, 4 with both renal and bone uptake, 2 with breast uptake, and 1 with thyroid uptake. Extracardiac uptake was more common in subjects with Tc-99m PYP scans at 1 hour (23.8%) than at 3 hours (6.2%). Overall, four individuals (1.1%) had clinically actionable findings.. Extracardiac Tc-99m PYP uptake manifested in about 1 in 9 SCAN-MP subjects but was clinically actionable in only 1.1% of cases.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Middle Aged; Prealbumin; Prevalence; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed

Technetium-99mm pyrophosphate (Tc-PYP) scintigraphy is a highly accurate non-invasive method for the diagnosis of transthyretin (ATTR) cardiac amyloidosis. Prognosis for this disease is improved following treatment with the transthyretin (TTR) stabilizer tafamidis. Although tafamidis slows disease progression, its effects on myocardial amyloid and Tc-PYP uptake remain unclear. We present a patient with ATTR cardiac amyloidosis who had a strongly positive initial Tc-PYP scan, with a dramatic decrease in Tc-PYP uptake on repeat scan after 3 years of tafamidis treatment. However, myocardial biopsy showed persistent diffuse amyloid deposits. This case highlights the need for further studies regarding the utility of serial Tc-PYP scans in monitoring the progress of ATTR cardiomyopathy.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

Technetium-99 m 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) and technetium-99 m sodium pyrophosphate (PYP) are the two most commonly used radiotracers for cardiac amyloidosis (CA), but no studies have directly compared them. Therefore, in this study, we directly compared the diagnostic and clinical utility of DPD and PYP scintigraphy in patients with CA.. Ten patients with CA were enrolled. Eight clinical variables and 12 scintigraphic parameters were used. Clinical variables were age, sex, estimated glomerular filtration rate (eGFR), N-terminal pro brain natriuretic peptide (NT-proBNP), and the results of electromyography (EMG), a sensory test, electrocardiogram, and echocardiography (EchoCG). Four heart retention ratios (heart/whole-body profile, heart/pelvis, heart/skull, and heart/contralateral lung) were calculated from the DPD and PYP scans and two visual scoring systems (Perugini and Dorbala systems) were used. Comparative analyses were performed between radiotracers and between visual scoring systems using clinical variables and scintigraphic parameters.. Twenty DPD parameters and nine PYP parameters had significant associations with age, eGFR, NT-proBNP, EchoCG, and EMG. DPD parameters had more frequent significant associations with clinical variables than PYP parameters. Compared to visual scores in the DPD scan, the proportion of patients with higher visual scores in the PYP scan was relatively greater than those with lower visual scores, and there were more patients with a visual score of 2 or higher in PYP scans than DPD scans.. DPD scintigraphy may reflect the disease severity of CA better than PYP scintigraphy, whereas PYP scintigraphy may be a more sensitive imaging modality for identifying CA involvement.

Topics: Amyloidosis; Cardiomyopathies; Heart; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diphosphates; Heart; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

With documented high specificity, 99m Tc-pyrophosphate (PYP) scan enables the diagnosis of transthyretin cardiomyopathy to be made reliably without endomyocardial biopsy in patients who do not have monoclonal gammopathy. We report a case with extensive myocardial uptake of Perugini 3 score in the 3-hour 99m Tc-PYP myocardial SPECT that suggested transthyretin cardiac amyloidosis. However, a followed endomyocardial biopsy revealed no amyloid deposition. In this case, hyperphosphatemia was the most likely and presumptive cause of the false-positive 99m Tc-PYP scan. With this case, our experiences of the potential causes of false-positive results of 99m Tc-PYP are further expanded.

Topics: Biopsy; Cardiomyopathies; Diphosphates; Humans; Hyperphosphatemia; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diphosphates; Heart; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Quantitation of myocardial. Consecutive patients who underwent. Seventy patients were identified, mean age 70.4 ± 11.4 years, with ATTR-CM and AL-CM diagnosed in 22 (31%) and 11 (16%) patients, respectively. In patients with ATTR-CM, there were significant correlations between CPA (r. CPA and VOI were correlated with CMR measures of myocardial fibrosis in patients with ATTR-CM.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Magnetic Resonance Spectroscopy; Middle Aged; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Stroke Volume; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

Radionuclide imaging using bone-avid tracers plays a critical role in diagnosing transthyretin cardiac amyloidosis (ATTR-CA), but technetium-99m-pyrophosphate (PYP) rarely allows the detection of extracardiac amyloid infiltration. We retrospectively investigated the frequency of PYP uptake in the subcutaneous abdominal fat of patients with ATTR-CA and its relevance to the results of fine-needle aspiration biopsy (FNAB) of this tissue.. Chest-centered images of PYP scintigraphy were obtained 2 h after the intravenous injection of the tracer (20 mCi), and the frequency of PYP uptake in the subcutaneous abdominal fat was evaluated. Amyloid deposits of fat smears taken by subcutaneous abdominal fat FNAB were assessed by Congo red staining.. Twenty-four patients with ATTR-CA were included. Ten (41.7%) patients showed some PYP uptake in the subcutaneous abdominal fat (positive PYP group), and 14 patients did not (negative PYP group). Amyloid deposits were detected by subcutaneous abdominal fat FNAB in 7/10 patients (70.0%) of the positive PYP group versus 0/14 patients (0%) of the negative PYP group, and the difference was significant.. In patients with ATTR-CA, abnormal PYP uptake in the subcutaneous abdominal fat could reflect the regional amyloid deposition confirmed by FNAB of this tissue.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Plaque, Amyloid; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Transthyretin cardiac amyloidosis (ATTR and ATTRv) is an underrecognized cause of heart failure that results from myocardial deposition of misfolded protein (TTR or prealbumin). The diagnosis can be confirmed by uptake of 99m Tc-pyrophosphate ( 99m Tc-PYP) in the heart with serologic studies to rule out light chain disease. We present the case of a 70-year-old woman who underwent a 99m Tc-PYP scan. The patient had a large right-sided pleural effusion that lowered counts in the right chest on planar imaging, interfered with ratio-based grading of PYP uptake, and highlighted the importance of obtaining SPECT/CT for problem-solving in cases where uptake ratios may be spurious.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Pleural Effusion; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized disease, in which atrial fibrillation (AF) has been shown to be prevalent. Cardiac scintigraphy with technetium-99m-pyrophosphate (99mTc-PyP) labeled bone-seeking tracers is used to noninvasively make the diagnosis of ATTR-CA, based on ventricular myocardial uptake. Assessment of atrial wall uptake (AU) on 99mTc-PyP is currently not used in the clinical setting Methods: We analyzed a cohort of patients referred for 99mTc-PyP scan at a tertiary center to explore AU and associations between any and incident AF, ATTR-CA, and all-cause mortality.. Among 580 patients included, 296 patients (51%) had a diagnosis of AF; 164 patients (28%) had scans consistent with ATTR-CA while 117 patients (20%) had AU. Of 117 patients with AU, 107 (91%) had any AF. In contrast, of 463 patients without AU 191(41%) had any AF. Of those with AU, 59/117(50%) patients had a 99mTc-PyP diagnosis of ATTR-CA while 58/117(50%) patients did not have such a diagnosis (. In a consecutive cohort of patients undergoing 99mTc-PyP scans, 20% had AU, which was statistically associated with any AF, independently of ATTR-CA diagnosis and sex. AU was associated with significantly lower freedom from incident AF at 1-year. Overlooking AU on 99mTc-PyP scans could potentially miss an earlier disease manifestation, or an additional risk factor for any/incident AF.

Topics: Atrial Fibrillation; Cardiomyopathies; Diphosphates; Heart Atria; Humans; Prealbumin; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

Subcutaneous tissue and gastrointestinal tract biopsy sensitivity are inadequate, especially in patients with ATTRwt; however, the combination of these extracardiac biopsies contributes to increased sensitivity in patients with positive

Topics: Amyloid Neuropathies, Familial; Biopsy; Cardiomyopathies; Diphosphates; Humans; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed

Topics: Amyloidosis; Cardiomyopathies; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

We included 318 patients in the analysis (n = 86 patients +ATTR-CM; n = 232 patients -ATTR-CM). The median follow-up time was 20.1 months. During the study period, 67% of +ATTR-CM patients received tafamidis (median treatment duration, 17 months). The median H/CL ratio was 1.58 (interquartile range, 1.40-1.75). An H/CL ratio of more than 1.6 or less than 1.6 did not seem to have an impact on survival probability in +ATTR-CM patients (P = .30; hazard ratio, 0.65; 95% confidence interval, 0.31-1.41). Cardiac biomarkers were poorly correlated with H/CL (troponin T, R

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Natriuretic Peptide, Brain; Prealbumin; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Troponin T

Clinical algorithms stipulate that transthyretin amyloid cardiomyopathy (ATTR-CM) can be diagnosed noninvasively by technetium-99m pyrophosphate (PYP) imaging when light chain (AL) amyloidosis has been excluded. We sought to define the distribution of light chain abnormalities and final diagnosis of ATTR-CM among patients referred for PYP imaging. We conducted a retrospective cohort study of 378 sequential patients with suspected ATTR-CM, referred for PYP imaging from October 2014 to January 2019. PYP scans were adjudicated as per guidelines. We found that 97 patients (26%) had abnormal plasma cell dyscrasia (PCD) markers, including serum free light chain (FLC) and/or urine/serum immunofixation electrophoresis (IFE). After exclusions for incomplete data or known AL amyloidosis, the final study population with abnormal PCD testing was n = 82. Final adjudication of amyloidosis was determined by multidisciplinary clinical assessment and/or tissue biopsy. The median age of cohort was 75 (68 to 81) years, 88% were men, and 33% were Black. Of the 82 patients, 62 had positive PYP scans (76%) and 20 had negative PYP scans (24%). A total of 64 patients had adjudicated ATTR-CM, confirmed by tissue biopsy in 41 (64%). Of those with confirmed ATTR-CM, 44 (69%) had abnormal FLC ratio between 1.65 and 3.1 and normal IFE. In conclusion, among patients referred for technetium-99m-PYP imaging for suspected ATTR-CM, 26% exhibited abnormalities of PCD markers. An FLC ratio 1.65 to 3.1, with normal IFE was noted in 69% of those with ATTR-CM, suggesting that ATTR-CM can be diagnosed noninvasively without cardiac biopsy in patients with positive PYP scan and similar plasma cell testing results.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Immunoglobulin Light-chain Amyloidosis; Male; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a form of heart failure (HF) with preserved ejection fraction (HFpEF). Technetium Tc 99m pyrophosphate scintigraphy (PYP) enables ATTR-CM diagnosis. It is unclear which patients with HFpEF have sufficient risk of ATTR-CM to warrant PYP.. To derive and validate a simple ATTR-CM score to predict increased risk of ATTR-CM in patients with HFpEF.. Retrospective cohort study of 666 patients with HF (ejection fraction ≥ 40%) and suspected ATTR-CM referred for PYP at Mayo Clinic, Rochester, Minnesota, from May 10, 2013, through August 31, 2020. These data were analyzed September 2020 through December 2020. A logistic regression model predictive of ATTR-CM was derived and converted to a point-based ATTR-CM risk score. The score was further validated in a community ATTR-CM epidemiology study of older patients with HFpEF with increased left ventricular wall thickness ([WT] ≥ 12 mm) and in an external (Northwestern University, Chicago, Illinois) HFpEF cohort referred for PYP. Race was self-reported by the participants. In all cohorts, both case patients and control patients were definitively ascertained by PYP scanning and specialist evaluation.. Performance of the derived ATTR-CM score in all cohorts (referral validation, community validation, and external validation) and prevalence of a high-risk ATTR-CM score in 4 multinational HFpEF clinical trials.. Participant cohorts included were referral derivation (n = 416; 13 participants [3%] were Black and 380 participants [94%] were White; ATTR-CM prevalence = 45%), referral validation (n = 250; 12 participants [5%]were Black and 228 participants [93%] were White; ATTR-CM prevalence = 48% ), community validation (n = 286; 5 participants [2%] were Black and 275 participants [96%] were White; ATTR-CM prevalence = 6% ), and external validation (n = 66; 23 participants [37%] were Black and 36 participants [58%] were White; ATTR-CM prevalence = 39%). Score variables included age, male sex, hypertension diagnosis, relative WT more than 0.57, posterior WT of 12 mm or more, and ejection fraction less than 60% (score range -1 to 10). Discrimination (area under the receiver operating characteristic curve [AUC] 0.89; 95% CI, 0.86-0.92; P < .001) and calibration (Hosmer-Lemeshow; χ2 = 4.6; P = .46) were strong. Discrimination (AUC ≥ 0.84; P < .001 for all) and calibration (Hosmer-Lemeshow χ2  = 2.8; P = .84; Hosmer-Lemeshow χ2  = 4.4; P = .35; Hosmer-Lemeshow χ2 = 2.5; P = .78 in referral, community, and external validation cohorts, respectively) were maintained in all validation cohorts. Precision-recall curves and predictive value vs prevalence plots indicated clinically useful classification performance for a score of 6 or more (positive predictive value ≥25%) in clinically relevant ATTR-CM prevalence (≥10% of patients with HFpEF) scenarios. In the HFpEF clinical trials, 11% to 35% of male and 0% to 6% of female patients had a high-risk (≥6) ATTR-CM score.. A simple 6 variable clinical score may be used to guide use of PYP and increase recognition of ATTR-CM among patients with HFpEF in the community. Further validation in larger and more diverse populations is needed.

Topics: Amyloidosis; Cardiomyopathies; Female; Heart Failure; Humans; Male; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Stroke Volume; Technetium Tc 99m Pyrophosphate

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.. В статье суммируется текущий опыт отдела радионуклидной диагностики и позитронно-эмиссионной томографии ФГБУ НМИЦ кардиологии им. акад. Е.И. Чазова в выполнении сцинтиграфии миокарда с 99mTc-пирофосфатом при дифференциальной диагностике типов амилоидоза сердца. Проанализированы возможные причины ложноположительных, сомнительных и недиагностических результатов исследования, предложены способы их устранения, в том числе путем модификации протоколов планарного и томографического исследований и оптимизации диагностического алгоритма амилоидоза сердца в целом.

Topics: Algorithms; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Myocardial Perfusion Imaging; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Echocardiographic deformation-based ratios and novel multi-parametric scores have been suggested to discriminate transthyretin cardiac amyloidosis (ATTR-CM) from other causes of increased left ventricular wall thickness among patients referred for ATTR-CM evaluation. Their relative predictive accuracy has not been well studied. We sought to (1) identify echocardiographic parameters predictive of ATTR-CM and (2) compare the diagnostic accuracy of these parameters in patients with suspected ATTR-CM referred for technetium-99m-pyrophosphate scintigraphy.. Echocardiograms from 598 patients referred to 3 major amyloidosis centers for technetium-99m-pyrophosphate to detect ATTR-CM were analyzed, including longitudinal strain (LS) analysis. Deformation ratios (septal apex to base ratio, relative apical sparing, ejection fraction to global LS), a multi-center European increased wall thickness score, and Mayo Clinic derived ATTR score (transthyretin cardiac amyloidosis score) were calculated. A logistic regression model was used to identify the parameters that best associated with a diagnosis of ATTR-CM. Comparison of the diagnostic capacity of the parameters was performed by receiver operating characteristic curves and the area under the curve (AUC).. Over half of the subjects (54.2%) were diagnosed with ATTR-CM (78% were men, median age of 76 years). Age, inferolateral wall thickness, and basal LS were the strongest predictors of ATTR-CM, AUC of 0.87 (95% CI: 0.83, 0.90), superior to the increased wall thickness score AUC of 0.78 (95% CI: 0.73, 0.83;. Inferolateral wall thickness and average basal LS performed as well as or better than more complex echo ratios and multiparametric scores to predict ATTR-CM.

Topics: Aged; Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Prealbumin; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloidosis; Atrial Fibrillation; Cardiomyopathies; Diphosphates; Heart; Humans; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Heart Failure; Humans; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloid Neuropathies, Familial; Cardiomyopathies; Humans; Male; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Cardiac scintigraphy has emerged as a key diagnostic test for transthyretin cardiac amyloidosis (ATTR-CA). However, there are potential limitations and pitfalls in the interpretation of cardiac scintigraphy for ATTR-CA that are worth noting. We present here a series of three cases which illustrate some of these important principles.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiac Imaging Techniques; Cardiomyopathies; Female; Humans; Male; Middle Aged; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Antirheumatic Agents; Cardiomyopathies; Cardiotoxicity; Female; Humans; Hydroxychloroquine; Lupus Erythematosus, Systemic; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Diagnostic Errors; Humans; Male; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Cardiomyopathies; Humans; Magnetic Resonance Imaging; Male; Myocardial Perfusion Imaging; Radiopharmaceuticals; Sarcoidosis; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Tc-99m pyrophosphate (PYP) SPECT is recommended for indeterminate findings on planar imaging. We aimed to compare the findings on planar PYP scintigraphy alone to that of routinely performed PYP SPECT.. PYP scintigraphy data of 133 patients (53% men; mean age 76 years) were evaluated. SPECT was routinely performed following 1-hour planar imaging, in all cases. Semiquantitative visual score and heart-to-contralateral (H/CL) ratio were determined in all patients as recommended.. PYP images from 35 patients (26%) were considered to be positive based on SPECT myocardial uptake. Among them, 20 (57%) had a H/CL ratio ≥1.5 and 34 had a visual score ≥ 2. SPECT identified myocardial uptake in one patient with a visual score < 2 and refuted the presence of myocardial uptake in two patients with a visual score ≥ 2. Visual score correlated well with SPECT (r = 0.94; P < .0001) and had an accuracy of 98% for tomographic myocardial uptake. Addition of H/CL ratio reduced the diagnostic performance of visual score.. Planar-derived visual score has an excellent accuracy for tomographic myocardial uptake, though it misclassifies a small proportion of patients. H/CL ratio decreases the diagnostic certainty of planar imaging. Tomographic imaging prevents misdiagnoses and should always be performed.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Humans; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloid Neuropathies, Familial; Cardiology; Cardiomyopathies; Humans; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloid Neuropathies, Familial; Biopsy; Black People; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Carrier Proteins; False Positive Reactions; Female; Genetic Testing; Humans; Magnetic Resonance Imaging; Middle Aged; Myocardium; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Quantitative assessment of myocardial radiotracer activity with CPA or VOI have high diagnostic accuracy for ATTR-CM. Both measures are potential non-invasive markers to follow progression of disease or response to therapy.. La evaluación cuantitativa de la actividad del radiotrazador en miocárdico con CPA o VOI tiene una alta certeza diagnóstica para ATTR-CM. Ambas medidas son potenciales marcadores no invasivos para seguir la progresión de la enfermedad o la respuesta a terapia.. 背景:. L’imagerie au 99mTc-pyrophosphate est devenue une méthode non invasive importante pour le diagnostic de l’amyloidose cardiaque à transthyrétine (ATTR-CM). La quantification de l’activité du 99mTc-pyrophosphate sur les images SPECT, pourrait être un marqueur de l’intensité de la maladie. Dans cette étude, nous avons évalué la précision diagnostique et la signification clinique de la quantification au 99mTc-pyrophosphate. MéTHODES ET RéSULTATS: Les patients ayant bénéficié d’une imagerie au 99mTc-pyrophosphate pour suspicion d’ATTR-CM ont été inclus. Nous avons calculé l’activité (CPA) et le volume (VOI) du 99mTc-pyrophosphate (CPA) au niveau du myocarde sur les images SPECT en rapport à l’activité sanguine au niveau de la cavité ventriculaire gauche. La précision du test a été évaluée en utilisant la surface (AUC) sous la courbe ROC. Au total, 124 patients ont été étudiés (âge moyen de 73,9 ± 11,4). Quarante trois de ces patients (34.7%) furent diagnostiqués positivement pour l’ ATTR-CM. La précision diagnostique de la CPA s’est révélée la plus élevée (AUC 0,996, IC à 95% 0,987 - 1,00), et s’est avérée significativement plus élevée que le score de Perugini (AUC 0,952, p = 0,016). Chez les patients avec ATTR-CM, la CPA est associée à une fraction d’éjection ventriculaire gauche réduite (odds ratio ajusté de 1,28, p = 0,035) et une augmentation d’ hospitalisation pour insuffisance cardiaque (hazard ratio ajusté de 1,29, p = 0,006).. L’évaluation quantitative de l’activité du 99mTc-pyrophosphate est d’une grande précision diagnostique pour l’ ATTR-CM. Les mesures CAP et VOI sont des marqueurs non invasifs potentiels pour le suivi de la progression de la maladie ou réponse au traitement.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Female; Humans; Male; Middle Aged; Observer Variation; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Retrospective Studies; ROC Curve; Stroke Volume; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

Patients with cardiac amyloidosis light chain (AL) present with negative Tc-99m pyrophosphate (PYP) scintigraphy (absent or mild heart uptake). On the contrary, patients with cardiac amyloidosis transthyretin (ATTR) present with positive Tc-99m PYP scanning (intensive heart uptake). We present a false positive Tc-99m PYP scintigraphy (grade 2, the heart-to-contralateral ratio is 1.65) in a patient with AL.. A 42-year-old Chinese man complained of effort intolerance, chest discomfort, and short of breath progressively over 1 year. New York Heart Association Class III. Physical examination showed legs swelling. Laboratory revealed elevated brain natriuretic peptide of 23,031 ng/mL (0-88) and Troponin-T of 273.4 ng/mL (0-14).. Cardiac amyloidosis light chain. Evidences: free light chains (FLCs): decreased serum free kappa/lambda ratio of 0.043 (0.31-1.56). Immunofixation electrophoresis: a positive lambda light chain monoclonal protein. Cardiac biopsy: HE: Ambiguity Congo red strain. Myocardial immunofluorescence: positive lambda light chain. Myocardial immunohistochemistry: positive lambda light chain, negative kappa light chain, and TTR.. Furosemide 40 mg qd, torasemide 20 mg qd, spirolactone 20 mg qd, potassium chloride 10 mL per 500 mL urine, atorvastatin calcium tablet 20 mg qd, aspirin enteric-coated tablets 100 mg qd during the 2-weeks in-hospital.. The patient died 2 months later after discharge.. False positive Tc-99m PYP scintigraphy may rarely presented in patients with cardiac amyloidosis light chain. So, the clonal plasma cell process based on the FLCs and immunofixation is a base to rule out AL cardiac amyloidosis when we interpret a positive Tc-99m PYP scintigraphy.

Topics: Adult; Cardiomyopathies; False Positive Reactions; Fatal Outcome; Humans; Immunoglobulin Light-chain Amyloidosis; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Biomarkers; Biopsy; Bone and Bones; Cardiomyopathies; Heart; Humans; Image Enhancement; Multimodal Imaging; Prealbumin; Radionuclide Imaging; Risk Assessment; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

A 61-year-old man was hospitalized for suspected cardiac amyloidosis. 99mTc-Pyrophosphate scintigraphy showed intense radiotracer uptake in the heart compared with the ribs, suggestive of transthyretin cardiac amyloidosis. Subsequent genetic test showed missense mutations in the transthyretin gene, which confirmed the diagnosis. Incidentally, a regional radiotracer uptake was seen in the bilateral lungs, respectively, corresponding to areas of atelectasis on the localizing CT of the SPECT/CT. Attention should be paid to radiotracer retention in lung atelectasis as it influences the H/CL (heart-to-contralateral lung) ratio calculation and may hinder the diagnosis of cardiac amyloidosis based on the quantitative H/CL ratio.

Topics: Amyloidosis; Cardiomyopathies; Humans; Lung; Male; Middle Aged; Prealbumin; Technetium Tc 99m Pyrophosphate

A 46-year-old man underwent Tc-pyrophosphate scan to evaluate possible infiltrative myocardiopathy revealed by echocardiography. The images did not show abnormal cardiac activity. However, diffuse abnormal activity in the liver and spleen was noted. Pathological examination from the specimen acquired from hepatic biopsy demonstrated amyloidosis, light chain type.

Topics: Amyloidosis; Cardiomyopathies; Humans; Liver; Male; Middle Aged; Radiopharmaceuticals; Spleen; Technetium Tc 99m Pyrophosphate

Technetium-99 m pyrophosphate protocols for transthyretin cardiac amyloidosis diagnosis have variably used 1- and 3-hour imaging time points. We investigated whether imaging at 1 hour with superior efficiency had comparable diagnostic accuracy as 3-hour imaging.. This is a registry analysis of patients with suspected transthyretin cardiac amyloidosis referred for technetium-99 m pyrophosphate at a single tertiary center from June 2015 through January 2019. Patients underwent planar and single-photon emission computed tomography (SPECT) imaging at 1 and 3 hours. A positive Tc-99m pyrophosphate study was defined by the presence of diffuse myocardial tracer uptake on SPECT. For planar imaging, visual semiquantitative (grades 0-3, ≥2 considered positive) and quantitative heart to contralateral ratios (≥1.5 considered positive) were used.. Two hundred thirty-three patients (69% men; median age, 77 [69-83] years) underwent the study protocol. There were 60 (25.8%) patients with diffuse myocardial uptake, 1 (0.4%) with regional uptake, and 172 (73.8%) with no myocardial uptake. Results of SPECT were identical at 1 and 3 hours. Planar imaging at 1 hour had 98% sensitivity and 96% specificity. Planar grade 0 uptake or heart to contralateral ratio ≤1.2 and planar grade 3 uptake or heart to contralateral ratio ≥2.0 were always associated with negative and positive SPECT, respectively. For planar grades 1 and 2 uptake and heart to contralateral ratio 1.3 to 1.9, SPECT was needed to make a diagnosis. No patient with light-chain cardiac amyloidosis had positive SPECT.. An efficient 1-hour technetium-99 m pyrophosphate protocol had comparable diagnostic performance to a 3-hour protocol.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Time Factors; Tomography, Emission-Computed, Single-Photon

Multi-societal consensus recommendations endorse both planar and single photon emission tomographic (SPECT) image acquisitions for the evaluation of cardiac amyloidosis. However, the correlation between planar and SPECT findings and the optimal timing of image acquisitions remain uncertain.. This is an analysis of 109 consecutive patients who underwent technetium pyrophosphate nuclear scintigraphy for the evaluation of cardiac amyloidosis. Patients were imaged at 1 and 3 hours after radiotracer injection using both planar and SPECT/CT, and the correlations between imaging protocols were compared.. In the overall cohort (median age 77 years, 75% male), 33 patients had radiotracer localized to the myocardium on SPECT/CT images. There was strong correlation between 1- and 3-hour planar heart-to-contralateral lung ratios (mean difference 0.07, r = 0.94). However, there was discordance between planar image interpretation (based upon semiquantitative score and H/CL ratio) and myocardial localization of radiotracer on SPECT/CT in 17 patients (16%). The pattern of SPECT/CT uptake was identical at 1 and 3 hours in all cases (32 diffuse, 1 focal).. These data support the recommendation that SPECT/CT should be obtained in addition to planar images when performing nuclear scintigraphy for the detection of cardiac amyloidosis. A 1-hour planar and SPECT/CT protocol appears optimal.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Cohort Studies; Female; Humans; Male; Radiopharmaceuticals; Reproducibility of Results; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Pyrophosphate; Time Factors

ATTR cardiac amyloidosis (CA) can be diagnosed with Tc-99m-PYP scintigraphy. There are two recommended interpretative approaches: the quantitative heart-to-contralateral lung ratio (H/CL) at 1 hour and the semi-quantitative visual system at 3 hours. This study's aim was to compare both approaches and to apply the semi-quantitative method at 1 hour.. Tc-99m-PYP scans of 122 consecutive subjects were reviewed using both approaches. On 1 hour planar images, regions of interest were drawn over the heart and contralateral chest to determine H/CL. Myocardial uptake was graded on 1 and 3 hour SPECT images according to the semi-quantitative method. Concordance was examined using kappa statistics.. 31, 10, and 81 studies were positive, negative, and equivocal, respectively, for ATTR-CA using the H/CL approach. Using the grading system, 35, 77, and 10 scans were positive, negative, and equivocal, respectively. The quantitative approach led to a significantly higher proportion of equivocal studies compared to the semi-quantitative approach (P < .0001). These approaches yielded discordant results in 2 subjects; biopsy results were concordant with SPECT grade. 1 and 3 hour SPECT grades provided concordant result in 99% of cases.. The H/CL approach resulted in a high proportion of equivocal studies. Using SPECT imaging, the semi-quantitative approach minimized this proportion and showed high concordance at 1 and 3 hours.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Time Factors; Tomography, Emission-Computed, Single-Photon

To investigate the utility of the combined use of. Whole-body. Cardiac amyloidosis was detectable by. All three major types of cardiac amyloidosis can be detected and differentiated non-invasively by combined use of the two amyloid imaging methods and

Topics: Adult; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Aniline Compounds; Cardiomyopathies; Female; Humans; Male; Middle Aged; Positron-Emission Tomography; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thiazoles; Young Adult

Increasing recognition that transthyretin cardiac amyloidosis (ATTR-CA) is much more common than previously appreciated and the emergence of novel disease-modifying therapeutic agents have led to a paradigm shift in which ATTR-CA screening is considered in high-risk populations, such as patients with heart failure with preserved ejection fraction (HFpEF) or aortic stenosis. Radiation risk from. Radiation doses to individual organs from. Very low cancer risks associated with

Topics: Adult; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Female; Humans; Male; Middle Aged; Neoplasms, Radiation-Induced; Radiation Exposure; Radiopharmaceuticals; Risk Assessment; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Neoplasms; Prealbumin; Technetium Tc 99m Pyrophosphate

Assessment of myocardial uptake of Tc-99m-pyrophosphate (Tc-99m PYP) is pivotal in distinguishing transthyretin-associated cardiac amyloidosis (ATTR) from light chain amyloid (AL). It is often difficult to differentiate myocardial uptake from blood pool radioactivity with planar imaging or SPECT. We studied whether simultaneous dual-isotope Tc-99m PYP/Tl-201 SPECT improves assessment of Tc-99m PYP uptake compared to single-isotope SPECT.. Simultaneous Tc-99m PYP/Tl-201 dual-isotope SPECT was acquired in 112 patients studied for possible cardiac amyloidosis. Visual interpretation was performed by two observers on single-isotope followed by dual-isotope SPECT. Heart-to-contralateral lung ratio (H/CL) of myocardial counts quantified by single-isotope and dual-isotope SPECT was compared between ATTR, AL, and no amyloidosis groups.. In 112 patients (39 ATTR and 26 AL patients, and 47 no amyloidosis), a lower proportion of no amyloidosis and AL patients were classified visually as equivocal with dual-isotope SPECT compared to single-isotope SPECT (2% vs 19%, P = 0.02 and 8% vs 35%, P = 0.04, respectively). H/CL measurements with single-isotope and dual-isotope were lower in AL and no amyloidosis patients vs ATTR patients (P < 0.05). Interobserver agreement of visual assessment was improved with dual-isotope SPECT (P = 0.03). AUCs for detection of ATTR by visual assessment and H/CL quantification were higher with dual-isotope (0.94 and 0.95, respectively) compared to single-isotope SPECT (0.84, P = 0.001 and 0.92, P = 0.02).. Tc-99m PYP/Tl-201 SPECT improves visual differentiation of ATTR and AL amyloidosis compared to single-isotope SPECT. Visual assessment and H/CL quantitation with dual-isotope SPECT provide similar discrimination between patients with ATTR and AL amyloidosis.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Transthyretin amyloid deposition is present in 17% of autopsies of patients with heart failure and a preserved ejection fraction (HFpEF). Technetium-pyrophosphate scintigraphy (Tc-PYP) is sensitive and specific to diagnose cardiac transthyretin amyloid deposition (ATTR). The prevalence of ATTR by Tc-PYP was evaluated along with echocardiographic parameters in patients with HFpEF. One-hundred consecutive patients with HFpEF, who had Tc-PYP, were retrospectively evaluated. Echocardiographic variables were analyzed to compare patients with positive versus negative ATTR infiltration. Myocardial ATTR was present in 19% of patients. Individuals with ATTR were older with a mean age of 82 ± 7 versus 75 ± 13 years (P = 0.03), had increased left ventricular hypertrophy with the interventricular septum measuring 1.6 (IQR, 1.4-2.0) versus 1.4 (IQR, 1.3-1.6) cm (P = 0.002), had a greater mean left ventricular mass index of 160 ± 50 g/m versus 131 ± 44 g/m (P = 0.01), and a reduced global longitudinal strain measuring -11% (IQR, -9 to -12) versus -12% (IQR, -10 to -16), P = 0.04. The prevalence of ATTR myocardial deposition demonstrated by Tc-PYP in patients with HFpEF is comparable to that of autopsy studies. It is more common in older patients, with increased left ventricular hypertrophy and reduced global longitudinal strain.

Topics: Acute Disease; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Three types of amyloid are responsible for cardiac amyloidosis. Differentiation of the subtype is critical for the disease progression and the therapeutic decision.. Myocardial scintigraphy using Tc-PYP is able to differentiate the cardiac amyloid subtype with high sensitivity and specificity. The myocardial uptake of PYP is higher in patients with TTR amyloidosis.. Non-invasive tests for the detection of cardiac amyloidosis, like myocardial scintigraphy with bone seeking tracers, can play a major role in the diagnosis progression and therapeutic management of patients with cardiac amyloidosis.

Topics: Aged; Amyloid; Amyloidosis; Bone and Bones; Cardiomyopathies; Disease Progression; Humans; Myocardium; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Female; Heart Ventricles; Humans; Technetium Tc 99m Pyrophosphate; Ultrasonography, Doppler

This study sought to investigate the regional uptake of technetium 99m-pyrophosphate (TcPYP) in transthyretin cardiac amyloidosis (ATTR) and its association with mortality.. TcPYP nuclear scintigraphy is a diagnostic and prognostic tool in ATTR. Echocardiography has identified a pattern of regional variation in longitudinal strain (LS) with a gradient of improved strain from base to apex in ATTR.. Consecutive patients with ATTR were evaluated who underwent TcPYP nuclear scintigraphy with planar and attenuation corrected single-photon emission computed tomography (SPECT). Heart-to-contralateral lung (H/CL) ratio was calculated on planar images, and left ventricular (LV) uptake was determined in each of the 17 segments using SPECT. A measure of apical-sparing of myocardial TcPYP uptake, termed the apical-sparing ratio (ASR), was calculated as basal + mid / apical counts.. Overall, 54 patients with ATTR (age 78 ± 9 years, 76% male, 31% hereditary ATTR) were analyzed. There was increased TcPYP uptake in basal and mid relative to apical LV segments, and an apical-sparing LS pattern on echocardiography. The right ventricle similarly showed greater uptake in basal segments. There were 26 deaths over 1.8 years median follow-up. The ASR of TcPYP uptake was associated with age-adjusted all-cause mortality (p = 0.013) with worse prognosis seen at levels <2.75. Global LS was also prognostic (p = 0.01), whereas H/CL ratio and total LV uptake indexed to blood pool were not (p = 0.772 and p = 0.850, respectively). The prognostic utility of the ASR persisted in multivariable modeling (p = 0.003), whereas global LS did not.. There is decreased TcPYP uptake in apical as compared to mid and basal segments in the LV, mimicking apical-sparing LS seen on echocardiography. Regional distribution of LV TcPYP uptake is associated with mortality, whereas overall amount of uptake as measured by H/CL ratio and indexed LV SPECT uptake is not.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Female; Heart Ventricles; Humans; Male; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left; Ventricular Function, Right

Technetium pyrophosphate (. An imaging protocol using 750 K counts, 10 mCi of

Topics: Aged; Amyloidosis; Biopsy; Cardiac Imaging Techniques; Cardiology; Cardiomyopathies; Diphosphonates; Female; Heart Failure; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Mutation; Myocardial Perfusion Imaging; Organotechnetium Compounds; Prealbumin; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Pyrophosphate

Quantitative uptake of Technetium 99 m-pyrophosphate (TcPYP) is sensitive and specific for diagnosing transthyretin cardiac amyloidosis (ATTR). We sought to examine the association between TcPYP uptake intensity and echocardiographic measures of disease severity and clinical outcomes.. A retrospective analysis was performed of 75 patients who underwent TcPYP scintigraphy. Planar images were evaluated semiquantitatively and using heart-to-contralateral lung (H/CL) ratio. The associations between H/CL ratio and echocardiographic parameters and outcomes were evaluated using linear regression and Cox models, respectively. There were 48 patients diagnosed with ATTR with mean H/CL ratio 1.58 ± 0.22 (vs 1.08 ± 0.09 if semiquantitative score = 0). The H/CL ratio was not associated with any measured echocardiographic parameter. Both semiquantitative uptake grade and H/CL ratio were associated with all-cause mortality (P = 0.009 and 0.007, respectively) and all-cause mortality or heart failure hospitalization (P = 0.001 and 0.020, respectively); however, neither were associated with outcomes when limited to patients with confirmed ATTR (P = 0.18 and 0.465, respectively).. In patients with suspected ATTR, quantitative and semiquantitative uptake intensity of TcPYP is associated with all-cause mortality as well as all-cause mortality or heart failure hospitalization. However, in those with confirmed ATTR, there is no association with echocardiographic disease severity or outcomes.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Echocardiography; Female; Heart; Humans; Lung; Male; Proportional Hazards Models; Retrospective Studies; Technetium Tc 99m Pyrophosphate

Transthyretin cardiac amyloidosis (ATTR-CA) has been reported in patients with aortic stenosis (AS) but its prevalence and phenotype are not known. We examine elderly patients with severe symptomatic AS undergoing transcatheter aortic valve replacement (TAVR) and determine the prevalence and phenotype of ATTR-CA non-invasively.. We performed technetium-99m pyrophosphate (99mTc-PYP) cardiac scintigraphy prospectively on patients who underwent TAVR, to screen for ATTR-CA. Transthoracic echocardiography and speckle-strain imaging were performed. We assessed the association of several parameters with ATTR-CA using multivariable logistic regression and constructed receiver operating curves to evaluate the best predictors of ATTR-CA. Among 151 patients (mean age 84 ± 6 years, 68% men), 16% (n = 24) screened positive for ATTR-CA with 99mTc-PYP scintigraphy. Compared with patients without ATTR-CA, ATTR-CA patients had a thicker interventricular septum (1.3 vs. 1.1 cm, P = 0.007), higher left ventricular (LV) mass index (130 vs. 98 g/m2, P = 0.002), and lower stroke volume index (30 vs. 36 mL/m2, P = 0.009). ATTR-CA patients had advanced diastolic dysfunction with higher E/A ratio (2.3 vs. 0.9, P = 0.001) and lower deceleration time (176 vs. 257 ms, P < 0.0001); impairment in systolic function with lower ejection fraction (48% vs. 56%, P = 0.011), myocardial contraction fraction (26 vs. 41, P < 0.0001), and average of lateral and septal mitral annular tissue Doppler S' (4.0 vs. 6.6 cm/s, P < 0.0001). While ATTR-CA patients had more impaired global longitudinal strain (-12 vs. -16%, P = 0.007), relative apical longitudinal strain was the same regardless of ATTR-CA diagnosis (0.98 vs. 0.98, P = 0.991). Average S' best predicted ATTR-CA in multivariable logistic regression (odds ratio 16.67 per 1 cm/s decrease with AUC 0.96, 95% confidence interval 0.90-0.99, P = 0.002) with a value ≤6 conferring 100% sensitivity for predicting a positive 99mTc-PYP amyloid scan.. Transthyretin cardiac amyloidosis is prevalent in 16% of patients with severe calcific AS undergoing TAVR and is associated with a severe AS phenotype of low-flow low-gradient with mildly reduced ejection fraction. Average tissue Doppler mitral annular S' of < 6 cm/s may be a sensitive measure that should prompt a confirmatory 99mTc-PYP scan and subsequent testing for ATTR-CA. Prospective assessment of outcomes after TAVR is needed in patients with and without ATTR-CA.

Topics: Aged, 80 and over; Amyloid Neuropathies, Familial; Aortic Valve Stenosis; Cardiomyopathies; Echocardiography; Female; Humans; Male; Phenotype; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate; Transcatheter Aortic Valve Replacement; Vascular Calcification; Ventricular Dysfunction, Left

Tc99m-pyrophosphate (Tc99m-PYP) scintigraphy has emerged as a diagnostic modality for transthyretin (TTR) cardiac amyloidosis (CA). We sought to examine the variability in test utilization across multiple centers in the US.. An electronic, web-based survey addressing specifics on Tc-99m PYP imaging was emailed to ASNC members, totaling 2785 recipients. Only one response per institution was allowed.. Responses were collected from 101 centers between July 2 and July 27, 2015. Among the respondents, 24% performed Tc-99m PYP specifically for CA diagnosis. The most commonly used dose was 20 mCi (37%) and most centers (35%) imaged 1 hour after injection. Scans were most often interpreted by cardiologists (60%). Quantification of uptake was performed in 57% of institutions with almost half (43%) utilizing the heart-to-contralateral lung (H/CL) ratio.. This national survey shows relatively low penetrance and high variability in Tc99m-PYP scintigraphy for CA diagnosis highlighting the need for standardization.

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Female; Humans; Male; Middle Aged; Practice Patterns, Physicians'; Prevalence; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; United States; Utilization Review

Topics: Adult; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Asymptomatic Diseases; Cardiomyopathies; Disease Progression; Early Diagnosis; Female; Genetic Predisposition to Disease; Heart Failure; Humans; Male; Middle Aged; Mutation; Phenotype; Prealbumin; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Development of noninvasive imaging modalities to quantify amyloid burden over time is an unmet clinical need. Technetium pyrophosphate (. Serial

Topics: Aged; Amyloidosis; Cardiomyopathies; Female; Humans; Image Enhancement; Longitudinal Studies; Male; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Single-Blind Method; Subtraction Technique; Technetium Tc 99m Pyrophosphate

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Female; Humans; Male; Prealbumin; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Differentiating immunoglobulin light-chain (AL) from transthyretin-related cardiac amyloidoses (ATTR) is imperative given implications for prognosis, therapy, and genetic counseling. We validated the discriminatory ability of (99m)Tc-pyrophosphate ((99m)Tc-PYP) scintigraphy in AL versus ATTR.. Forty-five subjects (12 AL, 16 ATTR wild type, and 17 ATTR mutants) underwent (99m)Tc-PYP planar and single-photon positive emission computed tomography cardiac imaging. Scans were performed by experienced nuclear cardiologists blinded to the subjects' cohort assignment. Cardiac retention was assessed with both a semiquantitative visual score (range, 0; no uptake to 3, diffuse uptake) and by quantitative analysis by drawing a region of interest over the heart corrected for contralateral counts and calculating a heart-to-contralateral ratio. Subjects with ATTR cardiac amyloid had a significantly higher semiquantitative cardiac visual score than the AL cohort (2.9±0.06 versus 0.8±0.27; P<0.0001) as well as a higher quantitative score (1.80±0.04 versus 1.21±0.04; P<0.0001). Using a heart-to-contralateral ratio >1.5 consistent with intensely diffuse myocardial tracer retention had a 97% sensitivity and 100% specificity with area under the curve 0.992, P<0.0001 for identifying ATTR cardiac amyloidosis.. (99m)Tc-PYP cardiac imaging distinguishes AL from ATTR cardiac amyloidosis and may be a simple, widely available method for identifying subjects with ATTR cardiac amyloidosis, which should be studied in a larger prospective manner.

Topics: Aged; Amyloid Neuropathies, Familial; Cardiomyopathies; Chi-Square Distribution; Diagnosis, Differential; Female; Genetic Predisposition to Disease; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Mutation; Phenotype; Prealbumin; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Amyloidosis; Cardiomyopathies; Humans; Male; Prognosis; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

We report a previously healthy 73 years old woman, who was hospitalised with increasing dyspnea and signs of congestive heart failure. Echocardiography showed a normal left ventricular cavity with increased echogenicity of its walls and severe pulmonary hypertension. A lung ventilation/perfusion scintigraphy concluded that there was a low probability for pulmonary embolism. Coronary angiography was normal. A restrictive cardiomyopathy due to amyloid deposits was suspected. Myocardial pyrophosphate scintigraphy showed intense pyrophosphate uptake in the left ventricle wall. An abdominal fat tissue biopsy was positive for amyloid deposits.

Topics: Aged; Amyloidosis; Cardiomyopathies; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

A 62-year-old woman with skin sarcoidosis was admitted to our hospital to ascertain whether she had cardiac involvement. Although she displayed no cardiac signs or symptoms, the electrocardiogram showed first-degree atrioventricular block, right bundle branch block with left anterior fascicular block, and giant negative T waves in the V3 lead. Echocardiography revealed marked hypertrophy localized in the basal portion of the interventricular septum (IVS) without systolic dysfunction, mimicking hypertrophic cardiomyopathy (HCM). Exercise thallium-201 myocardial imaging revealed redistribution in the anteroseptal region. Both gallium-67 (67Ga) and technetium-99m pyrophosphate (99mTc-PYP) scintigraphy revealed abnormal uptake in the myocardium. These findings disappeared after 2 months of steroid treatment. Reports of cardiac sarcoidosis mimicking HCM are rare. However, hypertrophy in the basal portion of the IVS is an important sign of early cardiac involvement in sarcoidosis. 67Ga and 99mTc-PYP scintigraphy were useful and necessary to differentiate this type of cardiac sarcoidosis from HCM.

Topics: Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diagnosis, Differential; Echocardiography; Electrocardiography; Female; Gallium Radioisotopes; Heart Block; Humans; Middle Aged; Radionuclide Imaging; Sarcoidosis; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

This study attempted to assess myocardial sympathetic innervation using iodine-123 (I-123) metaidobenzylguanidine (MIBG) imaging in patients with familial amyloid polyneuropathy.. Signs and symptoms of cardiac autonomic dysfunction are commonly seen in patients with cardiac amyloidosis. However, the incidence and magnitude of abnormalities in myocardial sympathetic nerve function by means of I-123 MIBG imaging and their relation to clinical findings, cardiac function and the results of thallium-201 (Tl-201) and technetium-99m pyrophosphate (Tc-99m PYP) myocardial scanning have not yet been clarified.. We performed M-mode, two-dimensional and Doppler echocardiography and I-123 MIBG, Tl-201 and Tc-99m PYP imaging of the heart in 12 patients with familial amyloid polyneuropathy and biopsy-proved cardiac amyloidosis.. Ten of 12 patients had no clinical evidence of overt heart disease, but left ventricular (LV) wall thickening was observed in 4 of these 10. Left ventricular percent fractional shortening and Doppler transmitral flow velocity patterns were found to be normal in all 12 patients. Eight of 12 patients showed no myocardial MIBG accumulation, with limited uptake in the remaining 4 demonstrated only in the LV anterior wall. Diffuse but mild myocardial uptake of Tc-99m PYP occurred in only 4 of 12 patients, and all 12 had normal results on Tl-201 myocardial scanning. Complete defects on myocardial MIBG scans were found in five of eight patients with negative findings on Tc-99m PYP myocardial scanning. The incidence and magnitude of myocardial uptake of MIBG were independent of clinical findings, extent of endomyocardial amyloid deposition, electrocardiographic QRS voltage and ventricular wall thickness.. Patients with familial amyloid polyneuropathy show a high incidence of myocardial adrenergic denervation with viable myocardium that can be identified very early in cardiac amyloidosis, before the development of clinically apparent heart disease, ventricular wall thickening, significant LV systolic and diastolic dysfunction and positive findings on Tc-99m PYP myocardial scanning.

Topics: 3-Iodobenzylguanidine; Adult; Amyloid Neuropathies; Autonomic Nervous System Diseases; Cardiomyopathies; Contrast Media; Echocardiography; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Myocardial scintigraphic studies, using 123I-metaiodobenzylguanidine (MIBG), 99mTc-pyrophosphate (PYP) and 201Tl were performed in 4 patients with cardiac amyloidosis. In MIBG myocardial images, 2 patients with familial amyloid polyneuropathy (FAP) showed complete or partial defect and the other 2 with primary amyloidosis had normal myocardial uptake of MIBG. In PYP myocardial images, diffuse myocardial uptake of PYP was mild in 2 patients with FAP and moderate in the other 2. 201Tl myocardial images revealed normal myocardial uptake of 201Tl in 2 patients with FAP and 1 with primary amyloidosis, and intense myocardial uptake in the other one with primary amyloidosis. These results suggest that myocardial scintigraphies with PYP and 201Tl may be useful for the detection of cardiac amyloidosis and estimation of its pathophysiology. And MIBG myocardial scintigraphy may provide useful information about sympathetic nerve abnormalities which vary with type of the fibril protein, clinical syndromes and disease process of cardiac amyloidosis.

Topics: 3-Iodobenzylguanidine; Adult; Amyloidosis; Cardiomyopathies; Female; Heart; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Antibodies, Monoclonal; Cardiomyopathies; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Contrast Media; Diagnosis, Differential; Heart Diseases; Heart Transplantation; Humans; Indium Radioisotopes; Myocardial Infarction; Myocarditis; Myosins; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes

Eighty-one consecutive patients, 32 males and 49 females, with biopsy-proven systemic sarcoidosis, none of whom had clinical evidence of heart disease, underwent M-mode and two-dimensional echocardiography, ECG and chest X-ray in order to investigate the frequency of sarcoid pericardial effusion. Mild or moderate size pericardial accumulations were found by echocardiography in 17 patients (21%), four males and 13 females (mean age 49.7 +/- 9.2 years). Pericardial effusion could not be correlated with clinical symptoms or physical signs, chest X-ray and ECG findings. All 17 patients with pericardial effusion were also studied by technetium-99m pyrophosphate radionuclide myocardial imaging, targeting to reveal the coincident presence of specific heart muscle disease or 'infiltrative cardiomyopathy'. The results showed abnormal scans in 13 of 14 patients with technically satisfactory scans, indicating the coincidence of sarcoid myocardial involvement in 92% of the patients with pericardial effusion, representing 16% of the total population studied. Thus, pericardial effusion in sarcoidosis should not be considered a rare condition, while concomitant presence of positive technetium-99m pyrophosphate radionuclide myocardial imaging could suggest that sarcoid pericardial effusion is often accompanied by specific heart muscle disease. This observation has not been well established previously in the literature.

Topics: Cardiomyopathies; Echocardiography; Female; Humans; Male; Middle Aged; Pericardial Effusion; Radionuclide Imaging; Sarcoidosis; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Echocardiography, Doppler; Female; Heart; Humans; Male; Middle Aged; Nervous System Diseases; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Two unusual examples of cardiac uptake in elderly patients who had received serial bone scans, one with a "waxing" and the other with a "waning" pattern of myocardial tracer uptake, are presented. An apparent temporal discordance between echocardiographic and scintigraphic findings is noted. Neither of the two patients had clinical, electrocardiographic, or other laboratory evidence of old or new myocardial infarction. Possible causes for the temporal changes are described. Presumptive diagnoses of senile cardiac amyloidosis were made based on clinical findings, noninvasive imaging, and comparison with a historic cohort at the Veterans Administration Medical Center in Houston.

Topics: Aged; Aged, 80 and over; Amyloidosis; Bone and Bones; Cardiomyopathies; Heart; Humans; Male; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Time Factors

Technetium 99m cardiac scintigraphy as practiced at present for diagnosing amyloisodid only provides a visual semi-quantitative assessment of uptake of the isotope. To improve the diagnostic accuracy of the method, the authors evaluated prospectively a personal technique of scintigraphy quantification based on early images obtained at the 20th minute in 15 patients with neuropathic amyloidosis. Doppler echocardiographic studies indicated that 9 patients had cardiac involvement whilst 6 were free of cardiac amyloidosis. The index of isotopic uptake (ratio of cardiac/abdominal uptake) was 0.44 to 1.58 in the first group and 0.09 to 0.31 in the second group. The correlation between the scintigraphic index and interventricular septal or posterior wall thickness measured by echocardiography was poor. These results obtained in 15 patients with neuropathic amyloidosis suggest that the scintigraphic index measured at the 20th minute is discriminatory and allows identification of those patients with cardiac involvement. On the other hand, the correlations with echocardiographic wall thickness are poor. Technetium 99m cardiac scintigraphy with this technique of quantification is a useful tool for diagnosing cardiac amyloidosis, especially when echocardiography is difficult to interpret.

Topics: Adult; Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Echocardiography, Doppler; Female; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Diagnosis, Differential; Echocardiography; Echocardiography, Doppler; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Echocardiography; Electrocardiography; Familial Mediterranean Fever; Female; Heart; Humans; Kidney Diseases; Kidney Failure, Chronic; Male; Nephrotic Syndrome; Proteinuria; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Tc-99m(V) DMSA scintigraphy was performed on two patients with primary cardiac amyloidosis. Scintigraphy performed (after radionuclide administration) showed accumulation in the myocardium.

Topics: Amyloidosis; Cardiomyopathies; Heart; Humans; Male; Middle Aged; Organotechnetium Compounds; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

A patient with polymyositis who had cardiac involvement underwent myocardial scan with technetium-99m-pyrophosphate. We used Activity Index for evaluating myocardial uptake of technetium-99m-pyrophosphate, which correlated with the degree of serum creatine phosphokinase elevation. Our findings indicate that these examinations may be helpful for identifying patients who have cardiac involvement and evaluating their response to the treatment with corticosteroids or immunosuppressants.

Topics: Cardiomyopathies; Humans; Male; Middle Aged; Myositis; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

To evaluate the usefulness of myocardial scintigraphy as a monitoring tool for chronic doxorubicin (DXR) cardiotoxicity, a rat model was used to investigate the relationship between the myocardial uptake of thallium 201 (Tl) or rechnetium 99m pyrophosphate (99mTc-PPi) and histological changes of the heart. Although there was no significant difference in myocardial Tl uptake between control and DXR-treated rats at an early phase after Tl injection, late-phase Tl uptake was significantly higher in the DXR-treated rats than in the control rats, indicating a slow wash-out of Tl from the myocardium. The wash-out rate calculated from scintigraphic examination of DXR-treated rats was significantly decreased with increasing degree of cardiomyopathy. Since the Tl wash-out rate was sharply decreased even in animals with minimal histological changes, it may be a possible monitoring tool for the early detection of chronic DXR cardiotoxicity. On the other hand, myocardial 99mTc-PPi images could be obtained only in rats with severe myocardial changes and hence would not useful for early detection.

Topics: Animals; Cardiomyopathies; Doxorubicin; Female; Monitoring, Physiologic; Myocardium; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

99mTc-pyrophosphate musculoskeletal imaging and 99mTc-red blood cell gated blood pool imaging were performed on 10 patients with documented polymyositis/dermatomyositis. Abnormal 99mTc-pyrophosphate uptake by peripheral muscles was found in 8 patients (6 mild, 2 marked). Cardiac uptake occurred in 5 patients and was 3+ in 2 with cardiovascular symptoms. These 2 patients also had abnormal EF on gated blood pool imaging. Patients without myocardial 99mTc-pyrophosphate uptake had normal EF. Patients with myocardial 99mTc-pyrophosphate uptake had abnormal wall motion, in proportion to the degree of uptake. Response to therapy and outcome were poorer in patients with marked scintigraphic changes. These findings suggest that the magnitude of 99mTc-pyrophosphate myocardial uptake may have prognostic implications in these patients.

Topics: Adolescent; Adult; Cardiomyopathies; Child; Dermatomyositis; Female; Heart; Humans; Male; Middle Aged; Musculoskeletal System; Myositis; Papillary Muscles; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

The possible myocardial injury induced by electrical cardioversion in the treatment of supraventricular arrhythmias was analyzed after 45 countershocks of 200 joules and after 6 of 600 joules (total accumulated energy). In all patients myocardial injury was evaluated by serial CK, CK-Mb, and myoglobin determinations and in 48 cases a cardiac gammagraphy with technetium pyrophosphate was also performed. Significant increases in total CK and myoglobin were observed in 2 (4%) patients treated with 200 joules and in 3 (50%) patients receiving 600 joules. CK-Mb was also increased in one patient receiving 200 joules (13.5 U/I) and in one patient treated with 600 joules (27.8 U/I). In all cases technetium gammagraphy was negative.

Topics: Adult; Arrhythmias, Cardiac; Cardiomyopathies; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Electric Countershock; Female; Heart; Humans; Isoenzymes; Male; Middle Aged; Myoglobin; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

A case report of patient with cardiac sarcoidosis is presented. Advanced atrioventricular (AV) block and abnormalities of radionuclide imaging were improved by steroid therapy. We stress the effectiveness of steroid therapy together with usefulness of radionuclide techniques.

Topics: Cardiomyopathies; Diphosphates; Female; Heart Block; Humans; Middle Aged; Pacemaker, Artificial; Prednisone; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

This study was aimed to determine whether nuclear methods were useful for examining cardiac pathology and for making a decision of corticosteroid therapy in patients with sarcoidosis. Thirty six patients were divided into two groups; GpA consisted of 19 patients with cardiac sarcoidosis and abnormal ECG findings, and GpB of 17 patients with sarcoidosis without ECG abnormalities. Cardiac uptake of 67Ga-citrate in 2 and 99mTc-PYP in one of GpA was observed and steroid therapy resulted in the disappearance of the uptake. 201Tl-CL cardiac tomograms disclosed perfusion defects in 10 of 14 patients (71%) in GpA, including defects with redistribution in 8 of the 10 pts, but only one case in GpB. Radionuclide ventriculography using 99mTc-RBC revealed abnormal response of left ventricular (LV) function to exercise and LV dysfunction in GpA. These data suggest that nuclear study is a useful tool for diagnosing cardiac sarcoidosis, evaluating therapeutic effectiveness and long-term follow-up in patients with sarcoidosis.

Topics: Adult; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Heart; Humans; Male; Middle Aged; Myocardium; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

This study describes the results of scintigraphy with 99mTc-labeled methylene-diphosphonate (99mTc-MDP) and pyrophosphate (99mTc-PYP) as a noninvasive test for the distribution of organ involvement in five different types of amyloidosis. Scintigraphy with 99mTc-labeled phosphates appeared to be a sensitive noninvasive screening test for the extent and the distribution of organ involvement in systemic AA and systemic AL amyloidosis as well as in local bronchial amyloid, local dermal amyloid, and familial amyloidotic polyneuropathy. Echocardiography, however, was more sensitive for demonstrating cardiac involvement in systemic amyloidosis than 99mTc-MDP or 99mTc-PYP scintigraphy. 99mTc-MDP images showed a better contrast than 99mTc-PYP images, although there was no difference in the extent or the intensity of soft-tissue uptake.

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Connective Tissue; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Amyloidosis is a systemic disease frequently involving the myocardium and leading to functional disturbances of the heart. Amyloidosis can mimic other cardiac diseases. A conclusive clinical diagnosis of cardiac involvement can only be made by a combination of different diagnostic methods. In 7 patients with myocardial amyloidosis we used a combined first-pass and static scintigraphy with technetium-99 m-pyrophosphate. There was only insignificant myocardial uptake of the tracer. The first-pass studies however revealed reduced systolic function in 4/7 patients and impaired diastolic function in 6/7 patients. Therefore, although cardiac amyloid could not be demonstrated in the static scintigraphy due to amyloid fibril amount and composition, myocardial functional abnormalities were seen in the first-pass study.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; Humans; Technetium; Technetium Tc 99m Pyrophosphate; Ventriculography, First-Pass

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Heart; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To validate the significance of technetium-99m-pyrophosphate (Tc-99m PYP) myocardial scintigraphy in diagnosing cardiac amyloidosis, 2 patients with familial amyloid polyneuropathy (FAP) and 1 patient with amyloidosis secondary to chronic rheumatic arthritis were studied. All three patients had echocardiographic abnormalities, which were increased wall thickness of the interventricular septum and the left ventricular posterior wall, and granular sparkling appearance in the septum. In 2 patients with FAP, abnormal myocardial uptake of Tc-99m PYP was diffusely detected in Tc-99m PYP SPECT. In the remaining 1 patient with secondary amyloidosis, however, Tc-99m PYP SPECT showed no abnormality, although we had confirmed the presence of myocardial amyloid deposits (type AA amyloid protein) with high amount in the histological examination. Thus, these results indicate that Tc-99m PYP scintigraphy may have a limitation in detecting cardiac involvement in secondary amyloidosis although it is useful in FAP.

Topics: Adult; Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Male; Middle Aged; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

The relationship between myocardial lactate metabolism and the energy dose of direct countershock was studied in 15 dogs anesthetized with halothane. Five dogs received two shocks of 5 joules delivered energy each, five animals received two shocks of 10 joules delivered energy each, and five dogs received two shocks of 20 joules delivered energy each. All animals had positive myocardial lactate extraction in the baseline state (5 joules, 38% +/- 23.7 (SD); 10 joules, 59.6% +/- 11.4; 20 joules, 38% +/- 11.1). Lactate extraction after countershock progressively decreased with increasing energy dose and then returned to baseline. The maximal reduction in percent lactate extraction increased with increasing energy dose (5 joules, 13.9% +/- 16.1; 10 joules, 33% +/- 37; 20 joules, 30.5% +/- 37.5) and seemed to reach a threshold below which no further decrease occurred. Myocardial damage, as measured by a damage index derived from myocardial uptake of technetium-99 pyrophosphate, increased steadily with increasing energy dose (2.0 +/- 2.5 with 5-joule shocks; 38 +/- 32 with 10 joules; and 99 +/- 70 with 20 joules). These results show a consistent reduction in aerobic metabolism immediately following electric countershock. Even at low-energy doses, myocardial lactate extraction showed a detectable decrease and at higher energies approached net lactate production. Reductions of global lactate extraction did not completely predict the amount of myocardial damage. Localized measures of anaerobic metabolism or mitochondrial function might provide a better correlation with localized damage.

Topics: Anesthetics, Inhalation; Animals; Cardiomyopathies; Differential Threshold; Disease Models, Animal; Dogs; Electric Countershock; Halothane; Lactic Acid; Myocardium; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Marked clinical or electrocardiographic changes, suggestive of heart disease, were only detected in 14 (7%) of 190 patients with sarcoidosis. Diffuse myocardial accumulation of 99mTc pyrophosphate (2+ or 3+) was seen in 12 (43%) of 28 patients with active sarcoidosis. Repeated scintigraphy showed normal values in 3 patients after a course of corticosteroid therapy. Echocardiographic signs of heart disease were found in 33 (37%) of 89 patients, including left-ventricular contractility disorders in 21, thinning (5) or thickening (7) of left-ventricular wall and ventricular septum, mitral prolapse in 3 and limited pericardial exudate in 5. Signs of pulmonary heart were detected in 17 patients. Clinical and electrocardiographic symptoms of cardiac sarcoidosis were significantly more frequent in patients with myocardial Tc-pyrophosphate accumulation and echocardiographic changes. It is suggested that myocardial Tc-pyrophosphate scintigraphy and echocardiography may be used for the diagnosis of cardiac sarcoidosis, including its latent forms.

Topics: Adult; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; False Negative Reactions; Heart; Humans; Middle Aged; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Male; Middle Aged; Peripheral Nervous System Diseases; Predictive Value of Tests; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

Topics: Adult; Cardiomyopathies; Climacteric; Diagnosis, Differential; Diphosphates; Electrocardiography; Female; Heart; Humans; Middle Aged; Neurocirculatory Asthenia; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Cardiomyopathies; Diphosphates; Electrocardiography; Female; Heart; Humans; Myositis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Experimental cardiomyopathy was provoked in 24 dogs with high intravenous doses of adrenaline and theophylline. These lesions were studied by means of the new agent 99mTc-AHDP and 99mTc-PYP in comparison. Cardiomyopathy could be imaged as early as 4 h after the onset of involvement but not later than 7 days. A maximum accumulation occurred in lesions 24 h old. 99mTc uptake in the myocardium was graded scintigraphically. 99mTc-AHDP was accumulated in the altered myocardium to a greater extent than 99mTc-PYP. Scintigraphic findings were in good agreement with plasma levels of creatine-kinase. A comparison with histology demonstrated that the maximum accumulation of radiopharmaceuticals occurred at the time when the development of myocardium involvement reached the stage of myocytolysis.

Topics: Animals; Cardiomyopathies; Diphosphates; Diphosphonates; Dogs; Epinephrine; Organometallic Compounds; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Theophylline

Topics: Adult; Cardiomyopathies; Diphosphates; Echocardiography; Humans; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate

To determine whether technetium-99m-pyrophosphate (Tc-99m-PYP) scanning or two-dimensional echocardiography can detect amyloid heart disease in an earlier stage of familial amyloid polyneuropathy, 15 patients were examined. Although 10 of the 15 patients had no clinical evidence of congestive heart failure, as well as normal ventricular wall thickness and normal values for left ventricular systolic function, five (50%) of them showed mild or moderate myocardial uptake. On the other hand, none had characteristic highly refractile myocardial echoes on the two-dimensional echocardiographic images (p less than 0.01), and values for diastolic function were reduced in four of the five and normal in the remaining one. In 85 control subjects, diffuse positive pyrophosphate scans of the heart were found in four (5%) of them (three with dilated cardiomyopathy and one with sarcoidosis), and highly refractile granular sparkling echoes were observed in nine (11%) (five with hypertrophic cardiomyopathy, three with aortic stenosis, and one with hypereosinophilic syndrome). We conclude that Tc-99m-PYP scanning is a more sensitive and specific method and may have the potential ability to detect amyloid heart disease in the earlier stage of familial amyloid polyneuropathy than two-dimensional echocardiography.

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Polyneuropathies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Thirteen patients with systemic lupus erythematosus, 8 patients with polymyositis, and 6 patients with spondylitis ankylopoetica (Bechterew's disease) underwent clinical cardiologic examination and scintigraphy of the myocardium (99mTc-pyrophosphate), ECG, echocardiography, polygraphy, and their blood pressure was taken. The aim of the study was to ascertain how such a combination of non-invasive examinations can help in recognizing a cardiac involvement. In systemic lupus erythematosus cases one or more positive findings were revealed in 9 patients (69%), in 4 patients all examinations were negative (31%). Four patients (50%) with polymyositis had positive findings. In patients with spondylitis ankylopoetica positive findings occurred in 2 cases (33%). The study has shown that a combination of non-invasive cardiologic methods increases the probability of detecting cardiac involvement in systemic connective tissue diseases.

Topics: Cardiomyopathies; Connective Tissue Diseases; Diphosphates; Electrocardiography; Humans; Lupus Erythematosus, Systemic; Myositis; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

Thirty-four patients with amyloidosis proved by biopsy specimen were studied using technetium Tc 99m pyrophosphate scintigraphy to assess its utility in the diagnosis of amyloid heart involvement. Of 14 patients studied retrospectively, only three had intense uptake judged to be diagnostic of cardiac amyloidosis. In a prospective analysis of 20 patients with amyloidosis, all of whom had evidence of cardiac involvement by two-dimensional echocardiography, 17 had abnormal scans. Fourteen of the 17 scans had only 1+ or 2+ uptake, a finding that also was present in 15 of the 20 control patients (without amyloid heart disease). Only three of the 20 patients with cardiac amyloidosis had intense uptake that was considered unequivocal and diagnostic of amyloidosis. Of the five patients with biopsy specimen proof of endomyocardial amyloidosis, only one had intense uptake and one had no uptake. When intense uptake of technetium Tc 99m pyrophosphate is found in the heart of a patient, amyloidosis is highly likely. The technique, however, is not sufficiently sensitive to warrant routine screening of patients with amyloidosis or cardiomyopathies. Cross-sectional echocardiography is superior to pyrophosphate scintigraphy for recognition of cardiac amyloidosis.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Polyneuropathies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

This report describes the unusual presentation of a patient with primary cardiac amyloidosis. Initial clinical symptoms and hemodynamic studies, including Technetium-99m-pyrophosphate scintigraphy, suggested hypertrophic obstructive cardiomyopathy, but endomyocardial biopsy revealed diffuse amyloid infiltration. Only two other cases of left ventricular outflow tract obstruction due to cardiac amyloidosis have been reported. The false-negative technetium-99m-pyrophosphate scintigram in this patient argues for the use of endomyocardial biopsy to aid in the diagnosis of left ventricular hypertrophy.

Topics: Amyloidosis; Biopsy; Cardiac Catheterization; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diagnosis, Differential; Diphosphates; Echocardiography; Endocardium; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Amyloidosis is an important entity in the differential diagnosis of cardiac failure of undetermined etiology. In this case report, the typical pattern of combined systolic and diastolic impairment in amyloid cardiomyopathy was demonstrated by analysis of the cardiac blood pool study. In addition, the patient described had mild uptake of Ga-67 citrate, as well as the characteristically intense myocardial uptake of Tc-99m pyrophosphate. Scintigraphic assessment may be particularly helpful when the diagnosis of amyloidosis is being considered in a patient with unexplained cardiac failure.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Heart Ventricles; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Methods for evaluating cardiac myocyte necrosis utilizing antibodies specific for the heavy or light chains of cardiac myosin are reviewed. Cell death, associated with sarcolemmal disruption, results in the leakage of myosin light chains from the cytoplasm as well as the accessibility of myosin heavy chains to exogenous specific antibodies. Measurement of plasma light chain concentration has been useful in the diagnosis of myocardial infarction, though more recently, patients with congestive cardiomyopathy associated with an inflammatory infiltrate have been identified by an elevated plasma light chain concentration. The binding of myosin heavy chains to necrotic myocytes has been useful in the study of mechanisms of ischemic cell death in cell culture, in the diagnosis and quantification of myocardial infarction, both experimentally and clinically, and more recently in the study of experimental myocarditis and cardiac transplantation. It is hoped that these methods may evolve as useful clinical tools in the identification of those cardiomyopathy patients whose course is characterized by rapid myocyte loss.

Topics: Animals; Antibodies; Biopsy; Cardiomyopathies; Cell Survival; Creatine Kinase; Diphosphates; Heart; Heart Failure; Heart Transplantation; Humans; Immunoglobulin Fab Fragments; Indium; Isoenzymes; Mice; Myocardial Infarction; Myocardium; Myosins; Necrosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

We describe herein the case of a 62-year-old man affected by congestive heart failure of obscure origin, in which the clinical history, the electrocardiographic and echocardiographic findings were compatible with the diagnosis of amyloid cardiomyopathy. Cardiac catheterization disclosed a restrictive physiology. Tc-99m-pyrophosphate myocardial scintiscan was negative despite the markedly increased left ventricular wall thickness on echocardiographic examination. A definite diagnosis was obtained by means of endomyocardial biopsy.

Topics: Amyloidosis; Biopsy; Cardiomyopathies; Diphosphates; Echocardiography; False Negative Reactions; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diagnosis, Differential; Echocardiography; Electrocardiography; Heart Aneurysm; Heart Diseases; Humans; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Thrombosis; Tin Polyphosphates

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To depict the three-dimensional distribution of 99mTc-pyrophosphate in the heart, emission computed tomography (ECT) was performed, following the conventional planar imaging, in 32 cases with suspected acute myocardial infarction (AMI). There were 23 cases with evidence of AMI, 7 with unstable angina (UA), and 2 with dilated cardiomyopathy (DCM). While the planar images showed discrete cardiac activity in only 11 of the 23 cases (48%) with AMI, the ECT images delineated focal myocardial uptake clearly in 20 of them (87%). On the other hand, the ECT images revealed cardiac blood-pool activity without significant myocardial uptake in all cases with UA and DCM in which the planar images showed diffuse activity. Thus, the ECT imaging of 99mTc-pyrophosphate seems to be a valuable technique for assessing the presence and localization of myocardial necrosis, especially in cases showing diffuse cardiac activity in the planar imaging.

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Cardiomyopathies; Diagnosis, Differential; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Tomography, X-Ray

This report describes an American family with a high incidence of symptomatic cardiac amyloidosis among four siblings, and explores the role of echocardiography and technetium pyrophosphate myocardial scintigraphy in the detection of this infiltrative cardiomyopathy within the involved family.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Heart; Heart Failure; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A patient had severe congestive cardiomyopathy secondary to myocardial sarcoidosis. The clinical diagnosis was confirmed by radionuclide ventriculography, thallium 201 (201Tl), gallium-67 (67Ga), and technetium-99m (99mTc) pyrophosphate (TcPYP) scintigraphy. Myocardial TcPYP uptake has not been reported previously in sarcoidosis. In this patient, TcPYP was as useful as gallium scanning and thallium imaging in documenting the myocardial process.

Topics: Adult; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Heart; Humans; Radioisotopes; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

To determine the value of technetium-99m-pyrophosphate myocardial scintigraphy in the diagnosis of amyloid heart disease this procedure was prospectively performed in 20 consecutive patients with biopsy-proven primary amyloidosis. Eleven patients had echocardiographic abnormalities compatible with amyloid cardiomyopathy, 9 of whom had congestive heart failure. Diffuse myocardial pyrophosphate uptake was of equal or greater intensity than that of the ribs in 9 of the 11 patients with echocardiograms suggestive of amyloidosis, but in only 2 of the 9 with normal echocardiograms, despite abnormal electrocardiograms (p less than 0.01). Increased wall thickness measured by M-mode echocardiography correlated with myocardial pyrophosphate uptake (r = 0.68, p less than 0.01). None of 10 control patients with nonamyloid, nonischemic heart disease had a strongly positive myocardial pyrophosphate uptake. Thus, myocardial technetium-99m-pyrophosphate scanning is a sensitive and specific test for the diagnosis of cardiac amyloidosis in patients with congestive heart failure of obscure origin. It does not appear to be of value for the early detection of cardiac involvement in patients with known primary amyloidosis without echocardiographic abnormalities.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Cardiomyopathies; Diphosphates; Dogs; Gluconates; Heart; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Ten consecutive patients with tissue-proven amyloidosis, seven of whom presented with congestive heart failure, were found to exhibit intense diffuse uptake of technetium-99m-pyrophosphate (Tc-99m-PYP) on cardiac radionuclide imaging. The patients exhibited echocardiographic and systolic time interval abnormalities suggesting combined restrictive and congestive cardiomyopathic changes. On M-mode echocardiograms, there was symmetrically increased thickness of the interventricular septum and left ventricular (LV) posterior wall in diastole (10 of 10), decreased fractional shortening of the LV minor axis diameter in systole (eight of nine), and decreased percent thickening of the LV minor axis diameter in systole (eight of nine) and LV posterior wall (10 of 10) in systole. Three patients demonstrated enlarged LV end-diastolic diameter. All 10 patients had abnormal PEP/LVET and eight had shortened LVETI. When combined with noninvasive tests of LV performance, positive myocardial pyrophosphate (PYP) scanning provides a new and useful adjunct in the diagnosis of amyloid heart disease.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Systole; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Electrocardiography; Heart Ventricles; Humans; Male; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adolescent; Adult; Aged; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Child; Diphosphates; Heart; Humans; Middle Aged; Muscular Dystrophies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diphosphates; Heart; Heart Injuries; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Cardiomyopathies; Diphosphates; Female; Humans; Lupus Erythematosus, Systemic; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Scleroderma, Systemic; Sugar Acids; Technetium; Technetium Tc 99m Pyrophosphate

The spontaneous occurrence of perimyocardial calcification localized in the right ventricle has been reported in an inbred strain of DBA/2 mice. In this paper we examined the correlation between the myocardial uptake ratio of technetium-99m pyrophosphate (99mTc-PYP) and pathological findings in these mice ranging in age from one to 12 months and became lower with age, while calcification and fibrosis in the perimyocardium of the right ventricle became more prominent in aged mice. This may be due to an insidious onset of degeneration with calcification and fibrosis in spontaneously occurring perimyocardial lesions in these mice. Persistent abnormal uptake of 99mTc-PYP observed in the present study suggests the usefulness of such scintigrams in the diagnosis of chronic perimyocardial disease.

Topics: Animals; Calcinosis; Cardiomyopathies; Diphosphates; Heart; Mice; Mice, Inbred DBA; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In long-term daunorubicin treated rabbits increased myocardial accumulation of 99Tcm-pyrophosphate and 99Tcm-gluconate of a varying degree were recorded, visible at gamma camera examination in more than half of the animals. Chronic cardiomyopathy morphologically and topographically different from the ischemic myocardial injury was demonstrated in most animals at light microscopic examination. The myocardial abnormalities were classified in qualitative and quantitative scores and compared with the degree of isotope accumulation. The rabbits receiving a large single dose of daunorubicin had slightly increased isotope accumulation in the myocardium but no histopathologic changes.

Topics: Animals; Cardiomyopathies; Daunorubicin; Diphosphates; Drug Administration Schedule; Female; Gluconates; Heart; Male; Myocardium; Organ Size; Organotechnetium Compounds; Rabbits; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Radioactive imaging agents are chemically designed for selective distribution. Another approach to selectivity is to find stable compounds that favorably influence this distribution. Using a rat model of myocardial necrosis, we studied effects of various stable compounds (as a single, large dose or fractionated into short series) on the ratio, uptake of Tc-99m pyrophosphate (PPi) by the target lesion/uptake by the principal nontarget, bone (L/B). Vitamin D3s ability to increase L/B was mediated by the hypercalcemia and hyperphosphatemia that it caused. The hypercalcemia was accompanied by increased [Ca] in the lesion. In contrast, pulse doses of desoxycorticosterone acetate (DOCA) at 7 and 6 hr before killing increased uptake by lesion, increasing L/B from 0.19 +/- 0.03 to 0.45 +/- 0.08 (p less than 0.01), with no change in serum [Ca] and minimal changes in serum [P], [Na], and [K]. DOCA also increased the lesion-to-blood ratio from 6.5 +/- 0.07 to 15.4 +/- 3.9 (p less than 0.05). These results encourage further study of DOCA's effect and investigation of other stable drugs that may influence distribution of other imaging agents.

Topics: Animals; Calcium; Cardiomyopathies; Cholecalciferol; Desoxycorticosterone; Diphosphates; Drug Interactions; Etidronic Acid; Phosphorus; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Pyrophosphate; Tissue Distribution

Topics: Animals; Blood Flow Velocity; Body Burden; Bone and Bones; Bone Resorption; Calcium; Cardiomyopathies; Diphosphates; Dogs; Drug Interactions; Humans; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tissue Distribution

Scintigraphic examination of the myocardium using 99mTc-labelled pyrophosphate was carried out in 10 dogs with experimentally produced cardiomyopathy. This was brought about by intravenous administration of high doses of adrenalin and theophylline. The scan was positive in 8 out of 10 dogs. "Hot" foci were very extensive. The degree of accumulation was however low (2+). Histological examination of the myocardium using the light microscope showed only scarcely distinguishable damage to the tissue without the presence of necrosis. ECG examinations were normal in all cases. By means of 99mTc-labelled pyrophosphate even very small myocardial disorders can thus be detected. This fact may be of clinical importance for an early diagnosis of heart lesions.

Topics: Animals; Cardiomyopathies; Diphosphates; Dogs; Heart; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A survey is presented of research results of pyrophosphate myocardial scanning in 130 dogs and 150 patients with various myocardial lesions. The results of experiments in animals were immediately applied in clinical practice. The results showed that acute transmural myocardial lesions yielded practically in all instances positive scintigraphic findings. The findings in nontransmural infarctions were less convincing--they were positive in 60% of cases. Positive scintigraphic findings were also obtained in 80% of dogs with experimentally induced temporary ischaemia, and in 80% of dogs with experimentally induced dystrophy of the myocardium. In patients with angina pectoris positive findings were obtained in 1/3 of the cases, and in patients with cardiomyopathies, in 1/3 to 1/4 of the cases (in dependence on the etiology of the cardiomyopathy). It appears that 99mTc-PYP is a highly sensitive, but nonspecific, detector of myocardial lesions.

Topics: Angina Pectoris; Animals; Cardiomyopathies; Coronary Artery Bypass; Coronary Disease; Diphosphates; Dogs; Humans; Myocardial Infarction; Myocardium; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate