ABSTRACT

Amyloidosis is a systemic disorder characterized by the extracellular deposition of amyloid fibrils in various tissues, with the potential for cardiac involvement. Cardiac amyloidosis, a relatively uncommon and frequently underdiagnosed etiology of heart failure, can manifest due to the infiltration of several amyloid types into the myocardium. The definitive diagnosis typically involves an endomyocardial biopsy. Utilizing scintigraphic imaging with Technetium- 99m (Tc-99m) labeled bisphosphonates can aid in the early identification of cardiac involvement and differentiate between different forms of cardiac amyloidosis. This guideline aims to support nuclear medicine practitioners in advising, performing imaging procedures, documenting findings, and interpreting results from scintigraphy involving Tc-99m-labeled bone radiopharmaceuticals for the assessment of transthyretin cardiac amyloidosis.

Keywords: Cardiac amyloidosis, scintigraphy, SPECT, SPECT/CT

References

Wechalekar AD, Gillmore JD, Hawkins PN. Systemic amyloidosis. Lancet 2016;387:2641-2654.

Çavuşoğlu Y, Özpelit E, Çelik A, et al. Cardiac amyloidosis: Recent advances in the diagnosis and therapy. Turk Kardiyoloji Dernegi Arsivi 2019;47:Supplement 1.

Dorbala S, Ando Y, Bokhari S, et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: part 1 of 2—evidence base and standardized methods of imaging. J Nucl Cardiol 2019;26:2065-2123.

Slart RH, Chen W, Tubben A, et al. Emerging Role of Scintigraphy Using Bone-Seeking Tracers for Diagnosis of Cardiac Amyloidosis: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024;222:e2329347.

Treglia G, Glaudemans AW, Bertagna F, et al. Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis. Eur J Nucl Med Mol Imaging 2018;45:1945-1955.

Gillmore JD, Maurer MS, Falk RH, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 2016;133:2404-2412.

Dorbala S, Ando Y, Bokhari S, et al. Addendum to ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: part 1 of 2—evidence base and standardized methods of imaging. J Card Fail 2021;28:1769-1774.

Thelander U, Westermark GT, Antoni G, et al. Cardiac microcalcifications in transthyretin (ATTR) amyloidosis. Int J Cardiol 2022;352:84-91.

Dorbala S, Bokhari S, Glaudemans AW, et al. ASNC cardiac amyloidosis practice points-99m Technetium-Pyrophosphate Imaging for Transthyretin Cardiac Amyloidosis.

Arbelo E, Protonotarios A, Gimeno JR, et al. 2023 ESC Guidelines for the management of cardiomyopathies: Developed by the task force on the management of cardiomyopathies of the European Society of Cardiology (ESC). Eur Heart J 2023;44:3503-3626.

Perugini E, Guidalotti PL, Salvi F, et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol 2005;46:1076-1084.

Yang JC, Fox J, Chen C, Yu AF. Cardiac ATTR amyloid nuclear imaging—not all bone scintigraphy radionuclide tracers are created equal. J Nucl Cardiol 2018;25:1879-1884.

Coskun N, Kartal MO, Erdogan AS, Tufekcioglu O, Ozdemir E. Tc-99m pyrophosphate scintigraphy for cardiac amyloidosis: concordance between planar and SPECT/CT imaging. Int J Cardiovasc Imaging 2022;38:2081-2088.

Özdemir E, Tosun FC, Altun GD, Demir H, Özdemir S, Sen F. Kardiyak Transtiretin Amiloidozu Degerlendirilmesinde Sintigrafik Goruntuleme Kilavuzu/Procedure Guideline for Scintigraphic Imaging in Cardiac Transthyretin Amyloidosis. Nucl Med Semin 2020:190-198.

Bokhari S, Castaño A, Pozniakoff T, Deslisle S, Latif F, Maurer MS. 99mTc-pyrophosphate scintigraphy for differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circ Cardiovasc Imaging 2013;6:195-201.

Rapezzi C, Aimo A, Serenelli M, et al. Critical comparison of documents from scientific societies on cardiac amyloidosis: JACC state-of-the-art review. J Am Coll Cardiol 2022;79:1288-1303.

Lades G, Carpenet H, Benoit U, Aboyans V, Monteil J. Tc-99m HMDP bone scintigraphy for cardiac amyloidosis diagnosis: A false positive case. J Nucl Cardiol 2022;29:2051-2052.