The Utility of 99m Tc-DPD Scintigraphy in the Diagnosis of Cardiac Amyloidosis: An Australian Experience

Moore, Peter; Burrage, Matthew K; Mackenzie, Emily; Law, Wei-Yip; Korczyk, Dariusz; Mollee, Peter

doi:10.1016/j.hlc.2016.12.017

Cited by 26 publications

(35 citation statements)

References 30 publications

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“…Of the 2947 studies, we identified 27 meeting the inclusion criteria, including data on 3493 patients ( Figure ). Twenty‐two studies evaluated the performance of CMR in diagnosing either cardiac amyloidosis or ATTR amyloidosis, with a further five studies assessing the diagnostic performance of nuclear scintigraphy . Seventeen studies assessing the performance of index tests in the diagnosis of cardiac amyloidosis included patients with a range of cardiac conditions, whereas 9 out of 11 studies diagnosing ATTR amyloidosis included patients with ATTR or AL amyloidosis only.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

et al. 2019

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AimsThe study aims to systematically assess the diagnostic performance of cardiac magnetic resonance (CMR) and nuclear scintigraphy (index tests) for the diagnosis and differentiation of subtypes of cardiac amyloidosis.Methods and resultsMEDLINE and Embase electronic databases were searched for studies evaluating the diagnostic performance of CMR or nuclear scintigraphy in detecting cardiac amyloidosis and subsequently in differentiating transthyretin amyloidosis (ATTR) from immunoglobulin light‐chain (AL) amyloidosis. In this meta‐analysis, histopathological examination of tissue from endomyocardial biopsy (EMB) or extra‐cardiac organs were reference standards. Pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated, and a random effects meta‐analysis was used to estimate diagnostic odds ratios. Methodological quality was assessed using a validated instrument. Of the 2947 studies identified, 27 met the criteria for inclusion. Sensitivity and specificity of CMR in diagnosing cardiac amyloidosis was 85.7% and 92.0% against EMB reference and 78.9% and 93.9% with any organ histology reference. Corresponding sensitivity and specificity of nuclear scintigraphy was 88.4% and 87.2% against EMB reference and 82.0% and 98.8% with histology from any organ. CMR was unable to reliably differentiate ATTR from AL amyloidosis (sensitivity 28.1–99.0% and specificity 11.0–60.0%). Sensitivity and specificity of nuclear scintigraphy in the differentiation of ATTR from AL amyloidosis ranged from 90.9% to 91.5% and from 88.6% to 97.1%. Pooled negative likelihood ratio and positive likelihood ratio for scintigraphy in this setting were 0.1 and 8, with EMB reference standard. Study quality assessed by QUADAS‐2 was generally poor with evidence of bias.ConclusionsCardiac magnetic resonance is a useful test for diagnosing cardiac amyloidosis but is not reliable in further classifying the disease. Nuclear scintigraphy offers strong diagnostic performance in both the detection of cardiac amyloidosis and differentiating ATTR from AL amyloidosis. Our findings support the use of both imaging modalities in a non‐invasive diagnostic algorithm that also tests for the presence of monoclonal protein.

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Section: Resultsmentioning

confidence: 99%

Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

et al. 2019

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“…However, only POSITIVE DPD SCINTIGRAPHY IN THE ELDERLY 0.4% of patients aged over 70 (6/1652) showed a positive DPD scan. Even if we assume the sensitivity of the DPD scan is much lower than currently estimated, 9,10,18) the prevalence of wtTTR amyloidosis in elderly patients demonstrated by autopsies does not seem to reflect true prevalence in the general population.…”

Section: Discussionmentioning

confidence: 86%

“…Among the various imaging modalities used to detect cardiac involvement, the 99 m Tc-3,3-diphosphono-1,2propanodicarboxylic acid ( 99 m Tc-DPD) scintigraphy (DPD scan) is reported to be useful in the diagnosis of wtTTR amyloidosis. [7][8][9][10] Recently suggested high incidence of wtTTR amyloidosis in the elderly, who are not defined as the selected group of heart failure with preserved ejection fraction (HFpEF), 5) leads us to think that wtTTR amyloidosis might be a frequent cause for age-related diastolic dysfunction.…”

mentioning

confidence: 99%

Prevalence of Positive <sup>99 m</sup>Tc-DPD Scintigraphy as an Indicator of the Prevalence of Wild-type Transthyretin Amyloidosis in the Elderly

2019

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Senile or wild-type transthyretin (wtTTR) amyloidosis is an age-related disease caused by the deposition of wtTTR amyloid protein. In contrast to light chain amyloidosis, 99 m Tc-DPD scintigraphy (DPD scan) is a useful diagnostic modality for wtTTR amyloidosis. We retrospectively analyzed patients older than 30 years who underwent DPD scanning for non-cardiac reasons at our hospital between June 2014 and March 2017 (n = 9,581). Transthoracic echocardiography was used to assess left ventricular hypertrophy (LVH), as well as systolic and diastolic function. A positive DPD scan was observed in only six patients (0.06%). All six of these patients were older than 70 years, and they constitute only 0.4% of patients in this age group (6/1652). Among the patients with a positive DPD scan, four showed concentric LVH and two showed a normal wall thickness. With respect to the severity of diastolic dysfunction and pulmonary artery pressure, patients with a positive DPD scan showed the expected E' and pulmonary artery systolic pressure for their age. Even considering the limited sensitivity of a positive DPD scan detecting wtTTR amyloidosis, the incidence of a positive DPD scan in non-cardiac patients indicated that wtTTR amyloid deposition does not seem to be a major cause for age-related diastolic dysfunction, nor does appear to have a high incidence in patients with heart failure with preserved EF in the elderly.

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Section: Cardiac Amyloidosismentioning

confidence: 99%

“…99mTc-DPD scans) and CMR, have led to greater recognition and earlier detection of cardiac amyloid. DPD scans [ 63 , 64 ] in particular have proven very effective at diagnosing cardiac amyloid, and have excellent sensitivity and specificity when working within a proposed diagnostic framework [ 65 , 66 ]. They have led to a new diagnosis of amyloid in 13% of patients with heart failure with preserved ejection fraction [ 67 ] and 16% of patients undergoing transcatheter aortic valve replacement [ 68 ], consistent with rates seen at autopsy [ 69 ].…”

Section: Cardiac Amyloidosismentioning

confidence: 99%

Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy

Burrage

Ferreira

2020

Curr Heart Fail Rep

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Purpose of Review Left ventricular hypertrophy (LVH) is a common presentation encountered in clinical practice with a diverse range of potential aetiologies. Differentiation of pathological from physiological hypertrophy can be challenging but is crucial for further management and prognostication. Cardiovascular magnetic resonance (CMR) with advanced myocardial tissue characterisation is a powerful tool that may help to differentiate these aetiologies in the assessment of LVH. Recent Findings The use of CMR for detailed morphological assessment of LVH is well described. More recently, advanced CMR techniques (late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain) have been used. These techniques are highly promising in helping to differentiate key aetiologies of LVH and provide valuable prognostic information. Summary Recent advancements in CMR tissue characterisation, such as parametric mapping, in combination with detailed morphological assessment and late gadolinium enhancement, provide a powerful resource that may help assess and differentiate important causes of LVH.

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The Utility of 99m Tc-DPD Scintigraphy in the Diagnosis of Cardiac Amyloidosis: An Australian Experience

Cited by 26 publications

References 30 publications

Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta‐analysis

Prevalence of Positive <sup>99 m</sup>Tc-DPD Scintigraphy as an Indicator of the Prevalence of Wild-type Transthyretin Amyloidosis in the Elderly

Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy

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