Performance of 99mTc-aprotinin scintigraphy for diagnosing light chain (AL) cardiac amyloidosis confirmed by endomyocardial biopsy

J Nucl Cardiol. 2020 Aug;27(4):1145-1153. doi: 10.1007/s12350-019-01868-9. Epub 2019 Oct 7.

Abstract

Background: Light chain (AL) cardiac amyloidosis is associated with a poor prognosis. Diagnosing at an early stage is critical for treatment and the management of cardiac complication.

Purpose: We aimed to evaluate the diagnostic performance of 99mTc-aprotinin images in patients with AL cardiac amyloidosis.

Methods and results: 99mTc-aprotinin scintigraphy and endomyocardial biopsy were performed in 10 patients with suspected amyloidosis. Endomyocardial biopsy showed amyloid deposits in 5 of 10 patients. 99mTc-aprotinin (planer image) was positive in 4 of 5 patients who had amyloid deposits in endomyocardial biopsy. On the other hand, all 5 patients without amyloid deposits were negative in planer image. 99mTc-aprotinin (SPECT/CT image) was positive in all 5 patients who had amyloid deposits.

Conclusions: 99mTc-aprotinin scintigraphy is valuable for the non-invasive diagnosis of AL cardiac amyloidosis.

Keywords: 99mTc-aprotinin scintigraphy; AL (light chain) cardiac amyloidosis; Nuclear imaging.

MeSH terms

  • Adult
  • Aged
  • Aprotinin / pharmacokinetics*
  • Biopsy*
  • Cardiomyopathies / diagnostic imaging*
  • Cardiomyopathies / pathology
  • Defibrillators, Implantable
  • Female
  • Humans
  • Immunoglobulin Light-chain Amyloidosis / diagnostic imaging*
  • Immunoglobulin Light-chain Amyloidosis / pathology
  • Male
  • Middle Aged
  • Myocardium / pathology*
  • Natriuretic Peptide, Brain / blood
  • Organotechnetium Compounds / pharmacokinetics*
  • Peptide Fragments / blood
  • Prospective Studies
  • Single Photon Emission Computed Tomography Computed Tomography

Substances

  • Organotechnetium Compounds
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • technetium Tc 99m aprotinin
  • Natriuretic Peptide, Brain
  • Aprotinin