Correlation of Quantitative 99mTc DPD Scintigraphy With Echocardiographic Alterations in Left Atrial Parameters in Transthyretin Amyloidosis

Mehmet Harapoz; Scott Evans; Paul Geenty; Fiona Kwok; Graeme Stewart; Mark S Taylor; David Farlow; Liza Thomas

doi:10.1016/j.hlc.2022.01.006

Correlation of Quantitative ^99mTc DPD Scintigraphy With Echocardiographic Alterations in Left Atrial Parameters in Transthyretin Amyloidosis

Heart Lung Circ. 2022 Jun;31(6):804-814. doi: 10.1016/j.hlc.2022.01.006. Epub 2022 Feb 15.

Authors

Mehmet Harapoz¹, Scott Evans², Paul Geenty¹, Fiona Kwok³, Graeme Stewart⁴, Mark S Taylor⁴, David Farlow⁵, Liza Thomas⁶

Affiliations

¹ Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
² Department of Nuclear Medicine, Westmead Hospital, Sydney, NSW, Australia.
³ Westmead Amyloidosis Service, Westmead Hospital, Sydney, NSW, Australia; Department of Haematology, Westmead Hospital, Sydney, NSW, Australia.
⁴ Westmead Amyloidosis Service, Westmead Hospital, Sydney, NSW, Australia; Department of Clinical Immunology and Allergy, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
⁵ Department of Nuclear Medicine, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
⁶ Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Amyloidosis Service, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia. Electronic address: liza.thomas@sydney.edu.au.

PMID: 35181228
DOI: 10.1016/j.hlc.2022.01.006

Abstract

Aim: Cardiac transthyretin amyloidosis (ATTR) patients have high rates of atrial arrhythmias. We evaluated echocardiographic structural and functional left atrial (LA) parameters and correlated these with technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (^99mTc-DPD) bone scintigraphy tracer uptake within the LA in ATTR patients.

Methods: ATTR patients (wild-type, hereditary and asymptomatic transthyretin [TTR] variant carriers) who had undergone ^99mTc-DPD and transthoracic echocardiogram (TTE) were selected. Quantitative ^99mTc-DPD uptake analysis and echocardiographic evaluation of LA structural and functional parameters was performed.

Results: Forty (40) ATTR patients (wild-type n=17; hereditary ATTR and TTR variant carriers n=23; median age 68.8±22 years) were included. TTE parameters including indexed LA minimum (LAV_min) (r=0.66), and LA maximum volumes (LAV_max) (r=0.64), LA emptying fraction (LAEF) (r=-0.68), LA function index (LAFI) (r=-0.70) and reservoir strain (ƐR) (r=-0.70) (p<0.001 for all) demonstrated good correlation to LA tracer uptake. Normal LA volume (LAV_min and LAV_max) and function (LAEF, LAFI and ƐR) was observed in hereditary ATTR and TTR variant carriers without cardiac tracer uptake. The subgroup of ATTR patients with atrial fibrillation/flutter demonstrated increased LAV_min and LAV_max with further reduction in LA function (LAEF, LAFI and ƐR). Receiver operating characteristic curves demonstrated strong diagnostic accuracies for LA structural (LAV_min and LAV_max; area under the curve [AUC] of 0.83 and 0.84 respectively) and functional (LAEF, LAFI and ƐR; AUC 0.81, 0.88 and 0.85, respectively) parameters.

Conclusion: Left atrial structural and functional parameters demonstrated good correlations with quantitative ^99mTc-DPD tracer LA uptake. Echocardiography and ^99mTc-DPD scintigraphy may have significant roles in identification and surveillance of ATTR patients likely to develop atrial arrhythmias.

Keywords: Amyloidosis; Cardiomyopathy; Echocardiography; Nuclear cardiology.

Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

MeSH terms

Aged
Aged, 80 and over
Amyloid Neuropathies, Familial* / diagnostic imaging
Cardiomyopathies*
Echocardiography
Humans
Middle Aged
Radionuclide Imaging
Tomography, X-Ray Computed

Supplementary concepts

Amyloidosis, Hereditary, Transthyretin-Related