Elucidating associations between technetium pyrophosphate scintigraphy, echocardiography and cardiac biomarkers in transthyretin cardiac amyloidosis.
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| Titel: | Elucidating associations between technetium pyrophosphate scintigraphy, echocardiography and cardiac biomarkers in transthyretin cardiac amyloidosis. |
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| Autoren: | Di Giovanni B; University of Toronto, Toronto, Ontario, Canada., Gustafson D; Department of Medicine, Queen's University School of Medicine, Kingston, Ontario, Canada.; University Health Network, Toronto, Ontario, Canada., Arivalagan P; University Health Network, Toronto, Ontario, Canada.; Institute of Medical Science, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada., Adamson MB; University Health Network, Toronto, Ontario, Canada.; Institute of Medical Science, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada., Vishram-Nielsen J; Department of Cardiology, Rigshospitalet, Kobenhavn, Denmark.; Division of Cardiology, Heart Failure, Heart Transplant, Toronto General Hospital, Toronto, Ontario, Canada., Delgado D; University of Toronto, Toronto, Ontario, Canada diego.delgado@uhn.ca.; University Health Network, Toronto, Ontario, Canada. |
| Quelle: | Open heart [Open Heart] 2025 Aug 21; Vol. 12 (2). Date of Electronic Publication: 2025 Aug 21. |
| Publikationsart: | Journal Article |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101631219 Publication Model: Electronic Cited Medium: Print ISSN: 2053-3624 (Print) Linking ISSN: 20533624 NLM ISO Abbreviation: Open Heart Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group |
| MeSH-Schlagworte: | Amyloid Neuropathies, Familial*/blood , Amyloid Neuropathies, Familial*/diagnosis , Amyloid Neuropathies, Familial*/complications , Amyloid Neuropathies, Familial*/diagnostic imaging , Technetium Tc 99m Pyrophosphate*/pharmacology , Technetium Tc 99m Pyrophosphate*/administration & dosage , Echocardiography*/methods , Cardiomyopathies*/blood , Cardiomyopathies*/diagnosis , Cardiomyopathies*/diagnostic imaging , Cardiomyopathies*/etiology , Radionuclide Imaging*/methods , Natriuretic Peptide, Brain*/blood , Troponin I*/blood, Humans ; Male ; Female ; Aged ; Retrospective Studies ; Biomarkers/blood ; Radiopharmaceuticals/administration & dosage ; Radiopharmaceuticals/pharmacology ; Ventricular Function, Left ; Middle Aged |
| Abstract: | Competing Interests: Competing interests: DD serves on the Canadian Advisory Boards for Akcea Therapeutics, Pfizer Inc., and Alnylam Pharmaceuticals. He has also received investigator-initiated research funding from Pfizer Global to support studies focused on the identification and validation of novel biomarkers in transthyretin amyloidosis. Background: Transthyretin amyloidosis is an under-recognised systemic disease whereby misfolded transthyretin proteins form fibrils capable of depositing in various tissues and organs. Despite improvements to diagnostic modalities, the associations between imaging techniques and clinical laboratory metrics remain unclear. Methods: A single-centre retrospective cohort study was performed including 183 patients aged 18 years or older diagnosed with transthyretin cardiac amyloidosis (ATTR-CA) in a tertiary care setting. Linear regression and multivariate proportional hazard models were used to examine the associations between established imaging modalities (ie, technetium-99m pyrophosphate ( 99m Tc-PYP) scintigraphy and echocardiography) and cardiac biomarkers (ie, cardiac troponin I and B-type natriuretic peptide (BNP)). The study included patients who visited the Toronto General Hospital Peter Munk Cardiac Centre between October 2012 and December 2022. Results: Of the 183 patients included, 143 (78.1%) were male, with a median age (IQR) of 73.0 (66.0-79.0) years. Primary analyses revealed significant associations between positive 99m Tc-PYP grading and echocardiographic parameters, particularly increased left ventricular (LV) mass (β=111.21, p=0.009) and greater interventricular septal thickness at end-diastole (IVSd) (β=0.48, p=0.003) in patients with hereditary transthyretin amyloidosis (ATTRm). Additionally, positive 99m Tc-PYP grades correlated significantly with cardiac biomarkers, including log-transformed BNP (logBNP; β=1.99, p=0.002) in patients with ATTRm and log-transformed Troponin (logTroponin; β=1.68, p=0.007) in patients with wild type ATTR (ATTRwt). Conversely, the heart-to-contralateral lung ratio, a quantitative index derived from 99m Tc-PYP scintigraphy, did not show significant correlations with cardiac biomarkers (logBNP and logTroponin), but demonstrated significant associations with LV mass (β=134.52, p=0.001) and IVSd (β=0.46, p=0.002) in patients with ATTRm. Conclusions: These data suggest strong associations exist between cardiac biomarkers, structural echocardiographic changes and 99m Tc-PYP scintigraphy, emphasising the importance of a multipronged diagnostic approach stratified by genotype. (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
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| Contributed Indexing: | Keywords: Biomarkers; Cardiac Imaging Techniques; Diagnostic Imaging; Echocardiography |
| Substance Nomenclature: | 0 (Biomarkers) 5L76I61H2B (Technetium Tc 99m Pyrophosphate) 114471-18-0 (Natriuretic Peptide, Brain) 0 (Radiopharmaceuticals) 0 (Troponin I) |
| SCR Disease Name: | Amyloidosis, Hereditary, Transthyretin-Related |
| Entry Date(s): | Date Created: 20250821 Date Completed: 20250821 Latest Revision: 20251110 |
| Update Code: | 20251111 |
| PubMed Central ID: | PMC12374618 |
| DOI: | 10.1136/openhrt-2024-002686 |
| PMID: | 40841121 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Competing Interests: Competing interests: DD serves on the Canadian Advisory Boards for Akcea Therapeutics, Pfizer Inc., and Alnylam Pharmaceuticals. He has also received investigator-initiated research funding from Pfizer Global to support studies focused on the identification and validation of novel biomarkers in transthyretin amyloidosis.<br />Background: Transthyretin amyloidosis is an under-recognised systemic disease whereby misfolded transthyretin proteins form fibrils capable of depositing in various tissues and organs. Despite improvements to diagnostic modalities, the associations between imaging techniques and clinical laboratory metrics remain unclear.<br />Methods: A single-centre retrospective cohort study was performed including 183 patients aged 18 years or older diagnosed with transthyretin cardiac amyloidosis (ATTR-CA) in a tertiary care setting. Linear regression and multivariate proportional hazard models were used to examine the associations between established imaging modalities (ie, technetium-99m pyrophosphate ( <sup>99m</sup> Tc-PYP) scintigraphy and echocardiography) and cardiac biomarkers (ie, cardiac troponin I and B-type natriuretic peptide (BNP)). The study included patients who visited the Toronto General Hospital Peter Munk Cardiac Centre between October 2012 and December 2022.<br />Results: Of the 183 patients included, 143 (78.1%) were male, with a median age (IQR) of 73.0 (66.0-79.0) years. Primary analyses revealed significant associations between positive <sup>99m</sup> Tc-PYP grading and echocardiographic parameters, particularly increased left ventricular (LV) mass (β=111.21, p=0.009) and greater interventricular septal thickness at end-diastole (IVSd) (β=0.48, p=0.003) in patients with hereditary transthyretin amyloidosis (ATTRm). Additionally, positive <sup>99m</sup> Tc-PYP grades correlated significantly with cardiac biomarkers, including log-transformed BNP (logBNP; β=1.99, p=0.002) in patients with ATTRm and log-transformed Troponin (logTroponin; β=1.68, p=0.007) in patients with wild type ATTR (ATTRwt). Conversely, the heart-to-contralateral lung ratio, a quantitative index derived from <sup>99m</sup> Tc-PYP scintigraphy, did not show significant correlations with cardiac biomarkers (logBNP and logTroponin), but demonstrated significant associations with LV mass (β=134.52, p=0.001) and IVSd (β=0.46, p=0.002) in patients with ATTRm.<br />Conclusions: These data suggest strong associations exist between cardiac biomarkers, structural echocardiographic changes and <sup>99m</sup> Tc-PYP scintigraphy, emphasising the importance of a multipronged diagnostic approach stratified by genotype.<br /> (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
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| ISSN: | 2053-3624 |
| DOI: | 10.1136/openhrt-2024-002686 |