title: Serial scanning with technetium pyrophosphate (99mTc-PYP) in advanced ATTR cardiac amyloidosis.
abstract: Development of noninvasive imaging modalities to quantify amyloid burden over time is an unmet clinical need. Technetium pyrophosphate (99mTc-PYP) scintigraphy is a simple and widely available radiotracer useful to differentiate transthyretin from light-chain amyloidosis in patients with advanced cardiac amyloidosis. We examined the utility of serial99mTc-PYP scanning to quantify amyloid burden over time in TTR cardiac amyloidosis (ATTR-CA).
  
  
  
  Twenty subjects with ATTR-CA (10 wild type, 10 mutant) underwent serial99mTc-PYP planar cardiac imaging. Cardiac retention was assessed both semiquantitatively (visual score 0, no uptake to 3, uptake greater than bone) and quantitatively (region of interest drawn over the heart, copied, and mirrored over the contralateral chest) to calculate a heart-to-contralateral (H/CL) ratio. Index scan mean visual score and H/CL were 3.0 ± 0.2 and 1.79 ± 0.2, respectively, and after an average 1.5 ± 0.5 years follow-up, did not differ, 3.0 ± 0.2, P = .33 and 1.76 ± 0.2, P = .44. H/CL change was minimal, 0.03 ± 0.17, did not correlate with time between scans, r = 0.19, P = .43, and was observed despite obvious clinical progression (increase in troponin ≥ 0.1 ng/mL, BNP ≥ 400 pg/mL, NYHA class, and/or death).
  
  
  
  Serial99mTc-PYP scanning in subjects with advanced ATTR-CA does not show significant changes over an average 1.5 years of follow-up despite obvious clinical progression.
authors.affiliation: Nuclear Cardiology Laboratory, Columbia College of Physicians & Surgeons, 622 W 168th St. P.H. 10-203, New York, NY, 10032, USA. ac3220@cumc.columbia.edu.|Division of Cardiology, Center for Advanced Cardiac Care, Columbia College of Physicians & Surgeons, New York, NY, USA. ac3220@cumc.columbia.edu.
authors.forename: Adam
authors.initials: A
authors.lastname: Castaño
authors.affiliation: Nuclear Cardiology Laboratory, Columbia College of Physicians & Surgeons, 622 W 168th St. P.H. 10-203, New York, NY, 10032, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: DeLuca
authors.affiliation: Nuclear Cardiology Laboratory, Columbia College of Physicians & Surgeons, 622 W 168th St. P.H. 10-203, New York, NY, 10032, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Weinberg
authors.affiliation: Nuclear Cardiology Laboratory, Columbia College of Physicians & Surgeons, 622 W 168th St. P.H. 10-203, New York, NY, 10032, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Pozniakoff
authors.affiliation: Department of Medicine, Institute of Human Nutrition, Columbia College of Physicians & Surgeons, New York, NY, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Blaner
authors.affiliation: Nuclear Cardiology Laboratory, Columbia College of Physicians & Surgeons, 622 W 168th St. P.H. 10-203, New York, NY, 10032, USA.
authors.forename: Altaf
authors.initials: A
authors.lastname: Pirmohamed
authors.affiliation: Alnylam Pharmaceuticals, Cambridge, MA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Bettencourt
authors.affiliation: Alnylam Pharmaceuticals, Cambridge, MA, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Gollob
authors.affiliation: Alnylam Pharmaceuticals, Cambridge, MA, USA.
authors.forename: Verena
authors.initials: V
authors.lastname: Karsten
authors.affiliation: Alnylam Pharmaceuticals, Cambridge, MA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Vest
authors.affiliation: Mailman School of Public Health, Columbia College of Physicians & Surgeons, New York, NY, USA.
authors.forename: Codruta
authors.initials: C
authors.lastname: Chiuzan
authors.affiliation: Division of Cardiology, Center for Advanced Cardiac Care, Columbia College of Physicians & Surgeons, New York, NY, USA.
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.affiliation: Nuclear Cardiology Laboratory, Columbia College of Physicians & Surgeons, 622 W 168th St. P.H. 10-203, New York, NY, 10032, USA.
authors.forename: Sabahat
authors.initials: S
authors.lastname: Bokhari
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000000981:diagnostic imaging*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013382:Subtraction Technique; D016698:Technetium Tc 99m Pyrophosphate
chemical_list: D019275:Radiopharmaceuticals; D016698:Technetium Tc 99m Pyrophosphate
keywords: 99mTc-PYP technetium pyrophosphate imaging; AL amyloid; ATTR-CA transthyretin cardiac amyloidosis