Cardiac Amyloid Imaging with 18F-Florbetaben PET: A Pilot Study

Our aim was to determine the feasibility of ¹⁸F-florbetaben PET in diagnosing cardiac amyloidosis.

¹⁸F-florbetaben PET was performed on 14 patients: 5 amyloid light chain, 5 amyloid transthyretin, and 4 control with hypertensive heart disease. Qualitative and quantitative assessments of ¹⁸F-florbetaben activity were performed using the SUV_mean of the left ventricular myocardium and blood pool and calculation of target-to-background SUV ratio. Myocardial ¹⁸F-forbetaben retention was also calculated as the percentage mean myocardial SUV change between 0 and 5 min and 15 and 20 min after radiotracer injection. Global left ventricular longitudinal and right ventricular free wall longitudinal strain were calculated using 2-dimensional speckle-tracking echocardiography.

Target-to-background SUV ratio and percentage myocardial ¹⁸F-forbetaben retention were higher in amyloid patients than in hypertensive controls. A cutoff of 40% was able to differentiate between cardiac amyloid patients and hypertensive controls. Percentage myocardial ¹⁸F-forbetaben retention was an independent determinant of both global left ventricular longitudinal and right ventricular free wall longitudinal strain via an inverse curve relationship.

¹⁸F-florbetaben PET imaging can accurately identify and differentiate between cardiac amyloidosis and hypertensive heart disease. Percentage myocardial ¹⁸F-florbetaben retention was an independent determinant of myocardial dysfunction in cardiac amyloidosis.