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Prognostic value of 99mtechnetium-pyrophosphate single-photon emission computed tomography visual grade in patients
Ardel J Romero Pabón1, Olivier F Clerc1, Sarah A M Cuddy2
1Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Background:
The aim of our study was to evaluate the prognostic value of amyloid burden estimated by technetium-pyrophosphate single-photon emission computed tomography (99mTc-PYP-SPECT) visual grade in patients with transthyretin (ATTR) amyloid cardiomyopathy (ATTR-CM) receiving TTR stabilization therapy.
Methods:
Our retrospective cohort study included 344 ATTR-CM participants receiving TTR stabilization therapy. 99mTc-PYP-SPECT myocardial uptake was graded as 0, 1, 2, or 3, based on myocardial uptake that was absent, less than, equal to, or greater than rib uptake, respectively. National Amyloidosis Center (NAC) stage was defined by N-terminal pro B-type natriuretic peptide (≤3000 pg/mL) and estimated glomerular filtration rate (≥45 mL/min/1.73 m2) levels. The primary outcome was all-cause mortality. Kaplan-Meier survival and multivariable Cox regression analyses were performed.
Results:
Of the 344 participants (median age: 80 years), 88% were men and 98% had a 99mTc-PYP-SPECT visual grade uptake of 2 or 3. Seventy-six participants (22.1%) died during follow-up (median: 27 months). In the Cox regression analysis adjusted for age, NAC stage, New York Heart Association (NYHA) class, left ventricular (LV) mass index, LV ejection fraction, and 99mTc-PYP-SPECT visual grade, only NAC stage (hazard ratio [HR]: 4.01, P value <.001) and NYHA class (HR: 5.22, P value = .011) strongly predicted mortality.
Conclusions:
In patients with ATTR-CM receiving TTR stabilization therapy, organ dysfunctions evidenced by NAC stage and NYHA class, but not by amyloid burden on 99mTc-PYP-SPECT visual grade, are strong predictors of mortality. Our results support a revision to 99mTc-PYP visual grading 2 and 3 into a single grade (positive). Future work is needed to evaluate whether amyloid burden measured by quantitative 99mTc-PYP-SPECT offers prognostic value in ATTR-CM.
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