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Perfusion defects on thallium-201 scintigraphy in cardiac amyloidosis
Yi-Hsin Hung1,2, An-Li Yu3, Chi-Lun Ko4,5
1Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Thallium-201 scintigraphy reveals abnormal myocardial perfusion in cardiac amyloidosis patients, correlating with left ventricular wall thickness. This imaging technique aids in detecting perfusion abnormalities in unexplained hypertrophy with nonobstructive coronary arteries.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Cardiac amyloidosis is a progressive disease characterized by amyloid protein deposition in the heart.
- Thallium-201 scintigraphy is utilized for assessing myocardial perfusion and detecting microvascular dysfunction.
- The relationship between cardiac amyloidosis and thallium-201 scintigraphy findings remains underexplored.
Purpose of the Study:
- To investigate the impact of amyloid deposition on thallium-201 scintigraphy results.
- To explore the correlation between cardiac amyloidosis and myocardial perfusion abnormalities detected by thallium-201 scintigraphy.
- To determine if thallium-201 scintigraphy can identify perfusion deficits in cardiac amyloidosis.
Main Methods:
- Retrospective analysis of patients with cardiac amyloidosis at National Taiwan University Hospital.
- Review of baseline characteristics, biochemical data, echocardiography, thallium-201 scintigraphy, and coronary angiography.
- Statistical analysis including Spearman's correlation and multivariable analysis to assess relationships between variables.
Main Results:
- Abnormal thallium-201 scintigraphy findings were present in 72.22% of patients with cardiac amyloidosis.
- Both summed stress score (SSS) and summed difference score (SDS) on thallium-201 scintigraphy significantly correlated with left ventricular (LV) posterior wall thickness.
- LV posterior wall thickness was the sole significant predictor of SSS in multivariable analysis.
- Coronary angiography in eight patients with abnormal scintigraphy showed no significant coronary artery lesions.
Conclusions:
- Thallium-201 scintigraphy frequently reveals perfusion abnormalities in cardiac amyloidosis patients, independent of significant epicardial coronary artery disease.
- Myocardial perfusion abnormalities detected by thallium-201 scintigraphy are associated with LV hypertrophy in cardiac amyloidosis.
- Thallium-201 scintigraphy may serve as a valuable tool for identifying myocardial perfusion abnormalities in cardiac amyloidosis, especially in cases with unexplained LV hypertrophy and nonobstructive coronary arteries.
Abstract:
Thallium-201 scintigraphy can detect microvascular diseases; however, the correlation between cardiac amyloidosis and thallium-201 scintigraphy findings is unknown. We aimed to investigate the influence of amyloid deposition on thallium-201 scintigraphy. We retrospectively analyzed individuals with cardiac amyloidosis at National Taiwan University Hospital, reviewing baseline characteristics, biochemistry, echocardiography, thallium-201 scintigraphy, and coronary angiography. Thirty-six participants were enrolled, of whom 32 had transthyretin amyloid cardiomyopathy. The left ventricular (LV) posterior wall thickness was 13.71 ± 2.45 mm, and the summed stress score (SSS) and summed difference score (SDS) on thallium-201 scintigraphy were 5.47 ± 6.42 and 2.16 ± 2.13, respectively. Abnormal thallium-201 scintigraphy findings were observed in 72.22% of patients. In Spearman's correlation analysis, both the SSS and summed difference score (SDS) were significantly correlated with LV posterior wall thickness (SSS: r = 0.43, p = 0.008; SDS: r = 0.50, p = 0.002). In multivariable analysis, LV posterior wall thickness remained the only significant predictor of SSS (β = 0.410, 95% CI: 0.250-1.895, p = 0.012). Coronary angiography was performed in eight of the patients with abnormal thallium-201 scintigraphy, none of whom had physiologically significant coronary artery lesions. Abnormal thallium-201 scintigraphy findings were common in the patients with cardiac amyloidosis, even though they did not have significant epicardial coronary lesions. Furthermore, SSS was associated with LV posterior wall thickness. These results suggest that thallium-201 scintigraphy may help identify myocardial perfusion abnormalities related to cardiac amyloidosis, particularly in patients presenting with unexplained LV hypertrophy and nonobstructive coronary arteries.
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