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Impact of Increasing Referral for 99mTc-DPD Scintigraphy on Prognosis Across the Phenotypic Spectrum of Restrictive

Chern Hsiang Choy1, Chun Shing Kwok1, Yasmin Wahid1

  • 1Midlands Amyloidosis Service, Centre for Rare Diseases, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.

JACC. Advances
|October 23, 2025
PubMed

Insights

Bone scintigraphy is crucial for diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM), but its prognostic value is unclear. Patients with negative scans show high mortality, similar to ATTR-CM, necessitating further research.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Genetics

Background:

  • Bone scintigraphy, specifically 99mTc-DPD scintigraphy, is a key tool in diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM).
  • The prognostic implications of 99mTc-DPD scintigraphy results, particularly in patients without ATTR-CM, are not well understood.

Purpose of the Study:

  • To analyze trends in 99mTc-DPD scintigraphy referrals.
  • To investigate the impact of referral patterns on the clinical characteristics and outcomes of patients with and without ATTR-CM.

Main Methods:

  • A 15-year retrospective cohort study of patients referred for 99mTc-DPD scintigraphy.
  • Analysis included echocardiography findings, diagnosis (ATTR-CM vs. non-amyloid cardiomyopathy), and 5-year mortality rates.

Main Results:

  • Referrals from cardiologists significantly increased over time.
  • Nearly half of patients (45%) were diagnosed with ATTR-CM (ATTRwt-CM or ATTRv-CM).
  • Patients with non-amyloid cardiomyopathy had similar 5-year mortality rates (31%) compared to ATTR-CM (40%), with no significant difference in survival after adjustment.

Conclusions:

  • Patients with negative 99mTc-DPD scintigraphy results exhibit unexpectedly high mortality, comparable to those with ATTR-CM.
  • This highlights an overlooked patient group requiring further investigation for targeted therapies and improved outcomes.
Abstract

Keywords:
(99m)Tc-DPD scintigraphycardiac amyloidosisprognosis

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