Cardiac amyloidosis: An update on nuclear cardiology in diagnosis and follow-up

Area of Science:

• Cardiology
• Nuclear Medicine
• Radiology

Background:

• Cardiac amyloidosis (CA) is a severe infiltrative cardiomyopathy leading to heart failure.
• Key forms include light-chain amyloidosis (AL-CA) and transthyretin amyloidosis (ATTR-CA).
• Cardiac involvement is a critical prognostic factor in CA.

Purpose of the Study:

• To review advances in molecular imaging for cardiac amyloidosis.
• To highlight the integration of novel imaging techniques with disease-modifying therapies.
• To discuss the diagnostic and prognostic impact of updated imaging modalities.

Main Methods:

• Review of scintigraphy, including [99mTc]Tc-diphosphonates SPECT/CT, for ATTR-CA diagnosis.
• Discussion of amyloid PET imaging with new pan-amyloid radiopharmaceuticals.
• Integration of imaging findings with emerging therapies like TTR stabilizers and gene silencers.

Main Results:

• Molecular imaging, particularly SPECT/CT, enables non-invasive diagnosis and quantification of ATTR-CA.
• Advanced PET imaging enhances diagnostic capabilities, quantification, and prognostic evaluation.
• New therapies are significantly altering the prognosis for patients with CA.

Conclusions:

• Molecular imaging has revolutionized the diagnosis and management of cardiac amyloidosis.
• The combination of advanced imaging and targeted therapies offers improved outcomes for CA patients.
• This review emphasizes the synergy between diagnostic imaging and therapeutic advancements in CA.