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The utility of Technitium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience
Abstract
S368
593 The utility of mitral valve index in the detection of prosthetic mitral valve dysfunction S. Luis 1,2,3,∗ , L. Blauwet 1 , R. Mehta 1 , H. Samardhi 2 , C. West 2 , C. Luis 2,3 , G. Scalia 2,3 , F. Miller Jr. 1 , D. Burstow 2,3 1 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America 2 Department of Cardiology, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia 3 School of Medicine, University of Queensland, Brisbane, Queensland, Australia
Background: Acoustic shadowing from prosthetic valves provides challenges in the assessment of prosthetic mitral dysfunction (PMD) by transthoracic echocardiography (TTE). We aimed to assess the utility of Doppler parameters, including the ratio of mitral prosthetic to LVOT TVI (MV index) for the detection of PMD. Methods: Retrospective TTE assessment of mitral prostheses was performed. PMD was defined by transoesophageal echocardiography (TEE) performed within 30 days of TTE. Patients with significant LVOT obstruction and ≥moderate aortic regurgitation were excluded. Results: 1088 studies were evaluated including 710 mechanical valves (672 bileaflet, 37 tilting disc and 1 unclassified) and 378 bioprosthetic valves (297 porcine, 63 pericardial and 18 unclassified). The mean heart rate was 79 ± 16bpm, with 58% of TTE studies performed sinus rhythm, 33% in an atrial arrhythmia and 9% in a paced rhythm. Mean left ventricular ejection fraction was 54% ± 14%. Study results are as displayed in table. Conclusions: In this large study cohort, MV index was significantly elevated in patients with significant PMD. Pressure half-time was a marker of prosthetic stenosis and remained normal in patients with isolated regurgitation. When used in combination with pressure half-time, E-velocity and mean gradient, MV index improves the diagnostic yield for PMR by TTE and should allow more appropriate patient selection for TEE evaluation.
http://dx.doi.org/10.1016/j.hlc.2015.06.596
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594 The utility of Technitium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience P. Moore ∗ , E. Mackenzie, P. Law, D. Korczyk, P. Mollee Princess Alexandra Hospital, Woolloongabba, QLD, Australia Introduction: The uptake of bone-seeking radiotracers in the amyloid heart is well recognised. 99m Tc-DPD has been shown to be highly sensitive for cardiac transthyretin (ATTR) amyloid in an overseas population, but is not registered for use in Australia. We explored its utility as a diagnostic tool within our population. Methods: Patients diagnosed with cardiac amyloid (AL) and both wild-type (ATTRwt ) and mutant ATTR (ATTRmut ) according to international consensus criteria were prospectively recruited from the amyloidosis clinic of the Princess Alexandra Hospital. Patients underwent injection with 700 MBq 99mTc-DPD, with planar whole body imaging performed at 5 minutes post-injection (soft tissue phase) and 3 hours (bone phase). A myocardial single-photon emission computed tomography (SPECT) study was acquired after the late whole-body scan. Two nuclear imaging specialists analysed scans independently. Positive cardiac uptake was identified as 99m Tc-DPD uptake on planar imaging. A qualitative system was used to grade the intensity of uptake. Cohen’s coefficient assessed agreement between specialists. Results: 17 patients (8 AL, 7 ATTRwt , 2 ATTRmut ) underwent 99m Tc-DPD scintigraphy. Median age was 62 years (range 57-79), and 16 (94.1%) were male. 99m Tc-DPD scintigraphy was positive in 4 of 8 (50%) AL patients, and 9 of 9 (100%) ATTR patients. Intensity of uptake was greater in the ATTR cohort. Interobserver agreement for planar imaging result was good ( = 0.72; 95% CI, 0.53-0.91). Conclusion: 99m Tc-DPD scintigraphy is highly sensitive for the diagnosis of cardiac ATTR amyloid, but less so for AL amyloid. http://dx.doi.org/10.1016/j.hlc.2015.06.597
S368
593 The utility of mitral valve index in the detection of prosthetic mitral valve dysfunction S. Luis 1,2,3,∗ , L. Blauwet 1 , R. Mehta 1 , H. Samardhi 2 , C. West 2 , C. Luis 2,3 , G. Scalia 2,3 , F. Miller Jr. 1 , D. Burstow 2,3 1 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America 2 Department of Cardiology, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia 3 School of Medicine, University of Queensland, Brisbane, Queensland, Australia
Background: Acoustic shadowing from prosthetic valves provides challenges in the assessment of prosthetic mitral dysfunction (PMD) by transthoracic echocardiography (TTE). We aimed to assess the utility of Doppler parameters, including the ratio of mitral prosthetic to LVOT TVI (MV index) for the detection of PMD. Methods: Retrospective TTE assessment of mitral prostheses was performed. PMD was defined by transoesophageal echocardiography (TEE) performed within 30 days of TTE. Patients with significant LVOT obstruction and ≥moderate aortic regurgitation were excluded. Results: 1088 studies were evaluated including 710 mechanical valves (672 bileaflet, 37 tilting disc and 1 unclassified) and 378 bioprosthetic valves (297 porcine, 63 pericardial and 18 unclassified). The mean heart rate was 79 ± 16bpm, with 58% of TTE studies performed sinus rhythm, 33% in an atrial arrhythmia and 9% in a paced rhythm. Mean left ventricular ejection fraction was 54% ± 14%. Study results are as displayed in table. Conclusions: In this large study cohort, MV index was significantly elevated in patients with significant PMD. Pressure half-time was a marker of prosthetic stenosis and remained normal in patients with isolated regurgitation. When used in combination with pressure half-time, E-velocity and mean gradient, MV index improves the diagnostic yield for PMR by TTE and should allow more appropriate patient selection for TEE evaluation.
http://dx.doi.org/10.1016/j.hlc.2015.06.596
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594 The utility of Technitium-99m-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy in the diagnosis of cardiac amyloidosis: an Australian experience P. Moore ∗ , E. Mackenzie, P. Law, D. Korczyk, P. Mollee Princess Alexandra Hospital, Woolloongabba, QLD, Australia Introduction: The uptake of bone-seeking radiotracers in the amyloid heart is well recognised. 99m Tc-DPD has been shown to be highly sensitive for cardiac transthyretin (ATTR) amyloid in an overseas population, but is not registered for use in Australia. We explored its utility as a diagnostic tool within our population. Methods: Patients diagnosed with cardiac amyloid (AL) and both wild-type (ATTRwt ) and mutant ATTR (ATTRmut ) according to international consensus criteria were prospectively recruited from the amyloidosis clinic of the Princess Alexandra Hospital. Patients underwent injection with 700 MBq 99mTc-DPD, with planar whole body imaging performed at 5 minutes post-injection (soft tissue phase) and 3 hours (bone phase). A myocardial single-photon emission computed tomography (SPECT) study was acquired after the late whole-body scan. Two nuclear imaging specialists analysed scans independently. Positive cardiac uptake was identified as 99m Tc-DPD uptake on planar imaging. A qualitative system was used to grade the intensity of uptake. Cohen’s coefficient assessed agreement between specialists. Results: 17 patients (8 AL, 7 ATTRwt , 2 ATTRmut ) underwent 99m Tc-DPD scintigraphy. Median age was 62 years (range 57-79), and 16 (94.1%) were male. 99m Tc-DPD scintigraphy was positive in 4 of 8 (50%) AL patients, and 9 of 9 (100%) ATTR patients. Intensity of uptake was greater in the ATTR cohort. Interobserver agreement for planar imaging result was good ( = 0.72; 95% CI, 0.53-0.91). Conclusion: 99m Tc-DPD scintigraphy is highly sensitive for the diagnosis of cardiac ATTR amyloid, but less so for AL amyloid. http://dx.doi.org/10.1016/j.hlc.2015.06.597