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Amyloid
The Journal of Protein Folding Disorders
Volume 29, 2022 - Issue 1
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Articles

The role of serial 99mTc-DPD scintigraphy in monitoring cardiac transthyretin amyloidosis

ORCID Icon, , , , , , , , & ORCID Icon show all
Pages 38-49 | Received 19 Jun 2021, Accepted 05 Oct 2021, Published online: 27 Oct 2021
 

Abstract

Purpose

Cardiac transthyretin amyloidosis is a usually fatal form of restrictive cardiomyopathy for which clinical trials of treatments are ongoing. It is anticipated that quantitative nuclear medicine scintigraphy, which is experiencing growing interest, will soon be used to evaluate treatment efficacy. We investigated its utility for monitoring changes in disease load over a significant time period.

Methods

Sixty-two treatment-naive patients underwent 99mTc-labelled 3,3-diphosphono-1,2propanodicarboxylic acid (99mTc-DPD) scintigraphy two to four times each over a five-year period. Quantitation of cardiac 99mTc-DPD retention was performed according to two established methods: measurement of heart-to-contralateral ratio (H/CL) in the anterior view (planar) and percentage of administered activity in the myocardium (SPECT).

Results

In total 170 datasets were analysed. Increased myocardial retention of 99mTc-DPD was demonstrable as early as 12 months from baseline. Year-on-year progression across the cohort was observed using SPECT-based quantitation, though on 30 occasions (27.8%) the change in our estimate was negative.

Conclusions

The spread of our results was notably high compared to the year-on-year increases. If left unaccounted for, variance may draw fallacious conclusions about changes in disease load. We therefore urge caution in drawing conclusions solely from nuclear medicine scintigraphy on a patient-by-patient basis, particularly across a short time period.

Disclosure statement

The authors report nothing declare.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

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