Prognostic implication of DPD quantification in transthyretin cardiac amyloidosis.

IF 6.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Imaging Pub Date : 2024-11-15 DOI:10.1093/ehjci/jeae295

René Rettl, Franz Duca, Christina Kronberger, Christina Binder, Robin Willixhofer, Nikita Ermolaev, Michael Poledniczek, Felix Hofer, Christian Nitsche, Christian Hengstenberg, Roza Badr Eslam, Johannes Kastner, Jutta Bergler-Klein, Marcus Hacker, Raffaella Calabretta, Andreas A Kammerlander

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引用次数: 0

Abstract

Aims: Quantification of cardiac [99mTc]-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) uptake enhances diagnostic capabilities and may facilitate prognostic stratification in patients with transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to evaluate the association of quantitative left ventricular (LV) DPD uptake with myocardial structure and function, and their implications on outcome in ATTR-CA.

Methods and results: Consecutive ATTR-CA patients (n=100) undergoing planar DPD scintigraphy with Perugini grade 2 or 3, alongside quantitative DPD SPECT/CT imaging and speckle-tracking echocardiography between 2019 and 2023, were included and divided into two cohorts based on median DPD retention index (low DPD uptake: ≤5.4, n=50; high DPD uptake: >5.4, n=50). The DPD retention index showed significant, albeit weak to modest, correlations with LV global longitudinal strain (LV-GLS: r=0.366,p<0.001), right ventricular free wall longitudinal strain (RV-FW-LS: r=0.316,p=0.002), LV diastolic function (E/e' average: r=0.304, p=0.013), NT-proBNP (r=0.332,p<0.001), troponin T (r=0.233,p=0.022), 6-minute walk distance (6MWD: r=-0.222,p=0.033) and National Amyloidosis Centre (NAC) stage (r=0.294,p=0.003). ATTR-CA patients in the high DPD uptake cohort demonstrated more advanced disease severity regarding longitudinal cardiac function (LV-GLS: p=0.012, RV-FW-LS: p=0.036), LV diastolic function (E/e' average: p=0.035), cardiac biomarkers (NT-proBNP: p=0.012, troponin T: p=0.044), exercise capacity (6MWD: p=0.035) and disease stage (NAC stage I: p=0.045, III: p=0.006), and experienced adverse outcomes compared to the low DPD uptake cohort [composite endpoint: all-cause death or heart failure hospitalization, HR: 2.873 (95%CI:1.439-5.737), p=0.003; DPD retention index: adjusted HR 1.221 (95%CI: 1.078-1.383), p=0.002].

Conclusion: In ATTR-CA, enhanced quantitative LV DPD uptake indicates advanced disease severity and is associated with adverse outcome. DPD quantification may facilitate prognostic stratification when diagnosing patients with ATTR-CA.

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转甲状腺素心脏淀粉样变性中 DPD 定量的预后意义。

目的：对心脏[99m锝]-3,3-二磷酸-1,2-丙二羧酸（DPD）摄取量进行定量分析可提高诊断能力，并有助于对转甲状腺素心脏淀粉样变性（ATTR-CA）患者进行预后分层。本研究旨在评估左心室（LV）DPD定量摄取与心肌结构和功能的关联及其对ATTR-CA预后的影响：在2019年至2023年期间，连续接受平面DPD闪烁成像、Perugini 2级或3级、定量DPD SPECT/CT成像和斑点追踪超声心动图检查的ATTR-CA患者（n=100）被纳入其中，并根据中位DPD保留指数分为两个队列（低DPD摄取：≤5.4，n=50；高DPD摄取：>5.4，n=50）。DPD保留指数与左心室整体纵向应变（LV-GLS：r=0.366,pConclusion）呈显著相关性，尽管相关性较弱：在ATTR-CA中，左心室DPD定量摄取增强表明疾病的严重程度达到晚期，并与不良预后相关。在诊断 ATTR-CA 患者时，DPD 定量可能有助于预后分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Heart Journal - Cardiovascular Imaging CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

9.70%

发文量

708

审稿时长

4-8 weeks

期刊介绍： European Heart Journal – Cardiovascular Imaging is a monthly international peer reviewed journal dealing with Cardiovascular Imaging. It is an official publication of the European Association of Cardiovascular Imaging, a branch of the European Society of Cardiology. The journal aims to publish the highest quality material, both scientific and clinical from all areas of cardiovascular imaging including echocardiography, magnetic resonance, computed tomography, nuclear and invasive imaging. A range of article types will be considered, including original research, reviews, editorials, image focus, letters and recommendation papers from relevant groups of the European Society of Cardiology. In addition it provides a forum for the exchange of information on all aspects of cardiovascular imaging.