Microvascular dysfunction assessed by dynamic cardiac SPECT in subjects with cardiac transthyretin amyloidosis

M. Bailly , A. Bisson , M. Courtehoux , N. Chane-Sone , A. Bernard
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Abstract

Introduction

Few studies found that coronary microvascular dysfunction was highly prevalent in subjects with cardiac transthyretin amyloidosis (ATTR), even in the absence of epicardial coronary artery disease (CAD). The aim of this preliminary report is to confirm the coronary microvascular dysfunction using dynamic cardiac SPECT.

Method

Adult patients with confirmed ATTR cardiomyopathy were included before Tafamidis treatment in a multicentric, prospective, observational cohort study (AMYTRE study, NCT05103943). Dynamic cardiac SPECT data were acquired on CZT-based pinhole cardiac cameras in listmode using a stress (249 ± 13 MBq)/rest (506 ± 17 MBq) one-day 99mTc-tetrofosmin protocol. Kinetic analysis was done with Corridor4DMTM software using a 1-tissue-compartment model and converted to myocardial blood flow using a previously determined extraction fraction correction. Myocardial flow reserve (MFR) was defined as the ratio between stress and rest myocardial blood flow.

Results

Thirteen (9 male, 4 female) patients were prospectively included. Mean age was 77 ± 18; mean BMI was 28 ± 8.1. ATTR was diagnosed on 99mTc-HDP bone scintigraphy (8 grade 2 and 5 grade 3). LVEF was preserved, mean 57 ± 7.5%. Twelve patients had normal perfusion imaging, without ischemia; 1 patient had moderate infero-basal ischemia (5–10% extent). MFR was significantly reduced both globally (1.5 ± 0.35) and in all territories (1.5 ± 0.34 for left anterior descending, 1.6 ± 0.39 for left circumflex, and 1.6 ± 0.45 for right coronary).

Conclusion

In this preliminary report, MFR is significantly reduced in all territories in patients with ATTR cardiomyopathy, undergoing cardiac dynamic SPECT. This confirms potential coronary microvascular dysfunction.

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动态心脏SPECT评估心脏转甲状腺蛋白淀粉样变患者微血管功能障碍
很少有研究发现,即使在没有心外膜冠状动脉疾病(CAD)的情况下,冠状动脉微血管功能障碍在心脏转甲状腺蛋白淀粉样变性(ATTR)患者中也非常普遍。本初步报告的目的是利用动态心脏SPECT确认冠状动脉微血管功能障碍。方法在一项多中心、前瞻性、观察性队列研究(AMYTRE研究,NCT05103943)中,纳入了在他法非地治疗前确诊为ATTR型心肌病的成年患者。采用应力(249±13 MBq)/休息(506±17 MBq) 1天99mTc-tetrofosmin方案,在基于cz的针孔心脏相机上获取动态心脏SPECT数据。动力学分析使用Corridor4DMTM软件进行,采用1组织室模型,并使用先前确定的提取分数校正转换为心肌血流量。心肌血流储备(MFR)定义为应激与静止心肌血流之比。结果前瞻性纳入13例患者,其中男9例,女4例。平均年龄77±18岁;平均BMI为28±8.1。99mTc-HDP骨显像诊断为ATTR(2级8例,3级5例),LVEF保留,平均57±7.5%。12例灌注成像正常,无缺血;1例中度基底下缺血(5-10%)。MFR在全球范围内(1.5±0.35)和所有区域均显著降低(左前降支1.5±0.34,左旋支1.6±0.39,右冠状动脉1.6±0.45)。在这份初步报告中,接受心脏动态SPECT的ATTR心肌病患者的MFR在所有区域均显著降低。这证实了潜在的冠状动脉微血管功能障碍。
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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
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发文量
508
期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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