Author + information
- Arnt Kristen,
- Scherer Katrin,
- Rebekka Kammerer,
- Fabian aus dem Siepen,
- Hugo A. Katus and
- Henning Steen
We evaluated the impact of different imaging tools for risk assessment in transthyretin (TTR) amyloidosis patients.
30 patients (21 male, 9 female; median age 69.5 years) with ATTR (wild-type n=13, hereditary n=17) were evaluated by cardiac MRI (CMR), and 99mTc-DPD scintigraphy. EDV, ESV, EF and myocardial mass were analyzed on a standard workstation (Philips Viewforum). Longitudinal function was assessed by MAPSE and TAPSE. Atrial septum thickness was measured on SSFP-4chamber views. Gadolinium contrast-enhanced CMR (CE-CMR) was assessed semi-quantitatively (absent=0, weak=1, moderate=2, severe=3) in an AHA modified 16 segment model of the LV as well as for the right/left atrium and right ventricle. Nuclear DPD-retention was assessed semi-quantitatively using a region of interest technique.
Median troponin T 0.02 [0.004; 0.12] µg/L, NT-proBNP 1217 [13; 6977] ng/L, and MDRD 76 [43; 134] mL/(min*1,73m2). By MRI LV mass was 166 [81;354] g, LV ejection fraction 59 [32; 72] %, MAPSE 8 [2; 19] mm, and TAPSE 14 [5; 23] mm). Thickness of atrial septum was 7 [3; 10] mm. CE-CMR was present in 26 patients (87%). Mean sum of semi-quantitative LGE was 27.0+/-2.7 (maximal sum 48). By 99mTc-DPD scintigraphy heart retention was 6.5 [2.2; 9.5] %, heart-to-body retention was 8.0 [3.5; 12.4] %. LV ejection fraction and NT-proBNP correlated well with heart and heart-to-body retention. Furthermore, there was a significant correlation of median of LGE and MDRD with heart retention, but with not with heart-to-body retention. LV mass, MAPSE, TAPSE, thickness of interatrial septum as well as modified body mass index did not correlate with heart and heart-to-body retention. In total, 6 patients died during median survival of 45 (13.6; 79.6) months. Multivariate analysis revealed median of MDRD, LV ejection fraction, and NT-proBNP as independent predictors of survival, but not CE-CMR or scintigraphic heart retention.
This preliminary study demonstrates the potential impact of cardiac MRI and laboratory findings, but not 99mTc-DPD scintigraphy for risk stratification of patients with TTR amyloidosis.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Dilated Cardiomyopathies: From Peripartum, Cancer Therapy, Familial Cardiomyopathies to Cardiac Amyloidosis
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1134-286
- 2013 American College of Cardiology Foundation