Harapoz Mehmet, Evans Scott, Geenty Paul, Kwok Fiona, Stewart Graeme, Taylor Mark S, Farlow David, Thomas Liza
Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
Front Cardiovasc Med. 2021 Oct 15;8:663929. doi: 10.3389/fcvm.2021.663929. eCollection 2021.
There has been a paradigm shift in diagnosis of cardiac transthyretin amyloidosis (ATTR) with non-invasive techniques including technetium-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (Tc-DPD) bone scintigraphy. We evaluated structural and functional biventricular alterations by transthoracic echocardiography (TTE) and determined the correlation with Tc-DPD tracer uptake in ATTR. ATTR patients (wild-type, hereditary or asymptomatic transthyretin [] variant carriers) with Tc-DPD and TTE were selected; Tc-DPD uptake was analyzed quantitatively. TTE assessment of left ventricle (LV) and right ventricle (RV) parameters was performed. Forty ATTR patients (wild-type = 17; hereditary ATTR and variant carriers = 23; median age 68.8 ± 22 years) were included. TTE parameters displaying good correlation with Tc-DPD tracer uptake included LV average wall thickness ( = 0.837), LV indexed mass (LVMI; = 0.802), RV wall thickness ( = 0.610), average e' ( = -0.830), E/e' ratio ( = 0.786), LV global longitudinal strain (GLS; = 0.714) and RV GLS ( = 0.632; < 0.001 for all). Hereditary ATTR and variant carriers without cardiac tracer uptake had normal echocardiographic parameters. Receiver operating characteristic curves demonstrated strong diagnostic accuracies for structural (LV wall thickness, LVMI and RV wall thickness; area under the curve (AUC) of 0.96 for all) and functional (LV and RV GLS; AUC of 0.86 and 0.88, respectively) parameters. Good correlations between TTE biventricular structural and functional parameters were demonstrated with quantitative Tc-DPD uptake. Echocardiography may potentially assume a significant role in longitudinal follow-up for monitoring disease progression and for evaluating treatment response.
包括锝-99m 3,3-二膦酰基-1,2-丙烷二羧酸（Tc-DPD）骨闪烁显像在内的非侵入性技术，已使心脏转甲状腺素蛋白淀粉样变性（ATTR）的诊断发生了范式转变。我们通过经胸超声心动图（TTE）评估双心室的结构和功能改变，并确定其与ATTR中Tc-DPD示踪剂摄取的相关性。选择了接受Tc-DPD和TTE检查的ATTR患者（野生型、遗传性或无症状转甲状腺素蛋白[]变异携带者）；对Tc-DPD摄取进行定量分析。对左心室（LV）和右心室（RV）参数进行TTE评估。纳入了40例ATTR患者（野生型 = 17例；遗传性ATTR和变异携带者 = 23例；中位年龄68.8±22岁）。与Tc-DPD示踪剂摄取显示出良好相关性的TTE参数包括LV平均壁厚（ = 0.837）、LV指数质量（LVMI； = 0.802）、RV壁厚（ = 0.610）、平均e'（ = -0.830）、E/e'比值（ = 0.786）、LV整体纵向应变（GLS； = 0.714）和RV GLS（ = 0.63）；所有参数的P均<0.001）。无心脏示踪剂摄取的遗传性ATTR和变异携带者的超声心动图参数正常。受试者工作特征曲线显示，结构参数（LV壁厚、LVMI和RV壁厚；曲线下面积（AUC）均为0.96）和功能参数（LV和RV GLS；AUC分别为0.86和0.88）具有很强的诊断准确性。定量Tc-DPD摄取与TTE双心室结构和功能参数之间显示出良好的相关性。超声心动图可能在监测疾病进展和评估治疗反应的纵向随访中发挥重要作用。
