心肌灌注断层显像技术摄取锝 99m-焦磷酸盐标记的骨显像剂与心房颤动的关系。

Association Between Atrial Uptake on Cardiac Scintigraphy With Technetium-99m-Pyrophosphate Labeled Bone-Seeking Tracers and Atrial Fibrillation.

机构信息

Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, OH (M. Hussain., A.K., E.D., T.M., O.A.H., S.A., W.H.T., D.K., P. Cremer, M.K., B.G., C.T., E.R.R., M. Hanna, W.J., P. Collier).

School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, United Kingdom (C.W.).

出版信息

Circ Cardiovasc Imaging. 2022 May;15(5):e013829. doi: 10.1161/CIRCIMAGING.121.013829. Epub 2022 May 17.

DOI:10.1161/CIRCIMAGING.121.013829

PMID:35580157

Abstract

BACKGROUND

Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized disease, in which atrial fibrillation (AF) has been shown to be prevalent. Cardiac scintigraphy with technetium-99m-pyrophosphate (99mTc-PyP) labeled bone-seeking tracers is used to noninvasively make the diagnosis of ATTR-CA, based on ventricular myocardial uptake. Assessment of atrial wall uptake (AU) on 99mTc-PyP is currently not used in the clinical setting Methods: We analyzed a cohort of patients referred for 99mTc-PyP scan at a tertiary center to explore AU and associations between any and incident AF, ATTR-CA, and all-cause mortality.

RESULTS

Among 580 patients included, 296 patients (51%) had a diagnosis of AF; 164 patients (28%) had scans consistent with ATTR-CA while 117 patients (20%) had AU. Of 117 patients with AU, 107 (91%) had any AF. In contrast, of 463 patients without AU 191(41%) had any AF. Of those with AU, 59/117(50%) patients had a 99mTc-PyP diagnosis of ATTR-CA while 58/117(50%) patients did not have such a diagnosis (=1.00). Patients with AU had significantly more any AF (hazard ratio [HR], 1.03 [95% CI, 1.02-1.04]; <0.001), independent of ATTR-CA diagnosis and sex. On multivariable Cox proportional hazards analyses adjusting for age, AU, ATTR-CA diagnosis, sex, smoking, hypertension, diabetes, left ventricular ejection fraction, and coronary artery disease, both age (HR, 1.03 [95% CI, 1.02-1.04]; <0.0001) and AU (HR, 2.68 [95% CI, 2.11-3.41]; <0.0001) were independently associated with the development of any AF. Freedom from incident AF at 1-year was significantly lower in patients with AU, both in patients with and without ATTR-CA respectively (HR, 2.27 [95% CI, 1.37-3.78]; <0.0001 versus HR, 2.21 [95% CI, 1.46-3.34]; <0.0001).

CONCLUSIONS

In a consecutive cohort of patients undergoing 99mTc-PyP scans, 20% had AU, which was statistically associated with any AF, independently of ATTR-CA diagnosis and sex. AU was associated with significantly lower freedom from incident AF at 1-year. Overlooking AU on 99mTc-PyP scans could potentially miss an earlier disease manifestation, or an additional risk factor for any/incident AF.

摘要

背景

转甲状腺素蛋白心脏淀粉样变（ATTR-CA）是一种日益被认识的疾病，其中心房颤动（AF）较为普遍。使用锝-99m-焦磷酸盐（99mTc-PyP）标记的骨骼寻找示踪剂进行心脏闪烁照相术可无创地做出ATTR-CA 的诊断，其依据是心室心肌摄取。目前，在临床环境中不使用 99mTc-PyP 评估心房壁摄取（AU）。

方法

我们分析了一个在三级中心进行 99mTc-PyP 扫描的患者队列，以探讨 AU 与任何 AF、ATTR-CA 和全因死亡率之间的关联。

结果

在 580 名患者中，296 名患者（51%）患有 AF；164 名患者（28%）的扫描结果符合 ATTR-CA，而 117 名患者（20%）有 AU。在有 AU 的 117 名患者中，107 名（91%）有任何 AF。相比之下，在 463 名没有 AU 的患者中，有 191 名（41%）有任何 AF。在有 AU 的患者中，59/117（50%）名患者的 99mTc-PyP 诊断为 ATTR-CA，而 58/117（50%）名患者没有这样的诊断（=1.00）。有 AU 的患者发生任何 AF 的几率明显更高（风险比 [HR]，1.03 [95%CI，1.02-1.04]；<0.001），与 ATTR-CA 诊断和性别无关。在调整年龄、AU、ATTR-CA 诊断、性别、吸烟、高血压、糖尿病、左心室射血分数和冠状动脉疾病后，多变量 Cox 比例风险分析表明，年龄（HR，1.03 [95%CI，1.02-1.04]；<0.0001）和 AU（HR，2.68 [95%CI，2.11-3.41]；<0.0001）与任何 AF 的发生均独立相关。在有 AU 和没有 AU 的患者中，分别有 AU 的患者在 1 年内发生任何 AF 的风险明显更低（HR，2.27 [95%CI，1.37-3.78]；<0.0001 与 HR，2.21 [95%CI，1.46-3.34]；<0.0001）。