Department of Nuclear Medicine, Taipei Veterans General Hospital, No.201, Section 2, Shipai Road, Beitou District, Taipei City, 11217, R.O.C, Taiwan.
Department of Nuclear Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan.
Jpn J Radiol. 2023 Aug;41(8):882-888. doi: 10.1007/s11604-023-01403-4. Epub 2023 Mar 15.
Tafamidis has been used for treatment of transthyretin cardiac amyloidosis (ATTR-CA). However, Tc-99 m pyrophosphate (PYP) cardiac scan for follow-up after tafamidis therapy has not been reported.
From May 2017 to March 2022, five patients with or without tafamidis therapy had received two Tc-99 m PYP cardiac scans. Tc-99 m PYP cardiac scan was performed with planar image and single photon emission computed tomography/computed tomography (SPECT/CT) 3 h after administration of Tc-99 m PYP. Perugini grading system was applied to determine positive or negative result of the scan. Heart to contralateral lung (H/CL) ratio as well as the difference of H/CL ratio between first and second Tc-99 m PYP cardiac scans (ΔH/CL ratio) was calculated.
In the five patients participated in this study, three received tafamidis therapy and H/CL ratio was significantly decreased (p = 0.02) after tafamidis therapy. Besides, the ΔH/CL ratio was larger in patients with tafamidis therapy than that in those without tafamidis therapy, albeit not reaching statistical significance (p = 0.2).
A decrease in H/CL ratio was found after tafamidis therapy in patients with ATTR-CA, albeit the magnitude of changes in the H/CL ratio (ΔH/CL ratio) was not significantly different from that of patients without tafamidis therapy. Future study with larger population might be required to further clarify the effect of tafamidis therapy on myocardial uptake of Tc-99 m PYP.
No clinical trial was conducted in our retrospective study.
他司美替尼已被用于治疗转甲状腺素蛋白心脏淀粉样变性（ATTR-CA）。然而，他司美替尼治疗后的 Tc-99m 焦磷酸盐（PYP）心脏扫描尚未见报道。
从 2017 年 5 月至 2022 年 3 月，5 名接受或未接受他司美替尼治疗的患者接受了两次 Tc-99m PYP 心脏扫描。Tc-99m PYP 心脏扫描在给予 Tc-99m PYP 后 3 小时进行，采用平面图像和单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）。应用佩鲁吉尼分级系统判断扫描结果的阳性或阴性。计算心脏与对侧肺（H/CL）比值以及两次 Tc-99m PYP 心脏扫描之间的 H/CL 比值差异（ΔH/CL 比值）。
在本研究中，5 名患者中有 3 名接受了他司美替尼治疗，治疗后 H/CL 比值显著降低（p=0.02）。此外，接受他司美替尼治疗的患者的ΔH/CL 比值大于未接受他司美替尼治疗的患者，尽管差异无统计学意义（p=0.2）。
在 ATTR-CA 患者中，我们发现他司美替尼治疗后 H/CL 比值降低，尽管 H/CL 比值的变化幅度（ΔH/CL 比值）与未接受他司美替尼治疗的患者无显著差异。可能需要进行更大规模的研究以进一步阐明他司美替尼治疗对 Tc-99m PYP 心肌摄取的影响。
在我们的回顾性研究中，没有进行临床试验。
