Suenaga Hiroki, Fukushima Kenji, Ishii Shiro, Hasegawa Osamu, Muto Yuuki, Yamakuni Ryo, Sugawara Shigeyasu, Sekino Hirofumi, Sato Akihiko, Oikawa Masayoshi, Takeishi Yasuchika, Ito Hiroshi
Department of Radiology and Nuclear Medicine, Fukushima Medical University, Fukushima, Japan.
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Ann Nucl Cardiol. 2024;10(1):16-22. doi: 10.17996/anc.23-00009. Epub 2024 Oct 31.
: We aimed to clarify the clinical characteristics of global and regional myocardial perfusion in patients with transthyretin type of cardiac amyloidosis (ATTR) using dual single-photon emission computed tomography (SPECT) with Tc pyrophosphate (PYP) and TL (TL). : Consecutive 178 (mean age 78±12, male 79) patients known or suspect of ATTR who underwent PYP-TL dual SPECT were retrospectively enrolled. Patients were categorized according to the visual grading for planar PYP uptake using Perugini grading, and the patients with grade greater than or equal to 2 were analyzed. In planar analysis, the heart/contralateral ratio (H/CL) for PYP, and heart/lung ratio (H/L) for TL were obtained to evaluate global myocardial uptake. In TL-SPECT polar map analysis, the heterogeneity of myocardial uptake was evaluated using segmental mean %uptake. Cardiac function and left ventricular function and end-diastolic ventricular mass (LVmass) were measured by echocardiography. : Among 178 patients, 39 patients showed PYP uptake with grade 2 or 3 and H/CL >1.3 (81±5 ys, male 28). Of those, 4 patients showed significant perfusion defect in TL scan. Among 35 patients without perfusion defect, H/L showed a significant inverse correlation to H/CL, and LVmass (r=-0.3, p=0.02; r=-0.4, p=0.03. 95% confidence interval -0.4 to 0.2, and -0.7 to -0.04 for H/CL and LVmass). Polar map analysis demonstrated significantly lower mean %uptake for TL in septum compared to lateral (79.4±8.4 vs. 84.3±6.2, p=0.006 for TL in septum vs. lateral, respectively). : In ATTR, TL uptake surrogated the reduction of global myocardial perfusion. A significant regional heterogeneity was observed with a notable reduction in septum despite the diffuse hypertrophy.
我们旨在通过使用焦磷酸锝（PYP）和替曲膦（TL）的双单光子发射计算机断层扫描（SPECT）来阐明转甲状腺素蛋白型心脏淀粉样变性（ATTR）患者整体和局部心肌灌注的临床特征。连续纳入178例已知或疑似ATTR且接受PYP-TL双SPECT检查的患者（平均年龄78±12岁，男性79例）。根据使用佩鲁吉尼分级对平面PYP摄取的视觉分级对患者进行分类，并对分级大于或等于2的患者进行分析。在平面分析中，获取PYP的心脏/对侧比值（H/CL）和TL的心脏/肺比值（H/L）以评估整体心肌摄取。在TL-SPECT极坐标图分析中，使用节段平均摄取百分比评估心肌摄取的异质性。通过超声心动图测量心功能、左心室功能和舒张末期心室质量（LVmass）。在178例患者中，39例患者PYP摄取分级为2或3且H/CL>1.3（81±5岁，男性28例）。其中，4例患者在TL扫描中显示明显的灌注缺损。在35例无灌注缺损的患者中，H/L与H/CL以及LVmass呈显著负相关（r=-0.3，p=0.02；r=-0.4，p=0.03。H/CL和LVmass的95%置信区间分别为-0.4至0.2和-0.7至-0.04）。极坐标图分析显示，与侧壁相比，TL在间隔的平均摄取百分比显著降低（TL在间隔与侧壁分别为79.4±8.4对84.3±6.2，p=0.006）。在ATTR中，TL摄取替代了整体心肌灌注的降低。观察到明显的区域异质性，尽管存在弥漫性肥厚，但间隔有明显减少。
