Vergaro Giuseppe, Aimo Alberto, Genovesi Dario, Soares Bezerra Lucas, Castiglione Vincenzo, Fabiani Iacopo, Barison Andrea, Panichella Giorgia, Del Giudice Maria Livia, Camerini Lara, Dugo Giovanni, Chubuchna Olena, Giorgetti Assuero, Buda Gabriele, Emdin Michele
Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Piazza Martiri della Liberta´ 33, 56127 Pisa, Italy.
Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Via Moruzzi 1, 56124 Pisa, Italy.
Eur Heart J Cardiovasc Imaging. 2025 Mar 3;26(3):500-508. doi: 10.1093/ehjci/jeae332.
The positron emission tomography (PET) tracer 18F-florbetaben is a promising diagnostic tool for light-chain cardiac amyloidosis (AL-CA). A greater cardiac uptake might signal more amyloid burden and a worse outcome. We aimed to assess the prognostic significance of 18F-florbetaben uptake in AL-CA.
Consecutive patients with AL-CA underwent 18F-florbetaben PET scans. Total amyloid burden (TAB; calculated as mean standardized uptake value multiplied by molecular volume) was assessed in the left and right ventricles (LV/RV) in early (5-15') and late (50-60') acquisitions. The endpoint was all-cause mortality. Forty patients (median age 69 years, 73% males, Mayo 2004 Stage III in 80%) underwent 18F-florbetaben PET with a median time from tissue biopsy of 21 days (interquartile range, IQR 7-83). Late LV TAB, but not early LV TAB, correlated with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity (hs)-troponin T. Over 13 months after the PET scan (IQR 5-21), 65% of patients died. A late LV TAB ≥273 cm3 (cut-off derived from spline curve analysis) predicted 18 and 24 month all-cause mortality independently from baseline variables, including NT-proBNP, hs-troponin T, and Mayo 2004 stage. Late RV TAB ≥135 cm3 independently predicted 18 and 24 month all-cause mortality. Patients with both late LV and RV TAB ≥ cut-offs had a shorter survival than those with only LV TAB ≥ cut-off and those with TAB in both ventricles < cut-offs (Log-rank 16.52, P < 0.001).
18F-florbetaben PET imaging offers valuable prognostic information in AL-CA. Values of late TAB measured in the LV and RV are strong predictors of all-cause mortality.
正电子发射断层扫描（PET）示踪剂18F-氟贝他宾是用于轻链型心脏淀粉样变性（AL-CA）的一种很有前景的诊断工具。较高的心脏摄取可能预示着更多的淀粉样蛋白负荷和更差的预后。我们旨在评估18F-氟贝他宾摄取在AL-CA中的预后意义。
连续的AL-CA患者接受了18F-氟贝他宾PET扫描。在早期（5 - 15分钟）和晚期（50 - 60分钟）采集时评估左心室和右心室的总淀粉样蛋白负荷（TAB；计算为平均标准化摄取值乘以分子体积）。终点为全因死亡率。40例患者（中位年龄69岁，73%为男性，80%处于Mayo 2004 III期）接受了18F-氟贝他宾PET检查，距组织活检的中位时间为21天（四分位间距，IQR 7 - 83）。晚期左心室TAB与N端前脑钠肽（NT-proBNP）和高敏（hs）肌钙蛋白T相关，但早期左心室TAB与之无关。在PET扫描后超过13个月（IQR 5 - 21），65%的患者死亡。晚期左心室TAB≥273 cm³（通过样条曲线分析得出的截断值）独立于基线变量（包括NT-proBNP、hs肌钙蛋白T和Mayo 2004分期）预测18个月和24个月的全因死亡率。晚期右心室TAB≥135 cm³独立预测18个月和24个月的全因死亡率。晚期左心室和右心室TAB均≥截断值的患者比仅左心室TAB≥截断值的患者以及双心室TAB均<截断值的患者生存期更短（对数秩检验16.52，P < 0.001）。
18F-氟贝他宾PET成像在AL-CA中提供了有价值的预后信息。在左心室和右心室测量的晚期TAB值是全因死亡率的有力预测指标。
