Falk R H, Lee V W, Rubinow A, Hood W B, Cohen A S
Am J Cardiol. 1983 Mar 1;51(5):826-30. doi: 10.1016/s0002-9149(83)80140-4.
To determine the value of technetium-99m-pyrophosphate myocardial scintigraphy in the diagnosis of amyloid heart disease this procedure was prospectively performed in 20 consecutive patients with biopsy-proven primary amyloidosis. Eleven patients had echocardiographic abnormalities compatible with amyloid cardiomyopathy, 9 of whom had congestive heart failure. Diffuse myocardial pyrophosphate uptake was of equal or greater intensity than that of the ribs in 9 of the 11 patients with echocardiograms suggestive of amyloidosis, but in only 2 of the 9 with normal echocardiograms, despite abnormal electrocardiograms (p less than 0.01). Increased wall thickness measured by M-mode echocardiography correlated with myocardial pyrophosphate uptake (r = 0.68, p less than 0.01). None of 10 control patients with nonamyloid, nonischemic heart disease had a strongly positive myocardial pyrophosphate uptake. Thus, myocardial technetium-99m-pyrophosphate scanning is a sensitive and specific test for the diagnosis of cardiac amyloidosis in patients with congestive heart failure of obscure origin. It does not appear to be of value for the early detection of cardiac involvement in patients with known primary amyloidosis without echocardiographic abnormalities.
为确定锝-99m焦磷酸盐心肌闪烁显像在淀粉样心脏病诊断中的价值，对连续20例经活检证实为原发性淀粉样变性的患者前瞻性地进行了该检查。11例患者有与淀粉样心肌病相符的超声心动图异常，其中9例有充血性心力衰竭。在11例超声心动图提示淀粉样变性的患者中，9例心肌焦磷酸盐摄取呈弥漫性，强度等于或大于肋骨，但在9例超声心动图正常的患者中只有2例如此，尽管心电图异常（p<0.01）。M型超声心动图测量的室壁增厚与心肌焦磷酸盐摄取相关（r = 0.68，p<0.01）。10例非淀粉样、非缺血性心脏病对照患者中无一例心肌焦磷酸盐摄取呈强阳性。因此，锝-99m焦磷酸盐心肌扫描是诊断病因不明的充血性心力衰竭患者心脏淀粉样变性的一项敏感且特异的检查。对于已知原发性淀粉样变性且无超声心动图异常的患者，该检查似乎对早期发现心脏受累无价值。
