Heart failure & cardiomyopathies
Tc-99m labelled bone scintigraphy in suspected cardiac amyloidosis
Authors' conclusion
The NBDC for ATTR-CM are highly specific [97% (95% CI 0.91-0.99)] in clinical setting, and diagnostic performance was further refined here using new cut-offs for sFLC ratio in patients with CKD. A grade 0 radionuclide scan all but excludes ATTR-CM but occurs in most patients with AL-CA. Grade 1 scans in patients with CA and no MG are strongly suggestive of early ATTR-type, but require urgent histologic corroboration.
Study context
- Population
- Patients with suspected or histologically proven cardiac amyloidosis referred to specialist centres, 2015–2021
- Participants
- 3,354 patients
- Comparison
- Bone scintigraphy-based non-biopsy diagnostic criteria (NBDC) for ATTR-CM in clinical practice
- Grade 2 or 3n = 2,080
- Grade 1n = 183
- Grade 0n = 1,091
- Outcome
- Performance of bone scintigraphy-based NBDC for ATTR-CM; Serum free light chain (sFLC) ratio cut-offs excluding MG in CKD
Methodological detailsmultinational, specialist centres
- Multinational
- Specialist centres
Performance
As reported in the abstract
NBDC for ATTR-CM
| Test or model | Value | Fulfilled NBDC | Biopsied with amyloid, all ATTR type | Cardiac amyloidosis (CA) | AL-CA among CA | ATTR-CM | Monoclonal gammopathy (MG) | AL-CA among MG | ATTR-CM without MG |
|---|---|---|---|---|---|---|---|---|---|
| Grade 2 or 3 | 79% | 1636/2080 | 403 | ||||||
| Grade 0 | 26% | 284 (26%) | 276 (97%) | 1 | |||||
| Grade 1 | 122 | 106 (87%) | 60/61 (98%) |
Value
Grade 2 or 379%
Grade 026%
Grade 1— not stated in the abstract
Fulfilled NBDC
Grade 2 or 31636/2080
Grade 0— not stated in the abstract
Grade 1— not stated in the abstract
Biopsied with amyloid, all ATTR type
Grade 2 or 3403
Grade 0— not stated in the abstract
Grade 1— not stated in the abstract
Cardiac amyloidosis (CA)
Grade 2 or 3— not stated in the abstract
Grade 0284 (26%)
Grade 1— not stated in the abstract
AL-CA among CA
Grade 2 or 3— not stated in the abstract
Grade 0276 (97%)
Grade 1— not stated in the abstract
ATTR-CM
Grade 2 or 3— not stated in the abstract
Grade 01
Grade 1— not stated in the abstract
Monoclonal gammopathy (MG)
Grade 2 or 3— not stated in the abstract
Grade 0— not stated in the abstract
Grade 1122
AL-CA among MG
Grade 2 or 3— not stated in the abstract
Grade 0— not stated in the abstract
Grade 1106 (87%)
ATTR-CM without MG
Grade 2 or 3— not stated in the abstract
Grade 0— not stated in the abstract
Grade 160/61 (98%)
- Specificity of NBDC for ATTR-CM
- 97% (95% CI 0.91-0.99)
Further findings
Survival, biopsied vs non-biopsied ATTR-CM
- Survival comparable
- P = 0.10
Original publication
Tc-99m labelled bone scintigraphy in suspected cardiac amyloidosis. Eur Heart J. Published 22 March 2023. doi:10.
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