Optimal Echocardiographic Parameters to Improve the Diagnostic Yield of Tc-99m-Bone Avid Tracer Cardiac Scintigraphy for Transthyretin Cardiac Amyloidosis. (15th November 2022)

• Record Type: Journal Article
• Authors: Cuddy, Sarah AM; Datar, Yesh; Ovsak, Gavin; Saith, Sunil; Murphy, Sean P.; Bay, Camden P.; Haddad, Mia; Lilleness, Brian; Muralidhar, Varsha; Pipilas, Alexandra; Vuong, Jacqueline; Guardino, Eric; Maurer, Mathew S.; Ruberg, Frederick L.; Falk, Rodney H.; Dorbala, Sharmila
• Is Part Of: Circulation. Volume 15:Number 11(2022)
• Page Start: e014645
• Publication Date: 2022-11-15
• Subjects: amyloidosis -- cardiomyopathy -- echocardiography -- transthyretin; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.122.014645
• Languages: English
• ISSNs: 1941-9651

Abstract

Abstract : Background: Echocardiographic deformation-based ratios and novel multi-parametric scores have been suggested to discriminate transthyretin cardiac amyloidosis (ATTR-CM) from other causes of increased left ventricular wall thickness among patients referred for ATTR-CM evaluation. Their relative predictive accuracy has not been well studied. We sought to (1) identify echocardiographic parameters predictive of ATTR-CM and (2) compare the diagnostic accuracy of these parameters in patients with suspected ATTR-CM referred for technetium-99m-pyrophosphate scintigraphy. Methods: Echocardiograms from 598 patients referred to 3 major amyloidosis centers for technetium-99m-pyrophosphate to detect ATTR-CM were analyzed, including longitudinal strain (LS) analysis. Deformation ratios (septal apex to base ratio, relative apical sparing, ejection fraction to global LS), a multi-center European increased wall thickness score, and Mayo Clinic derived ATTR score (transthyretin cardiac amyloidosis score) were calculated. A logistic regression model was used to identify the parameters that best associated with a diagnosis of ATTR-CM. Comparison of the diagnostic capacity of the parameters was performed by receiver operating characteristic curves and the area under the curve (AUC). Results: Over half of the subjects (54.2%) were diagnosed with ATTR-CM (78% were men, median age of 76 years). Age, inferolateral wall thickness, and basal LS were the strongest predictors of ATTR-CM, AUC of 0.87 (95% CI: 0.83, 0.90), superior to the increased wall thickness score AUC of 0.78 (95% CI: 0.73, 0.83; P =0.004). An inferolateral wall thickness of ≥14 mm (AUC: 0.73) was as accurate as the published cut-offs for transthyretin cardiac amyloidosis score and septal apex to base (AUC: 0.72 and 0.69, P =0.8 and P =0.1, respectively), and was superior to ejection fraction to global LS and relative apical sparing (AUC: 0.64 and 0.53, P <0.001, respectively). A cut-off of ≥−8% for average basal LS (AUC: 0.76, CI: 0.72–0.79) had a similar area under the curve to transthyretin cardiac amyloidosis score (TCAS) ( P =0.2); outperforming the other indices ( P <0.01). Conclusion: Inferolateral wall thickness and average basal LS performed as well as or better than more complex echo ratios and multiparametric scores to predict ATTR-CM.