Can Nuclear Imaging Techniques Predict Patient Outcome and Guide Medical Management in Hereditary Transthyretin Cardiac Amyloidosis?
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Purpose of Review
Nuclear imaging recently gained a key role in the diagnosis and prognostic assessment of transthyretin (TTR)-related cardiac amyloidosis. This review aims at summarizing the state-of-the art regarding the implementation of nuclear imaging in the management of hereditary mutated TTR-cardiac amyloidosis (mTTR-CA).
Although cardiac uptake of bone tracers is acknowledged as a specific marker of TTR amyloid cardiac burden, recent studies validated the implementation of bone scan in the flow chart for non-invasive diagnosis and follow-up of CA in multicenter trials. Simultaneously, cardiac denervation evidenced by MIBG scintigraphy proved to be a strong and independent prognostic marker of poor outcome in mTTR-CA.
By its unique ability to assess both amyloid burden and cardiac denervation, nuclear imaging may prove useful as part of multimodality imaging tools to trigger treatment initiation and monitoring in patients with mTTR-CA.
KeywordsCardiac amyloidosis Nuclear imaging Diagnosis Prognosis
The study has been supported by the Association Française Contre l'Amylose.
Compliance with Ethical Standards
Conflict of Interest
Eve Piekarski and Ludivine Eliahou declare that they have no conflict of interest.
Vincent Algalarrondo reports grants from Medtronic, St. Jude Medical, Sorin, and Boston Scientific.
François Rouzet reports grants from Alnylam and General Electrics.
Dominique Le Guludec reports grants from GE Healthcare, Alnylam, and Advanced Accelerator Application.
Michel S. Slama has received consulting fees from Pfizer, Alnylam, and Eidos, and his department has received a grant from Ionis-GSK.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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