ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis: Part 1 of 2—Evidence Base and Standardized Methods of Imaging

Abstract

accurate recognition at earlier stages. Imaging provides non-invasive tools for follow-up of disease remission/progression complementing clinical evaluation. Additional areas not defined include appropriate clinical indications for imaging, optimal imaging utilization by clinical presentation, accepted imaging methods, accurate image interpretation, and comprehensive and clear reporting. Prospective randomized clinical trial data for the diagnosis of amyloidosis and for imaging-based strategies for treatment are not available. A consensus of expert opinion is greatly needed to guide the appropriate clinical utilization of imaging in cardiac amyloidosis.

Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

“…[ 18 F]FDG PET is mainly applied in AL cardiac amyloidosis, and may be supportive of the usual diagnostic tests in differentiating between systemic amyloidosis (no increased FDG uptake at the amyloid site) and localized amyloidosis (increased FDG uptake at the amyloid site) (82). However, other more specific PET radiopharmaceuticals such as [ 11 (5). In general, AL demonstrates a higher retention of these specific PET compounds as compared with ATTR cardiac amyloidosis (20,83).…”

“…In general, AL demonstrates a higher retention of these specific PET compounds as compared with ATTR cardiac amyloidosis (20,83). SPECT imaging with bone tracers is generally preferred for the assessment of ATTR amyloidosis, although some preliminary research data have suggest [ 18 F]NaF PET might provide similar results to SPECT bone agents but with the opportunity for tracer quantification (5,84).…”

“…Specific PET amyloid-binding radiotracers, structurally similar to thioflavin-T and likely binding to the amyloid fibril structure, are already approved for imaging beta amyloid in Alzheimer's disease (4), such as [ 11 (5,6).…”

Cardiac Care of Patients with Cardiac Amyloidosis

“…However, improvements in the global longitudinal strain can be seen despite the lack of structural changes on echocardiogram [28, 29]. According to the recently published Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis, it is reasonable to use echocardiography to monitor disease progression and response to therapy in CA [30]. In addition, cardiovascular magnetic resonance assessment of LV wall thickness, LV mass, and particularly extracellular volume is emerging as a pivotal tool to assess disease progression and response to therapy [30].…”

“…According to the recently published Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis, it is reasonable to use echocardiography to monitor disease progression and response to therapy in CA [30]. In addition, cardiovascular magnetic resonance assessment of LV wall thickness, LV mass, and particularly extracellular volume is emerging as a pivotal tool to assess disease progression and response to therapy [30]. Importantly, NT-proBNP and high-sensitivity cardiac troponin T (hs-cTnT) are independent prognostic markers in patients with AL and ATTR-CA and are used for disease staging [31-33].…”