Pursuing an underdiagnosed disease: a simple imaging test for increasing suspicion of cardiac amyloidosis

Falk, Rodney H.; Dorbala, Sharmila

doi:10.1007/s00259-011-1727-y

Cited by 5 publications

(3 citation statements)

References 23 publications

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“…However, despite normocalcemia, our patient had hypoalbuminemia. As hypothesized by Falk and colleagues [7], hypoalbuminemia may allow altered tracer dynamics and higher isotope availability for the myocardium leading to a false positive. Other false positive cases will need to be reported to help determine the importance of these parameters.…”

Section: Contents Lists Available At Sciencedirectmentioning

confidence: 96%

Non-invasive imaging for cardiac amyloidosis — Delaying the obvious?

Ashley

Ding

Pimentel

2014

International Journal of Cardiology

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Section: Contents Lists Available At Sciencedirectmentioning

confidence: 96%

Non-invasive imaging for cardiac amyloidosis — Delaying the obvious?

Ashley

Ding

Pimentel

2014

International Journal of Cardiology

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“…Technetium ( 99m Tc)-based isotopes can identify cardiac involvement with amyloidosis, but have variable sensitivity and specificity for different types; for example, 99m Tc-3,3-diphosphono-1,2-propanocarboxylic acid, an agent not available in the USA, has a preference for cardiac uptake in ATTR versus AL [60]. Similarly, technetium pyrophosphate is a sensitive marker of cardiac amyloidosis with preferential myocardial uptake in ATTR compared with AL [61].…”

Section: • • Cardiac Mrimentioning

confidence: 98%

Recent Advances in the Diagnosis and Management of Cardiac Amyloidosis

Sher

Gertz

2013

Future Cardiol.

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The heart is commonly involved in various forms of amyloidosis and cardiomyopathy is a major cause of morbidity and mortality in these patients. Diagnosis of cardiac amyloidosis is often delayed due to nonspecific presenting symptoms and failure to recognize early signs of amyloid heart disease on routine cardiac imaging. Treatment of cardiac amyloidosis depends upon the type of amyloid protein. Systemic chemotherapy with or without stem cell transplantation is used to treat immunoglobulin-related amyloidosis and liver transplantation is used for familial transthyretin amyloidosis in select patients. Clinical trials with siRNA for the treatment of transthyretin amyloid cardiomyopathies and amyloid protein stabilizers are ongoing. Prognosis depends on the type of amyloid protein with poorer outcomes noted in immunoglobulin light-chain amyloidosis. Supportive care forms the cornerstone of management and advancements in cardiac imaging and proteomics are expected to positively impact our ability to diagnose, prognosticate and treat cardiac amyloidosis.

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“…Whereas the relatively modest scarring involvement in relation to amyloid infiltration is a limitation to diagnostic sensitivity, the subendocardial localization of such findings can also be potentially mistaken for existing myocardial infarction islands in CAD, thereby reducing the specificity of such findings for the confirmation of amyloidosis. The heart normally exhibits a low concentration of amyloid, and preliminary studies using amyloid PET tracers have shown promising results in the diagnosis of cardiac infiltration (41)(42)(43).…”

Section: Other Infiltrative Cardiomyopathiesmentioning

confidence: 99%

Potential Applications of PET/MR Imaging in Cardiology

Ratib

Nkoulou

2014

J Nucl Med

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Recent advances in hybrid PET/MR imaging have opened new perspectives for cardiovascular applications. Although cardiac MR imaging has gained wider adoption for routine clinical applications, PET images remain the reference in many applications for which objective analysis of metabolic and physiologic parameters is needed. In particular, in cardiovascular diseases-more specifically, coronary artery disease-the use of quantitative and measurable parameters in a reproducible way is essential for the management of therapeutic decisions and patient follow-up. Functional MR images and dynamic assessment of myocardial perfusion from transit of intravascular contrast medium can provide useful criteria for identifying areas of decreased myocardial perfusion or for assessing tissue viability from late contrast enhancement of scar tissue. PET images, however, will provide more quantitative data on true tissue perfusion and metabolism. Quantitative myocardial flow can also lead to accurate assessment of coronary flow reserve. The combination of both modalities will therefore provide complementary data that can be expected to improve the accuracy and reproducibility of diagnostic procedures. But the true potential of hybrid PET/MR imaging may reside in applications beyond the domain of coronary artery disease. The combination of both modalities in assessment of other cardiac diseases such as inflammation and of other systemic diseases can also be envisioned. It is also predicted that the 2 modalities combined could help characterize atherosclerotic plaques and differentiate plaques with a high risk of rupture from stable plaques. In the future, the development of new tracers will also open new perspectives in evaluating myocardial remodeling and in assessing the kinetics of stem cell therapy in myocardial infarction. New tracers will also provide new means for evaluating alterations in cardiac innervation, angiogenesis, and even the assessment of reporter gene technologies. The fusion of 2 potentially competing modalities can certainly offer the best of each modality in a single procedure. The impact of such advanced technology in routine clinical practice will still need to be demonstrated. Beyond the expected improvement in patient management and the potential impact on patient outcome, PET/MR imaging will also need to establish its medicoeconomic justification in an era of health-care economic restrictions. Theemer gence of hybrid PET/CT more than a decade ago has changed the perspective on the applicability of PET in clinical routines. The added value of anatomic localization and morphologic characterization provided by CT images allowed a better confidence in PET image interpretation and diagnostic accuracy, yielding a wider adoption of PET investigation in clinical practice. Although mostly driven by oncologic applications, the wider availability of PET/CT scanners has led to its broader access for other applications such as cardiology and neurology. Despite limitations in reimbursements, the progressive increase in P...

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Pursuing an underdiagnosed disease: a simple imaging test for increasing suspicion of cardiac amyloidosis

Cited by 5 publications

References 23 publications

Non-invasive imaging for cardiac amyloidosis — Delaying the obvious?

Non-invasive imaging for cardiac amyloidosis — Delaying the obvious?

Recent Advances in the Diagnosis and Management of Cardiac Amyloidosis

Potential Applications of PET/MR Imaging in Cardiology

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