Biagini, Elena

Ferlini, Alessandra

Gagliardi, Christian

Gallo, Pamela

Guidalotti, Pier Luigi

Leone, Ornella

Longhi, Simone

Milandri, Agnese

Pettinato, Cinzia

Quarta, Candida Cristina

Rapezzi, Claudio

Salvi, Fabrizio

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Pericardial/Myocardial Disease
E1546
JACC March 27, 2012
Volume 59, Issue 13
NON-INVASIVE IDENTIFICATION OF SENILE SYSTEMIC AMYLOIDOSIS: INCREMENTAL DIAGNOSTIC ROLE 
OF 99MTC-DPD SCINTIGRAPHY
ACC Moderated Poster Contributions
McCormick Place South, Hall A
Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Pericardial/Myocardial Disease I
Abstract Category: 12. Pericardial/Myocardial Disease
Presentation Number: 1125-32
Authors: Candida Cristina Quarta, Pier Luigi Guidalotti, Simone Longhi, Cinzia Pettinato, Ornella Leone, Fabrizio Salvi, Alessandra Ferlini, Agnese 
Milandri, Pamela Gallo, Christian Gagliardi, Elena Biagini, Claudio Rapezzi, University of Bologna, S.Orsola-Malpighi and Bellaria Hospital, Bologna, 
Italy, University of Ferrara, Ferrara, Italy
Background: Senile systemic amyloidosis (SSA), due to intramyocardial deposition of wild-type transthyretin (TTR), is often mistaken as 
hypertensive heart disease (HHD) or hypertrophic cardiomyopathy (HCM). In patients with amyloidotic cardiomyopathy 99mTc-DPD scintigraphy can 
differentiate between TTR (mutant and wild-type) and primary amyloidosis. We assessed the diagnostic performance of 99mTc-DPD scintigraphy in 
the non-invasive identification of SSA in a clinical context of elderly patients with unexplained concentric left ventricular (LV) “hypertrophy”. 
Methods: Patients undergone 99mTc-DPD scintigraphy in 2004-2010 for suspected SSA were included in the analysis. SSA was suspected in 
patients > 65 years with unexplained concentric LV “hypertrophy” (end-diastolic mean wall thickness > 14 mm) and non-dilated LV, who also 
presented one or more of: male gender; thickened atrio-ventricular valves; mild pericardial effusion; granular sparkling myocardial appearance; 
absent or mild LV hypertrophy on ECG. All patients with an already definite diagnosis able to explain LV wall thickness increase were excluded. 
Myocardial uptake of 99mTc-DPD (740 MBq iv) was semiquantitatively/visually assessed at 5 min/3 h.
Results: A total of 62 patients entered the analysis: 32 with SSA, 14 with hereditary TTR-related amyloidosis (ATTR) and exclusively cardiac 
phenotype and 16 with non-amyloidotic LV “hypertrophy” (9 HCM, 6 HHD, 1 Anderson-Fabry disease). 99mTc-DPD scintigraphy tested positive 
for myocardial uptake in all cases with TTR amyloidosis (both mutant and wild-type). No myocardial uptake of the tracer was apparent in non-
amyloidotic LV hypertrophy. Sensitivity and specificity of positive 99mTc-DPD myocardial tracer uptake (i.e. visual score ≥1) for the diagnosis of SSA 
and ATTR were both 100%.
Conclusions: In elderly patients with unexplained concentric LV “hypertrophy”, 99mTc-DPD scintigraphy can provide a highly accurate technique 
able to increase the diagnostic performance of echocardiography in the non-invasive identification of TTR-related (both mutant and wild-type) 
amyloidotic cardiomyopathy.


NON-INVASIVE IDENTIFICATION OF SENILE SYSTEMIC AMYLOIDOSIS: INCREMENTAL DIAGNOSTIC ROLE OF 99MTC-DPD SCINTIGRAPHY 

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NON-INVASIVE IDENTIFICATION OF SENILE SYSTEMIC AMYLOIDOSIS: INCREMENTAL DIAGNOSTIC ROLE OF 99MTC-DPD SCINTIGRAPHY

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