目的:本研究旨在描述1级心肌显像摄取患者的最终诊断和预后,这是需要通过组织活检进一步侵入性检查来诊断甲状腺素运载蛋白心脏淀粉样变性(ATTR-CA)的明确结果。
结果:我们回顾性比较了疑似ATTR-CA患者的临床和影像学参数(基于临床和超声心动图参数)与1级和心脏闪烁显像对2/3级焦磷酸锶的摄取。Prospective,1级患者接受了ATTR-CA的长期重新评估.在132名ATTR-CA疑似患者中,89(67%)被诊断为1级,43(33%)被诊断为2/3级摄取。1级与2/3级患者较年轻,以女性为主,生物标志物水平和左心室质量较低.根据现有的影像学和病理结果,89例1级摄取患者中只有6例(7%)最终诊断为轻链型心脏淀粉样变性,而没有患者被诊断为ATTR-CA。在2[四分位数间距(IQR)0.75,3.25]年的随访中,1级患者的生存率与2/3级摄取显著更好[风险比0.271(95%置信区间0.130~0.563,P=0.0005)].Prospective,30例1级摄取患者在中位随访3.2年(IQR2.2,3.9年)时重新评估。他们的纽约心脏协会课,生物标志物水平,超声心动图检查结果保持稳定。在重复的长期闪烁显像中,没有患者(0/25)表现出2/3级摄取。
结论:疑似ATTR-CA和1级闪烁显像摄取的患者表现出稳定的临床,实验室,成像,和闪烁显像表型以及长期随访中的良性生存状况。较大的研究应确定该人群的最佳评估策略。
This study aimed to characterize the final diagnosis and prognosis of patients with grade 1 myocardial scintigraphy uptake, which is an unequivocal result for the diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) requiring further invasive investigation with tissue biopsy.
We retrospectively compared the clinical and imaging parameters of patients suspected for ATTR-CA (based on clinical and echocardiographic parameters) with grade 1 vs. grades 2/3 technetium pyrophosphate uptake on cardiac scintigraphy. Prospectively, grade 1 patients underwent re-evaluation for ATTR-CA at long term. Of the 132 ATTR-CA suspected patients, 89 (67%) were diagnosed as grade 1 and 43 (33%) as grades 2/3 uptake. Grade 1 vs. grades 2/3 patients were younger and female predominant with lower biomarker levels and left ventricular mass. Based on available imaging and pathology findings, only 6 out of the 89 patients with grade 1 uptake (7%) were finally diagnosed with light-chain cardiac amyloidosis, whereas no patient was diagnosed with ATTR-CA. At 2 [interquartile range (IQR) 0.75, 3.25] years of follow-up, the survival of patients with grade 1 vs. grades 2/3 uptake was significantly better [hazard ratio 0.271 (95% confidence interval 0.130 to 0.563, P = 0.0005)]. Prospectively, 30 patients with grade 1 uptake were re-evaluated at a median follow-up of 3.2 (IQR 2.2, 3.9) years. Their New York Heart Association class, biomarker levels, and echocardiography findings remained stable. No patient (0/25) demonstrated grades 2/3 uptake at repeated long-term scintigraphy.
Patients with suspected ATTR-CA and a grade 1 scintigraphy uptake demonstrate a stable clinical, laboratory, imaging, and scintigraphy phenotype along with a benign survival profile at long-term follow-up. Larger studies should define the optimal evaluation strategy in this population.