Clarification of amyloidosis

The clarification of suspected cardiac amyloidosis is often not easy, and senile ATTR amyloidosis in particular is therefore probably often underdiagnosed.

However, ATTR amyloidosis in particular can be easily diagnosed by means of a simple skeletal scintigraphy. Although the mechanism by which the bone-specific tracers (e.g. DPD) attach to the amyloid in the heart is still unclear, skeletal scintigraphy shows a positive predictive value of 100% (with simultaneous exclusion of AL amyloidosis, i.e. negative serum and urine electrophoresis; Gillmore et al. Circulation. 2016 Jun 14;133(24):2404-12) for the diagnosis of ATTR amyloidosis (Figure 5). No special preparations are required for this.

Various imaging of the heart

74-year-old patient with hypertrophic left ventricular myocardium. The differential diagnosis was hypertensive heart disease with known hypertension, but echocardiography was suspicious for amyloidosis. The whole-body skeletal scintigraphy (left) clearly shows accumulation of the bone tracer in the myocardium. The local accumulation in the left ventricular myocardium (shown as a so-called polar plot, top right) is mainly septal and lateral, whereas the apex remains unaffected. The scintigraphically detected enrichment corresponds strikingly well with the echocardiographic strain map (bottom right). As there was no evidence of AL amyloidosis in the electrophoresis, the diagnosis of cardiac ATTR amyloidosis could be clearly established.

Responsible specialist

Philipp Kaufmann, Prof. Dr. med.

Director of Department, Department of Nuclear Medicine
Head of Outpatient Medicine

Tel. +41 44 255 41 96
Specialties: Specialist for non-invasive cardiac imaging (PET, SPECT, CT, MRI), Specialist FMH for Nuclear Medicine, Cardiology and Internal Medicine

Ronny Ralf Büchel, Prof. Dr. med.

Senior Attending Physician, Vice Director of Department, Department of Nuclear Medicine

Tel. +41 43 253 87 89
Specialties: Specialist in multimodal non-invasive cardiac imaging (PET, SPECT, CT, MRI)., FMH specialist in nuclear medicine and cardiology., Research group: Hybrid and molecular cardiac imaging

Aju Pazhenkottil, PD Dr. med.

Attending Physician with extended responsibilites, Department of Nuclear Medicine
Attending Physician, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine

Tel. +41 44 255 39 50
Specialties: Cardiac imaging (cardiac CT/NUK/MRI), Echocardiography, Psychocardiology

Andreas Giannopoulos, Dr. med. Dr. med. sc.(GR)

Attending Physician, Department of Nuclear Medicine

Tel. +41 43 253 08 43
Specialties: Specialist in multimodal non-invasive cardiac imaging (PET, SPECT, CT, echocardiography), Specialist in cardiology, Research group: Hybrid and molecular cardiac imaging

Dominik Benz, PD Dr. med.

Attending Physician, Department of Cardiology
Attending Physician, Department of Nuclear Medicine

Tel. +41 43 253 11 91
Specialties: Echocardiography, Cardiac imaging (MRI, CT, NUK), Cardiac amyloidosis

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