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Diagnosis of Cardiac Amyloidosis

The diagnosis of suspected cardiac amyloidosis is often not easy, and senile ATTR amyloidosis in particular is therefore likely to be underdiagnosed.

However, ATTR amyloidosis, in particular, can be easily diagnosed using a simple skeletal scintigraphy. Although it is still unclear by which mechanism the bone-specific tracers (e.g. DPD) attach to the amyloid in the heart, the skeletal scintigraphy shows a positive predictive value of 100% here (with AL amloidosis excluded at the same time, 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). There are no special preparations required for this diagnotic procedure.

74-year-old patient with hypertrophic left ventricular myocardium. In the differential diagnosis, with known hypertension, hypertensive heart disease was possible, but based echocardiography an amyloidosis was suspected. The whole-body skeletal scintigraphy (left) clearly shows accumulation of the bone tracer in the myocardium. The local enrichment in the left ventricular myocardium (shown as a so-called polar plot, top right) is found mainly septal and lateral, whereas the apex is spared. The scintigraphically proven enrichment coincides clearly well with the echocardiographic strain map (bottom right). Since there was no evidence of AL amyloidosis in the electrophoresis, a clear diagnosis of cardiac ATTR amyloidosis could be made.
74-year-old patient with hypertrophic left ventricular myocardium. In the differential diagnosis, with known hypertension, hypertensive heart disease was possible, but based echocardiography an amyloidosis was suspected. The whole-body skeletal scintigraphy (left) clearly shows accumulation of the bone tracer in the myocardium. The local enrichment in the left ventricular myocardium (shown as a so-called polar plot, top right) is found mainly septal and lateral, whereas the apex is spared. The scintigraphically proven enrichment coincides clearly well with the echocardiographic strain map (bottom right). Since there was no evidence of AL amyloidosis in the electrophoresis, a clear diagnosis of cardiac ATTR amyloidosis could be made.

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Responsible doctors

Philipp Kaufmann, Prof. Dr. med.

Director of the Department of Nuclear Medicine, Department of Nuclear Medicine
Director USZ Airport - The Circle, Department of Nuclear Medicine
Nuclear Medicine Physician, Department of Nuclear Medicine
Cardiologist, Department of Nuclear Medicine
Internist, Department of Nuclear Medicine

Specialties: Cardiac Imaging (PET, SPECT, CT, MRI)
Tel. +41 44 255 41 96
Mail pak@usz.ch

Ronny Ralf Büchel, Prof. Dr. med.

Senior Attending Physician, Department of Nuclear Medicine
Deputy Clinic Director , Department of Nuclear Medicine
Nuclear Medicine Physician, Department of Nuclear Medicine
Cardiologist, Department of Nuclear Medicine

Specialties: Cardiac Imaging (PET, SPECT, CT, MRI)
Tel. +41 43 253 87 89
Mail ronny.buechel@usz.ch

Cathérine Gebhard Ph.D., Prof. Dr. med.

Attending Physician, Department of Nuclear Medicine

Tel. +41 43 253 87 95
Mail gendermedizin@med.uzh.ch

Aju Paul Pazhenkottil, PD Dr. med.

Senior Attending Physician, Department of Nuclear Medicine
Cardiologist, Department of Nuclear Medicine

Specialties: Cardiac Imaging (PET, SPECT, CT, MRI, Echocardiography)
Tel. +41 44 255 39 50
Mail aju.pazhenkottil@usz.ch

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