ArticleEuropean heart journal. Imaging methods and practice2026
Yield and predictors of conversion on serial amyloid nuclear SPECT/CT in at-risk populations for transthyretin cardiac amyloidosis.
Article in European heart journal. Imaging methods and practice, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aims: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure, yet data guiding surveillance strategies in high-risk individuals remain limited. This study evaluated the incidence, imaging patterns, and clinical predictors of SPECT/CT conversion among patients undergoing serial Tc-99m PYP/HMDP imaging. Methods and results: We conducted a retrospective cohort study of 106 patients who underwent repeat Tc-99m PYP or HMDP cardiac SPECT/CT between 2018 and 2025. Patients with a positive initial scan or repeat imaging within less than 12 months were excluded. Conversion was defined as a new Perugini grade ≥1 with any myocardial radiotracer uptake on follow-up. Clinical characteristics, biomarkers, genetic testing, and extracardiac biopsy findings were analysed. Univariable and multivariable Cox regression identified predictors of conversion. Over a mean follow-up of 3.2 years, 14 patients (13.2%) showed imaging conversion. Echocardiographic parameters and absolute biomarker levels were comparable between groups; however, a ≥30% rise in NT-proBNP was more frequent among converters (71.4% vs. 38.1%, Conclusion: The combined presence of carpal tunnel syndrome and spinal stenosis identifies a high-risk phenotype for future imaging conversion. These exploratory findings support serial amyloid SPECT/CT for surveillance and highlight the value of musculoskeletal comorbidities in refining risk stratification for ATTR-CA.
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