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Biomarkers to Predict Abnormal Technetium-99m Pyrophosphate Scans in Patients With Suspected Transthyretin Amyloidosis
Journal article   Peer reviewed

Biomarkers to Predict Abnormal Technetium-99m Pyrophosphate Scans in Patients With Suspected Transthyretin Amyloidosis

Laura De Michieli, Omar F. AbouEzzeddine, Muhannad A. Abbasi, Daniel R. Davies, Christopher G. Scott, Eli Muchtar, Angela Dispenzieri, Martha Grogan, Margaret M. Redfield and Allan S. Jaffe
JACC CardioOncology, v 7(1), pp 70-78
01 Jan 2025
DOI: https://doi.org/10.1016/j.jaccao.2024.10.013
PMID: 39896120
url
https://doi.org/10.1016/j.jaccao.2024.10.013View
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Abstract

amyloidosis biomarkers cardiac troponin cardiomyopathy diagnostic performance transthyretin amyloid cardiomyopathy
Technetium Tc 99m pyrophosphate scintigraphy (99mTc PYP imaging) is a diagnostic tool for transthyretin amyloid cardiomyopathy (ATTR-CM). Cardiac biomarkers, particularly high-sensitivity cardiac troponin (hs-cTn) and N-terminal pro–B-type natriuretic peptide (NT-proBNP), may help identify patients at low or high risk for ATTR-CM. The authors sought to evaluate the predictive value of hs-cTnT and NT-proBNP in patients undergoing 99mTc PYP imaging for suspected ATTR-CM in a large U.S. cohort. This was a retrospective study of patients who underwent 99mTc PYP imaging between May 2013 and September 2022, including those with at least 1 hs-cTnT measurement within 6 months of the scan. ATTR-CM was diagnosed in 427 of 1,442 patients (29.6%). A hs-cTnT level <6 ng/L (n = 50, 3.5%) showed a negative predictive value of 100% (95% CI: 93%-100%) and sensitivity of 100% (95% CI: 99%-100%) for ruling out ATTR-CM. As the hs-cTnT threshold increased, the number of patients who could be ruled out also increased, but false negatives emerged. The positive predictive value for ruling in ATTR-CM remained low. NT-proBNP showed similar results (n = 1,378). The combination of hs-cTnT <14 ng/L and NT-proBNP <60 ng/L identified 45 patients (3.3%) without ATTR-CM. In patients undergoing 99mTc PYP imaging for suspected ATTR-CM, very low hs-cTnT levels can effectively rule out the diagnosis, although in a small subset of patients. Higher thresholds increase the risk of false negatives. NT-proBNP and combined biomarker strategies showed similar trends, the utility of hs-cTnT and NT-proBNP for ruling in the disease is limited. [Display omitted]

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