RESUMO
AIM: Myocardial uptake on bone scintigraphy has become useful for the detection of transthyretin cardiac amyloidosis (ATTR-CA). This study aimed to assess the prevalence of myocardial uptake in patients over 18 years of age with no clinical suspicion of cardiac amyloidosis (CA) who had undergone bone scintigraphy. METHODS AND RESULTS: This was an observational, retrospective, multicenter study across 21 Spanish hospitals (September-November 2019). Of the 9864 scans analyzed (locally and centrally), incidental cardiac uptake was observed in 71 patients (0.72%), a prevalence that increased with age. A previous diagnosis of heart failure was found in 16.9% of patients with positive uptake, with >50% in NYHA II. ATTR-CA was diagnosed in 10 patients, with a mean delay of 10.4 months (95% CI: 5.1-15.7). All were >70 years old, primarily male, and had greater left ventricular hypertrophy than patients without a confirmed diagnosis (p<0.0001). ATTR-CA patients had higher rates of orthostatic hypotension (30.0% vs. 3.8% in non-ATTR-CA; p=0.025). CONCLUSIONS: This is the first retrospective, national, multicenter study evaluating the prevalence of incidental cardiac uptake in bone scintigraphy performed for non-cardiac reasons, showing a prevalence of 0.72% in this population. Referral of these patients may facilitate early diagnosis of CA with a resulting benefit for patients.
Assuntos
Neuropatias Amiloides Familiares , Achados Incidentais , Cintilografia , Humanos , Masculino , Feminino , Espanha/epidemiologia , Idoso , Estudos Retrospectivos , Neuropatias Amiloides Familiares/diagnóstico por imagem , Idoso de 80 Anos ou mais , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/metabolismo , Cardiomiopatias/diagnóstico por imagem , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos/farmacocinética , Insuficiência Cardíaca/diagnóstico por imagem , Prevalência , Miocárdio/metabolismoRESUMO
BACKGROUND: The use of 18F-FDG Positron emission tomography/Computed tomography (PET/CT) in the initial staging of many cancers is clearly established. Most soft tissue sarcoma (STS) has a high affinity for 18F-FDG, which is why 18F-FDG PET/CT has been proposed as a non-invasive method, useful in diagnosis and follow-up. The standardized uptake value values (SUV), the volume-based metabolic parameters MTV (metabolic tumor volume), and TLG (total lesion glycolysis) determine tumor viability and provide its total volume and the total activity of metabolically active tumor cells. The histological grade is the most important predictor of metastases and mortality associated with STS, and a significant relationship between the metabolic parameters of 18F-FDG PET/CT and the histological grade has been described. METHODS: A retrospective study was conducted on STS patients, who had histological grade according to the FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) criteria, as well as a baseline PET/CT. SUV (SUVmax, SUVmean, and SUVpeak), MTV, and TLG were quantified. A T-student test was performed to establish the relationship between the metabolic biomarkers and the histological grade. Their usefulness as predictors of the histological grade was verified using receiver operator characteristic (ROC) curves. A survival function study was performed using the Kaplan-Meier method. To assess the prognostic utility of the metabolic biomarkers we use the Log-Rank method. RESULTS: The SUV values were useful to discriminate high-grade STS. We found a significant relationship between the histological grade and the SUV values. SUVmax, SUVpeak, MTV, and TLG were predictors of overall survival (OS). There were no significant differences in the OS for the SUVmean, or in the disease-free survival (DFS) for SUVmax, SUVmean, SUVpeak, MTV, and TLG. CONCLUSIONS: The SUVmax, SUVmean, and SUVpeak values correlate with the HG and are useful to discriminate high-grade from low-grade STS. Patients with high SUVmax, SUVpeak, MTV, and TLG have a significantly lower OS.
RESUMO
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Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Insuficiência Cardíaca/fisiopatologia , Cardioversão Elétrica/métodos , Desfibriladores Implantáveis/estatística & dados numéricos , Coração/inervação , Imagem do Acúmulo Cardíaco de Comporta/métodos , Fatores de RiscoAssuntos
Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Sistema de Condução Cardíaco/fisiopatologia , Prevenção Primária/métodos , Sistema Nervoso Simpático/fisiopatologia , Taquicardia Ventricular/terapia , Idoso , Morte Súbita Cardíaca/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/complicaçõesRESUMO
BACKGROUND: Myocardial uptake of bone tracers has emerged as useful tool for the early detection of transthyretin amyloidosis (ATTR). The prevalence of wild-type ATTR (ATTRwt) in individuals remains to be established. METHODS: All whole body bone scans performed in individualsâ¯≥â¯75â¯years with no previous clinical suspicion of ATTR were revised in a population-based university hospital over a 7-year period (1509 studies corresponding to 1114 patients; 80.5⯱â¯4.1â¯years, 65% males). Positive cardiac uptake was defined according to Perugini score as grade 2 or 3. Heart failure (HF) hospitalizations during the follow-up were obtained from regional administrative databases. RESULTS: Thirty-one patientsâ¯≥â¯75â¯years (2.78%) showed cardiac uptake; compared with those without uptake, these patients were older (85⯱â¯5 vs. 80⯱â¯4, pâ¯<â¯0.001) and predominantly males (90% vs. 64%, pâ¯=â¯0.005). The prevalence of cardiac uptake was 3.88% in males and 0.77% in females, and increased with age, reaching 13.9% in males≥85â¯years (2.7% among females). The estimated prevalence for the European standard populationâ¯≥â¯75â¯years was 4.15% in males, 1.03% in females and 2.59% in the general population. HF hospitalizations rates were 14% in patients without uptake and 29% in those with cardiac uptake (pâ¯=â¯0.034). After adjusting for age and gender, cardiac uptake was associated with a higher risk of HF hospitalization (OR 2.60, 95%CI 1.09-5.74, pâ¯=â¯0.022). CONCLUSIONS: Myocardial uptake in bone scan is very prevalent with ageing, mainly affects males and is associated with an increased risk of HF hospitalization. These findings reinforce ATTRwt as a relevant cause of HF in the elderly.