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Adverse event reporting can be found at the bottom of the page
Learn about ATTR-CM and uncover the differences between hereditary and wild-type ATTR-CM
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What is nuclear scintigraphy?
Nuclear scintigraphy using both planar and single-photon emission computed tomography (SPECT) imaging is a noninvasive, commonly available diagnostic tool with high sensitivity and specificity for ATTR-CM when combined with testing to rule out immunoglobulin light chain (AL) amyloidosis.1-3
If myocardial tracer uptake is visually present on SPECT, proceed to step 2, semiquantitative visual grading.
If no myocardial tracer uptake is present on SPECT, the visual grade is 0.
Positive SPECT with no blood pool
Adapted from Sennott J, Ananthasubramanaim K. Heart Fail Rev. 2022;27(5):1515-30. doi:10.1007/s10741-021-10179-6
Illustrative representation of 99mTc-PYP/99mTc-DPD/99mTc-HMDP* uptake.
Adapted from Dorbala et al. Expert consensus recommendations for multimodality imaging in cardiac amyloidosis. J Nucl Cardiol. 2019.
Visual scoring method in relation to bone (rib) uptake at 3 hours3
When cardiac amyloidosis is suspected, Grade 2 or 3 myocardial uptake with concurrent testing to rule out AL is diagnostic of ATTR-CM.3*‡
Quantification of cardiac 99mTc-PYP* uptake using H/CL ratio4
Illustrative representation.Adapted from Dorbala et al. Expert consensus recommendations for multimodality imaging in cardiac amyloidosis. J Nucl Cardiol. 2019.
Genetic testing—used in the ATTR-CM diagnostic process
Genetic testing—used in the ATTR-CM diagnostic process
Genetic testing—used in the ATTR-CM diagnostic process
Genetic testing—used in the ATTR-CM diagnostic process
ATTR=transthyretin amyloidosis; AL=lightchain amyloidosis; AS=aortic stenosis; CMR=cardiac magnetic resonance; CTS=carpal tunnel syndrome; DPD=99mtechnetium-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid; Echo=echocardiography; ECG= electrocardiography; HFpEF= Heart failure with preserved ejection fraction; HMDP=99mtechnetium-labelled hydroxymethylene diphosphonate; LV=left ventricle; PYP=99mtechnetium-labelled pyrophosphate; SFLC=serum-free light chain assay; SPECT= single photon emission computed tomography; TDI=tissue Doppler imaging; TTR= transthyretin.
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