Prevalence of Transthyretin Cardiac Amyloidosis in Patients with Heart Failure and Preserved Ejection Fraction as Diagnosed by Tc99m PYP Scintigraphy - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Igor Volodarsky Heart Center, Kaplan Medical Center, Rehobot, Israel Yakov Fabrikant Heart Center, Kaplan Medical Center, Rehobot, Israel Sara Shimoni Heart Center, Kaplan Medical Center, Rehobot, Israel Liaz Zilberman Heart Center, Kaplan Medical Center, Rehobot, Israel Sorel Goland Heart Center, Kaplan Medical Center, Rehobot, Israel Irina Fugenfirov Heart Center, Kaplan Medical Center, Rehobot, Israel Shay Lifshitz Heart Center, Kaplan Medical Center, Rehobot, Israel Sagi Tshori Nuclear Imaging Center, Kaplan Medical Center, Rehovot, Israel Jacob George Heart Center, Kaplan Medical Center, Rehobot, Israel

Introduction: Transthyretin-related cardiac amyloidosis (ATTR) is a progressive infiltrative cardiomyopathy that mimics hypertensive and hypertrophic heart disease and often remains undiagnosed. Recently Tc^99m scintigraphy has been shown to be a highly sensitive diagnostic tool for the diagnosis of cardiac ATTR. We suppose that using Tc^99m scintigraphy it is possible to find this condition among patients with otherwise unexplainable heart failure.

Aim: To evaluate the prevalence of cardiac ATTR by Tc^99m pyrophosphate (PYP) scintigraphy in patients with heart failure with preserved ejection fraction (HFpEF).

Methods: We included consecutive patients referred to Heart Failure Clinic in KMC with diagnosis of HFpEF. All patients have undergone planar (SPECT) one hour after the injection of 10 mCi of Tc^99m-PYP.

Results: from April through December 2017, 23 patients with HFpEF (Mean age 73±9 years, 43% males) were included and underwent Tc^99m-PYP scan. Fortheen patients had NYHA functional class (NYHA FC) I-II and 9 patients had FC III. The mean LVEF was 55.7±5.0%, mean interventricular septum thickness (IVS) was 13.7±2.3 mm, and mean posterior wall (PW) was 13.5±6.1 mm. There were 3 (13%) patients with mildly positive Tc^99m-PYP scan, 6 (26%) patients with strongly positive Tc^99m-PYP scan, 14 (61%) patients with negative Tc^99m-PYP scan. No statistically significant difference was found between patients with positive scan vs. negative scan regarding LVEF (57 vs 53% p=ns), LV end-diastolic diameter (45.5 vs 45.8 mm p=ns), IVS (13.3 vs 15.3 mm, p=ns), PW (11.7 v 12.8 mm p=ns) and mean diastolic disfunction degree (2 in both groups).

Conclusion: In this patient population ATTR positive by Tc^99m-PYP scan has been found in more than third of patients with HFpEF, suggesting that ATTR should always be considered in patients with unexplained heart failure because of the benefit of an early diagnosis and a possible option of the modifying disease treatment.