Impact of increasing referral for Tc-DPD scintigraphy on prognosis across the phenotypic spectrum of restrictive cardiomyopathy
Choy, Chern Hsiang Kwok, Chun Shing Wahid, Yasmin Liu, Boyang Turvey-Haigh, Lauren Parker, Kenneth Cullis, James Parekh, Poonam Hussain, Khalid Akhtar, Akshanna
Choy, Chern Hsiang
Kwok, Chun Shing
Wahid, Yasmin
Liu, Boyang
Turvey-Haigh, Lauren
Parker, Kenneth
Cullis, James
Parekh, Poonam
Hussain, Khalid
Akhtar, Akshanna
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Publication date
2025-10-07
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Abstract
Background
Although bone scintigraphy has been widely accepted as integral to the non-biopsy diagnostic algorithm for transthyretin amyloid cardiomyopathy (ATTR-CM), its prognostic role remains uncertain.
Objectives
The authors aimed to characterize changes in the referral pattern for Tc-DPD scintigraphy and its influence on the clinical phenotype and prognosis of patients diagnosed with ATTR-CM, and among those individuals in whom ATTR-CM is excluded.
Methods
Retrospective cohort study of all-comers referred for Tc-DPD scintigraphy to the Midlands Amyloidosis Service over 15 years.
Results
Of 528 patients referred for Tc-DPD scintigraphy, 477 underwent echocardiography suggestive for ATTR-CM and were included in the study. A heightened demand for Tc-DPD scintigraphy was linked to increasing proportions of referrals from cardiologists over 5-year periods (47% vs 87% vs 96%, P < 0.001). Nearly half of patients (216/477, 45%) were diagnosed with ATTR-CM: 186 had ATTRwt-CM and 30 had ATTRv-CM; the commonest TTR variant was V142I (25/30, 83%). Compared to ATTR-CM, patients with nonamyloid CM (261/477, 55%) were younger and more often female yet with similar 5-year mortality rates (40% vs 31%, P = 0.044). In an age- and sex-adjusted Cox-proportional hazards model, there was no significant difference in survival between patients with ATTRwt-CM and nonamyloid CM (HR 0.99, 95% CI: 0.98-1.38, P = 0.96). There was also no difference in mortality according to Perugini grading.
Conclusions
There is strikingly high mortality among patients with negative Tc-DPD scintigraphy, equivalent to that of ATTR-CM. This finding serves as a call for future studies to better characterise this seemingly overlooked cohort, with the aim of developing targeted therapies and improving outcomes.
Citation
Jones E, Ewing J, Hussein H, Maybury B, Raghavan M, Suhr J, Duncan N. An evaluation of a real-world, multi-disciplinary, treatment-free remission programme for patients with Chronic Myeloid Leukaemia. J Oncol Pharm Pract. 2025 Oct 9:10781552251384611. doi: 10.1177/10781552251384611
Type
Journal Article