ArticleEuropean heart journal2023
Tc-99m labelled bone scintigraphy in suspected cardiac amyloidosis.
Article in European heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 3 of them syntheses that pooled it.
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Who cites it
51 citing papers in PubMed, 3 syntheses or guidelines pooled it, 91 citations in OpenAlex.
- Diagnostic utility of immunofixation and free light chain assay in AL amyloidosis: a systematic review and meta-analysis.Blood advances · 2026Pooled it
- American Society of Hematology 2026 guidelines on diagnosis of light chain amyloidosis.Blood advances · 2026Guideline
- Pooled it
- Preclinical and preliminary clinical evaluation of [European journal of nuclear medicine and molecular imaging · 2026Trial
- Perugini Grade 3 Uptake Does Not Exclude AL Cardiac Amyloidosis: When Noninvasive Diagnosis Fails.JACC. Case reports · 2026Article
- Cascade genetic screening in families with hereditary transthyretin amyloidosis: diagnostic and prognostic impact.European heart journal · 2026Article
- Monoclonal gammopathy exclusion in transthyretin amyloid cardiomyopathy: iStopMM estimated glomerular filtration rate-adjusted serum-free light chain ratio cut-offs.European heart journal · 2026Article
- CMR-based assessment of long-term effects of tafamidis in patients with cardiac transthyretin amyloidosis.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Observational
- Apolipoprotein A-IV Cardiac Amyloidosis Diagnosed by Mass Spectrometry-Based Proteomic Analysis.JACC. Case reports · 2026Article
- Standardizing the Definition of Early Diagnosis in Wild-Type Transthyretin Amyloidosis.JACC. Advances · 2026Article
- Multimodal Diagnosis of Cardiac Amyloidosis: Integrating Imaging, Histochemistry, and Proteomics of Precise Typing.International journal of molecular sciences · 2026Review
- Expert consensus: first multidisciplinary consensus on nuclear cardiology.Archivos de cardiologia de Mexico · 2026Article
- Coronary Artery Disease in Cardiac Amyloidosis: Prevalence, Clinical Relevance, and Cardiac Magnetic Resonance Imaging Features.Journal of clinical medicine · 2025Article
- Navigating the emerging landscape of asymptomatic ATTR-CM: challenges, opportunities and the path ahead.Future cardiology · 2025Review
- Nuclear imaging and echocardiographic findings in hypertrophic cardiomyopathy with and without ATTR-CM.ESC heart failure · 2025Article
- Cardiac transthyretin amyloidosis treatment improves outcomes after aortic valve replacement for severe stenosis.European heart journal · 2025Observational
- Detecting early cardiomyopathy in transthyretin variant carriers: reappraising the diagnostic value of Perugini grade 1 radiotracer uptake on bone scintigraphy.European journal of nuclear medicine and molecular imaging · 2025Observational
- Cardiac amyloidosis detection from a single echocardiographic video clip: a novel artificial intelligence-based screening tool.European heart journal · 2025Article
- Imaging of metabolic dysfunction in genetic cardiomyopathies.The international journal of cardiovascular imaging · 2025Review
- Artificial intelligence-enabled electrocardiography and echocardiography to track preclinical progression of transthyretin amyloid cardiomyopathy.European heart journal · 2025Article
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Authors and funding
39 authors at 7 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsTo perform evaluation of widely embraced bone scintigraphy-based non-biopsy diagnostic criteria (NBDC) for ATTR amyloid cardiomyopathy (ATTR-CM) in clinical practice, and to refine serum free light chain (sFLC) ratio cut-offs that reliably exclude monoclonal gammopathy (MG) in chronic kidney disease. METHODS AND
resultsA multi-national retrospective study of 3354 patients with suspected or histologically proven cardiac amyloidosis (CA) referred to specialist centres from 2015 to 2021; evaluations included radionuclide bone scintigraphy, serum and urine immunofixation, sFLC assay, eGFR measurement and echocardiography. Seventy-nine percent (1636/2080) of patients with Perugini grade 2 or 3 radionuclide scans fulfilled NBDC for ATTR-CM through absence of a serum or urine monoclonal protein on immunofixation together with a sFLC ratio falling within revised cut-offs incorporating eGFR; 403 of these patients had amyloid on biopsy, all of which were ATTR type, and their survival was comparable to non-biopsied ATTR-CM patients (p = 0.10). Grade 0 radionuclide scans were present in 1091 patients, of whom 284 (26%) had CA, confirmed as AL type (AL-CA) in 276 (97%) and as ATTR-CM in only one case with an extremely rare TTR variant. Among 183 patients with grade 1 radionuclide scans, 122 had MG of whom 106 (87%) had AL-CA; 60/61 (98%) without MG had ATTR-CM.
conclusionThe NBDC for ATTR-CM are highly specific [97% (95% CI 0.91-0.99)] in clinical setting, and diagnostic performance was further refined here using new cut-offs for sFLC ratio in patients with CKD. A grade 0 radionuclide scan all but excludes ATTR-CM but occurs in most patients with AL-CA. Grade 1 scans in patients with CA and no MG are strongly suggestive of early ATTR-type, but require urgent histologic corroboration.
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