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Cardiac transthyretin amyloidosis is a usually fatal form of restrictive cardiomyopathy for which clinical trials of treatments are ongoing. It is anticipated that quantitative nuclear medicine scintigraphy, which is experiencing growing interest, will soon be used to evaluate treatment efficacy. We investigated its utility for monitoring changes in disease load over a significant time period. Sixty-two treatment-naive patients underwent  99m Tc-labelled 3,3-diphosphono-1,2propanodicarboxylic acid ( 99m Tc-DPD) scintigraphy two to four times each over a five-year period. Quantitation of cardiac  99m Tc-DPD retention was performed according to two established methods: measurement of heart-to-contralateral ratio (H/CL) in the anterior view (planar) and percentage of administered activity in the myocardium (SPECT). In total 170 datasets were analysed. Increased myocardial retention of  99m Tc-DPD was demonstrable as early as 12 months from baseline. Year-on-year progression across the cohort was observed using SPECT-based quantitation, though on 30 occasions (27.8%) the change in our estimate was negative. The spread of our results was notably high compared to the year-on-year increases. If left unaccounted for, variance may draw fallacious conclusions about changes in disease load. We therefore urge caution in drawing conclusions solely from nuclear medicine scintigraphy on a patient-by-patient basis, particularly across a short time period.

The role of serial 99m Tc-DPD scintigraphy in monitoring cardiac transthyretin amyloidosis