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Extensive Right Ventricular Uptake on 99mTc-Pyrophosphate Scintigraphy as a Marker of Poor Prognosis in Transthyretin Amyloid Cardiomyopathy: Experience of a Tertiary University Hospital
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Extensive Right Ventricular Uptake on 99mTc-Pyrophosphate Scintigraphy as a Marker of Poor Prognosis in Transthyretin Amyloid Cardiomyopathy: Experience of a Tertiary University Hospital

Adriana Pereira Glavam, Marcelo Imbroinise Bittencourt, Paulo Henrique Rosado de Castro, Francisco de Assis Romeiro Figueiroa Benício Coelho, Adriana Soares Xavier de Brito, Isabella Palazzo, Alex dos Santos Félix, Ana Paula dos Reis Velloso Siciliano, Gabriel Cordeiro Camargo, Julia Machado Barroso, …
Journal of nuclear cardiology, Vol.62(Supplement), 102860
09/2026
DOI: 10.1016/j.nuclcard.2026.102860
url
https://doi.org/10.1016/j.nuclcard.2026.102860View
Published (Version of record) Open Access

Abstract

Introduction: Scintigraphy with bone seeking tracers has revolutionized the non-invasive diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). While its role in accurate diagnosis is well established, recent evidence from large multicenter cohorts has identified right ventricular (RV) uptake as an emerging prognostic marker. However, the specific impact of the extent of RV tracer uptake on clinical outcomes requires further characterization, particularly in cohorts enriched for hereditary ATTR. This study aimed to evaluate the prevalence and extent of RV uptake evidenced on 99mTc-pyrophosphate scintigraphy in patients with non-invasive diagnosis of ATTR-CM and its relationship with clinical outcomes. Methods: Patients with clinical suspicion based on symptoms of heart failure (HF) and characteristic findings on echocardiography or cardiac magnetic resonance were prospectively enrolled. Non-invasive diagnosis was established by visual myocardial uptake grade 2 or 3 on SPECT/CT and absence of monoclonal gammopathy on serum and urine immunofixation. Genetic test was further performed. Extensive RV uptake on SPECT/CT was defined as tracer uptake encompassing the apical, mid-ventricular and basal segments while partial uptake was defined as involvement of basal or mid-ventricular segments, only. The primary composite endpoint included cardiovascular death, hospitalization for HF, and clinically significant arrhythmias. All patients provided informed consent, and the study was approved by the institutional ethics committee. Results: Thirty-eight patients were enrolled (mean age 76.1 ± 7.3, 78.9% male, 55.3 % African descent). A total of 54.5% were in NAC ATTR stage II or III, and 86.9% were in NYHA functional class II or III. Hereditary ATTR was present in 70.3% of patients, with Val122Ile as the most prevalent mutation (88.5%). Visual score of 3 for left ventricular uptake was observed in all SPECT/CT, with a predominantly homogeneous uptake pattern (94.7%). RV uptake was identified in 81.6% of scans. Extensive RV uptake was present in 60.5% of the studies, while partial RV uptake in only 21,1%. The occurrence of composite endpoint events was significantly higher in the group with extensive versus partial or absent RV uptake (52.12% vs. 20.0%, p=0.047). The group with extensive RV uptake had significantly shorter event-free survival (log-rank p=0.048) and extensive RV uptake was an independent predictor of outcomes in multivariate analysis (HR 3,69, p=0.047). Conclusion: In this cohort, predominantly formed by patients with hereditary ATTR, the prevalence of RV involvement on 99mTc-pyrophosphate scintigraphy was high and extensive RV uptake was the most common pattern. Extensive RV uptake was independently associated with a greater risk of adverse clinical outcomes confirming and extending prior evidence of its prognostic value.

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