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
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.
MIDER Authors
Affiliations
Date
2025-10-07
Type
Journal Article
Subject
Collections
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