Background: Cardiac transthyretin amyloidosis (ATTR) might be one of major causes of heart failure
especially in elderly patients. However, it appears underdiagnosed because of a relatively
high threshold of performing endomyocardial biopsy in daily practice. The purpose
of the present study was to evaluate the usefulness of 99mTc- pyrophosphate (PYP)
scintigraphy in screening of ATTR. Methods: Consecutive patients with non-ischemic and non-valvular heart failure over sixty
years of age studied with 99mTc-PYP scintigraphy were analyzed. Cardiac 99mTc-PYP
retention was graded from 0 to 3, where score 0–1 is negative and score 2–3 positive.
Results: There were 57 patients who underwent 99mTc-PYP in last two years, of whom nineteen
patients underwent endomyocardial biopsy concomitantly. Concordant with high prevalence
of ATTR in this population, 99mTc-PYP was positive in a quarter of patients (0, n = 17;
1 + , n = 26; 2 + , n = 9; 3 + , n = 5). Since all patients with ATTR positive biopsy
(n = 6) were 99mTc-PYP positive (2 + , n = 3; 3 + , n = 3), while patients with ATTR
negative biopsy (n = 13) were 99mTc-PYP negative except one patient (0, n = 4; 1 + ,
n = 8; 2 + , n = 1), both positive and negative predictive values of 99mTc-PYP were
high (0.857 and 1.000 respectively). Conclusions: 99mTc-PYP appears useful and should be encouraged to screen ATTR non-invasively.
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