The Importance Of Monoclonal Proteins Determination For The Correct Diagnosis Of Transthyretin Cardiac Amyloidosis By [Tc-99m]Tc-diphosphonates

Roteta, A. ; Nogueira Souto, D. ; Andres Gracia, A. ; Tardin Cardoso, L. ; Razola Alba, P. (Universidad de Zaragoza) ; Delgado Castro, M. (Universidad de Zaragoza) ; Escalera Temprado, T. ; Prats Rivera, E. (Universidad de Zaragoza) ; Abos Olivares, M. (Universidad de Zaragoza)

Resumen: EPS-066
Aim/Introduction: To analyze the influence of the determination of free monoclonal proteins in blood and urine in the final diagnosis of Transthyretin Cardiac Amyloidosis (TTRA).
Materials and Methods: We have analyzed 200 [99mTc]Tc-diphosphonates scans: 192 performed on 190 patients under suspicion of TTRA and 7 patients with grade II-III radiotracer myocardial deposit as a casual finding (November/2013 - January/2020). Likewise, clinical and laboratory characteristics (heart failure, LVEF, proBNP levels, immunofixation in serum and/or urine for the detection of monoclonal chains and chronic renal failure) have been evaluated. A positive case has been considered for TTRAwt or senile (Score Perugini II-III scan, negative immunofixation in serum and/or urine, negative genetic study), positive case for hereditary TTRA (Score Perugini II-III scan, negative immunofixation and positive genetic study), positive case for secondary amyloidosis (positive immunofixation and presence of hematologic malignancy) and undetermined amyloidosis (immunofixation not performed or positive and absence of haematologic malignancies at follow-up).
Results: 59 positive scans have been detected, 47 men (79’7%) and 12 women (20’3%). The mean age of the group of positives was 82’66 years, while that of the negatives was 72’15. The mean proBNP levels in the positives are 7561, compared to 5869 in the negative group. Immunofixation (serum and/or urine for detection of kappa or lambda monoclonal chains at 30 (50.8%) has been performed on these patients. Finally, 37.2% (22/59) resulted in ATTRwt, 3.4% (2/59) hereditary ATTR (genetic study: variant E54Q and mutation c.424> A (p.Va.122Ile) in exon 4 of TTR) and 1.7% (1/59) secondary amyloidosis. The remaining 34/59 (57.7%) cases were undetermined amyloidosis (6 positive immunofixation and 27 without monoclonal proteins determination).
Conclusion: Determination of monoclonal bands in blood and urine is mandatory to correctly characterize cases of cardiac amyloidosis and, in presence of monoclonal bands, to assess the existence of underlying haematological malignancies.

Idioma: Inglés

Año: 2020

Publicado en: EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 47, SUPPL 1 (2020), S150-S151
ISSN: 1619-7070

Originalmente disponible en: Texto completo de la revista

Factor impacto JCR: 9.236 (2020)

Categ. JCR: RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING rank: 5 / 134 = 0.037 (2020) - Q1 - T1

Factor impacto SCIMAGO: 2.313 - Radiology, Nuclear Medicine and Imaging (Q1) - Medicine (miscellaneous) (Q1)

Tipo y forma: Artículo (PostPrint)

Área (Departamento): Área Radiol. y Medicina Física (Dpto. Microb.Ped.Radio.Sal.Pú.)