Uncertain Clinical Relevance of Serial Bone Scintigraphy Findings in Treated Transthyretin Amyloid Cardiomyopathy

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BACKGROUND: Tc-DPD) scintigraphy is a critical part of the validated nonbiopsy diagnostic algorithm for transthyretin amyloid cardiomyopathy (ATTR-CM). With the advent of novel disease-modifying therapies for ATTR-CM, there is intense interest in establishing the utility of DPD scans as an indicator of treatment response. OBJECTIVES: Tc-DPD to track treatment response in ATTR-CM. METHODS: Tc-DPD/single-photon emission computed tomography-computed tomography scans were included. Myocardial percentage injected dose (PID), a proposed scintigraphic indicator of cardiac amyloid burden, was measured at baseline and follow-up. Change from baseline in this variable was compared with that of other validated biomarkers of disease severity. RESULTS: Tc-DPD scintigraphy despite disease progression was observed in 28/66 patients (42.4%). CONCLUSIONS: Tc-DPD uptake at follow-up and numerous established biomarkers of ATTR-CM treatment response. Changes in DPD uptake in ATTR-CM patients receiving DMT should be interpreted with caution.

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