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J. Am. Coll. Cardiol., Volume 75, Issue 4, February 2020 | DOI: 10.1016/j.jacc.2019.11.037 Pittsburgh B Compound Positron Emission Tomography in Patients With AL Cardiac Amyloidosis

Seung-Pyo Lee, MD, PhD^a, Hoon-Young Suh, MD^b, Sohyun Park, MD^b, Sera Oh, BS^b, Soon-Gu Kwak, MD^a, Hyue-Mee Kim, MD^a,c, Youngil Koh, MD, PhD^d, Jun-Bean Park, MD, PhD^a, Hyung-Kwan Kim, MD, PhD^a, Hyun-Jai Cho, MD, PhD^a, Yong-Jin Kim, MD, PhD^a, Inho Kim, MD, PhD^d, Sung-Soo Yoon, MD, PhD^d, Jeong-Wook Seo, MD, PhD^e, Jin-Chul Paeng, MD, PhD^b and Dae-Won Sohn, MD, PhD^a,∗

^aDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
^bDepartment of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
^cDepartment of Internal Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea
^dDivision of Hemato-oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
^eDepartment of Pathology, Seoul National University Hospital, Seoul, Republic of Korea

^∗Address for correspondence:
Dr. Dae-Won Sohn, Cardiovascular Center, Seoul National University Hospital and Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea.

Abstract

Background
It remains unknown whether the noninvasive evaluation of the degree of amyloid deposition in the myocardium can predict the prognosis of patients with light chain (AL) cardiac amyloidosis.

Objectives
The purpose of this study was to demonstrate that 11C-Pittsburgh B compound positron emission tomography (11C-PiB PET) is useful for prognostication of AL cardiac amyloidosis by noninvasively imaging the myocardial AL amyloid deposition.

Methods
This study consecutively enrolled 41 chemotherapy-naïve AL cardiac amyloidosis patients. The amyloid deposit was quantitatively assessed with amyloid P immunohistochemistry in endomyocardial biopsy specimens and was compared with the degree of myocardial 11C-PiB uptake on PET. The primary endpoint was a composite of all-cause death, heart transplantation, and acute decompensated heart failure.

Results
The degree of myocardial 11C-PiB PET uptake was significantly higher in the cardiac amyloidosis patients compared with normal subjects and correlated well with the degree of amyloid deposit on histology (R2 = 0.343, p < 0.001). During follow-up (median: 423 days, interquartile range: 93 to 1,222 days), 24 patients experienced the primary endpoint. When the cardiac amyloidosis patients were divided into tertiles by the degree of myocardial 11C-PiB PET uptake, patients with the highest PiB uptake experienced the worst clinical event-free survival (log-rank p = 0.014). The degree of myocardial PiB PET uptake was a significant predictor of clinical outcome on multivariate Cox regression analysis (adjusted hazard ratio: 1.185; 95% confidence interval: 1.054 to 1.332; p = 0.005).

Conclusions
These proof-of-concept results show that noninvasive evaluation of myocardial amyloid load by 11C-PiB PET reflects the degree of amyloid deposit and is an independent predictor of clinical outcome in AL cardiac amyloidosis patients.

Key Words
cardiac amyloidosis, positron emission tomography, prognosis

논문정보

형식Research article
게재일2020년 02월 (BRIC 등록일 2020-02-12)
연구진국내 연구진
분야 의약학 > 응용의학

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