[99mTc]Tc-Pyrophosphate Scintigraphy for Cardiac Amyloidosis - Evaluation of Scintigraphy Findings and Their Prognostic Value

Sep 29, 2026

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Association between [99mTc]Tc-pyrophosphate (PYP) uptake and survival in cardiac amyloidosis remains unclear. This retrospective study evaluated all [99mTc]Tc-PYP scintigraphy images from September 2020 to December 2023 in patients suspected of cardiac amyloidosis. Images were acquired 1 and 3 hours after injection. Quantitative and semiquantitative measures were analyzed, correlations with survival were tested, and prognostic implications of scintigraphic findings were assessed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

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Abstract

Background

Methods

Results

Conclusion

Introduction

Cardiac amyloidosis background and clinical impact

Epidemiology and treatment overview of AL and ATTR

Imaging and diagnostic approaches

Role of echocardiography, CMR, and biopsy

Rationale for PYP scintigraphy

Article published online: 2025-11-23 352 Original Article THIEME [ 99mTc]Tc-Pyrophosphate Scintigraphy for Cardiac Amyloidosis: Evaluation of Scintigraphy Findings and Their Prognostic Value Elife Akgün 1 Ümit Aksu2 Arda Güler3 Gamze Babur Güler3 Meryem Kaya2 Burcu Esen Akkaş2 1 Department of Nuclear Medicine, University of Health Sciences Türkiye, İstanbul Training and Research Hospital, Istanbul, Türkiye 2 Department of Nuclear Medicine, University of Health Sciences Türkiye, Başakşehir Çam and Sakura City Hospital, Istanbul, Türkiye 3 Department of Cardiology, University of Health Sciences Türkiye, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye World J Nuclear Med 2025;24:352–359. Address for correspondence Elife Akgün, MD, Department of Nuclear Medicine, University of Health Sciences Türkiye, Istanbul Training and Research Hospital, Istanbul 34265, Türkiye (e-mail: [elifekaymak@hotmail.com](elifekaymak@hotmail.com)). Abstract Keywords ► ATTR ► AL ► cardiac amyloidosis ► PYP ► scintigraphy ► prognosis Background Association of [99mTc]Tc-pyrophosphate (PYP) uptake with survival of cardiac amyloidosis (CA) is still unknown. This study aimed to describe the scintigraphic ﬁndings of CA suspected cases and determine the prognostic value of scintigraphy. Methods Between September 2020 and December 2023, all [99mTc]Tc-PYP scintigraphy images of CA suspected cases were evaluated retrospectively. The scintigraphy images were obtained 1 and 3 hours after intravenous injection of 740 MBq [99mTc]TcPYP. The quantitative and semiquantitative results of scintigraphy were analyzed, and their correlation with survival was evaluated. Results Among the 268 cases (147 females, 121 males; median age: 65), 12 (4.5%) were diagnosed with transthyretin (ATTR) CA and 19 (7.1%) with light chain (AL) CA. The median follow-up time was 386 days. ATTR CA cases exhibited signiﬁcantly higher [99mTc]Tc-PYP uptake than AL CA and non-CA cases. The 1- and 3-hour heart-tocontralateral lung ratios were positively highly correlated with each other, and SPECT/CT (single-photon computed tomography/computed tomography) imaging reduced equivocal results from 82 to 37% . Eight of the AL CA cases (42.1%), 1 ATTR CA case (8.3%), and 15 of non-CA cases (6%) died on follow-up. Median survival was 22 days in ATTR CA, 201 days in AL CA, and 105 days in non-CA deceased cases. Survival analysis indicated signiﬁcantly lower survival in non-CA cases compared with ATTR CA and AL CA. Conclusion [99mTc]Tc-PYP scintigraphy is highly sensitive and speciﬁc for detecting ATTR CA and differentiating from AL CA. Even in the absence of a diagnosis of CA, the fact that survival may be short in cases with high uptake on scintigraphy should be considered in the follow-up of these cases. article published online November 23, 2025 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1813662 . ISSN 1450-1147. © 2025 . The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited.([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) Thieme Medical and Scientiﬁc Publishers Pvt. Ltd. , A-12, 2nd Floor, Sector 2, Noida-201301 UP, India [99mTc]Tc-Pyrophosphate Scintigraphy for Cardiac Amyloidosis Akgün et al. 353 Introduction Misfolded amyloid proteins formed from light chain (AL) or transthyretin (ATTR) accumulation in the myocardium cause cardiac amyloidosis (CA) . These depositions result in thickening of different parts of the heart and affect heart function. It is one of the reasons for restrictive cardiomyopathy. Although amyloidosis is a multisystem disease, generally, cardiac involvement determines the prognosis. AL amyloidosis is a rare disease

FAQs

What was the goal of the study regarding [99mTc]Tc-PYP scintigraphy?

To describe scintigraphic findings in suspected cardiac amyloidosis cases and determine the prognostic value of scintigraphy for survival.

How were scintigraphy images obtained and analyzed in the study?

Images were acquired 1 and 3 hours after intravenous injection of 740 MBq [99mTc]Tc-PYP. Quantitative and semiquantitative results were analyzed and correlated with survival.

What did the results show about survival and tracer uptake patterns?

ATTR cases showed higher [99mTc]Tc-PYP uptake than AL cases and non-CA cases. Survival was significantly lower in non-CA cases compared with ATTR and AL groups.

Sep 29, 2026

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