Global and Regional Variations in Transthyretin Cardiac Amyloidosis: A Comparison of Longitudinal Strain and 99mTc-Pyrophosphate Imaging

Christopher Lee, Chieh Ju Chao, Pradyumna Agasthi, Amith R. Seri, Amar Shere, Lanyu Mi, Lisa Brown, Chance Marostica, Timothy Barry, Ming Yang, Julie Rosenthal, Samuel Unzek, Farouk Mookadam, Reza Arsanjani

Research output: Contribution to journalArticlepeer-review


There are limited data on the head-to-head comparison of 99mTc-pyrophosphate (99mTc-PYP) and echocardiographic strain imaging in the assessment of transthyretin (TTR) cardiac amyloidosis. Methods: At Mayo Clinic Arizona, patients who had undergone both a 99mTc-PYP scan and a transthoracic echocardiogram within a 90-d period were retrospectively identified for chart review and strain imaging analysis. Patients were divided into 2 groups according to their 99mTc-PYP results (PYP-positive [PYP1] or PYP-negative [PYP2]) for the comparison. A standard 17-segment model was used for segmental, regional, and global longitudinal strain comparison. A P value of less than 0.05 was deemed significant. Results: In total, 64 patients were included, the mean age was 75.1 6 13.0 y, and 57 (89.1%) were male. Comparing the PYP1 to the PYP2 group, the left ventricular global longitudinal strain was significantly worse in the former (PYP1 vs. PYP2, 210.5 6 2.6 vs. 213.1 6 4.1; P 5 0.003). PYP1 patients also had worse regional basal strain (24.6 6 2.6 vs. 28.8 6 4.0, P, 0.001) and a trend toward worse midventricular strain (29.6 6 4.0 vs. 211.7 6 4.4, P 5 0.07), but there was no statistical difference in the apical region (217.6 6 4.73 vs. 219.0 6 6.46, P 5 0.35). This is consistent with an apex-sparing pattern shown by the relative apical longitudinal strain index (1.3 6 0.5 vs. 1.0 6 0.3, P 5 0.008). Segment-to-segment analysis demonstrated a significant difference in strain between PYP1 and PYP2 segments in 4 segments: basal inferior (P 5 0.006), basal anterolateral (P 5 0.01), apical septal (P 5 0.002), and apical inferior (P 5 0.001). Left ventricular diastolic dysfunction was significantly different, with 17 (77.3%) patients in the PYP1 group versus 15 (36.6%) in PYP2 participants (P 5 0.002). Conclusion: Our study suggested that 99mTc-PYP uptake is related to overall worse LV segmental, regional, and global longitudinal strain function, as well as diastolic function, compared with patients without 99mTc-PYP uptake. These data are important for helping clinicians learn about the echocardiographic function features related to 99mTc-PYP uptake and can help generate hypotheses for future studies.

Original languageEnglish (US)
Pages (from-to)30-37
Number of pages8
JournalJournal of nuclear medicine technology
Issue number1
StatePublished - Mar 1 2022


  • Tc-pyrophosphate imaging
  • cardiology
  • correlative imaging
  • longitudinal strain
  • transthyretin cardiac amyloidosis

ASJC Scopus subject areas

  • General Medicine


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