JACC. Cardiovascular imaging · 2025
Early Detection of Transthyretin Cardiac Amyloidosis Using 124I-Evuzamitide Positron Emission Tomography/Computed Tomography.
Клиническое исследование II фазыСравнительное исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Smiley Dia A, Einstein Andrew J, O'Gorman Kevin J, Santana Denisse, Teruya Sergio, Chan Nicholas, Nalbandian Ani, Poterucha Timothy J, Helmke Stephen T, Mintz Akiva, Goldner Kim, Sekulic Miroslav, Mirabal Alfonsina, Cuomo Margaret O, Guadalupe Samantha, De Los Santos Jeffeny, Paulino Mary E, Mateo Kimberly A, Rodriguez Carlos M, Jimenez Massiel, Wardhere Abdirahman, Bampatsias Dimitrios, Castillo Michelle, Peng Boyu, Maurer Mathew S
Аннотация
BACKGROUND: Early detection of transthyretin cardiac amyloidosis (ATTR-CA) is vital, because currently available therapies are most effective early in the disease course. Although Perugini grade 2 or 3 uptake on scintigraphy using bone-avid tracers such as 99mTc-pyrophosphate is highly specific for ATTR-CA, absent monoclonal proteins, sensitivity is about 70%. Positron emission tomographic (PET)/computed tomographic (CT) imaging using the novel radiolabeled heparan sulfate proteoglycan-binding peptide 124I-evuzamitide has been shown to be useful for quantifying cardiac amyloid load in systemic amyloidosis.
OBJECTIVES: The aim of this study was to quantify myocardial 124I-evuzamitide PET uptake and compare diagnostic performance with that of 99mTc-pyrophosphate in patients with ATTR-CA and carriers.
METHODS: Twenty-five subjects underwent imaging using 124I-evuzamitide PET/CT imaging: 7 with wild-type ATTR-CA (all Columbia stage I) and 18 transthyretin amyloidosis (ATTR) variant-allele carriers with cardiomyopathy and/or neuropathy. Myocardial uptake was determined as left ventricular percentage of injected dose (mean activity concentration × volume/injected activity) and cardiac amyloid activity (mean specific uptake value × volume) within voxels with uptake above blood pool.
RESULTS: Eleven subjects with ATTR and Perugini grade 0 or 1 99mTc-pyrophosphate cardiac scans had cardiac uptake of 124I-evuzamitide, suggesting that 124I-evuzamitide PET/CT imaging may detect ATTR amyloid deposits when 99mTc-pyrophosphate cardiac scintigraphy does not. 124I-evuzamitide showed myocardial uptake in all 5 subjects with variant ATTR with biopsy-proven disease and in 2 subjects with wild-type ATTR and negative (grade 0) results on 99mTc-pyrophosphate scans but extracardiac biopsies showing ATTR. Myocardial amyloid load was moderately to strongly correlated with disease stage and with echocardiographic and quality-of-life measures.
CONCLUSIONS: 124I-evuzamitide PET/CT imaging can identify myocardial amyloid in variant transthyretin allele carriers and wild-type subjects when 99mTc-pyrophosphate does not. (Evuzamitide in PET/CT to Measure Potential Therapeutic Response in ATTR; NCT05635045).
OBJECTIVES: The aim of this study was to quantify myocardial 124I-evuzamitide PET uptake and compare diagnostic performance with that of 99mTc-pyrophosphate in patients with ATTR-CA and carriers.
METHODS: Twenty-five subjects underwent imaging using 124I-evuzamitide PET/CT imaging: 7 with wild-type ATTR-CA (all Columbia stage I) and 18 transthyretin amyloidosis (ATTR) variant-allele carriers with cardiomyopathy and/or neuropathy. Myocardial uptake was determined as left ventricular percentage of injected dose (mean activity concentration × volume/injected activity) and cardiac amyloid activity (mean specific uptake value × volume) within voxels with uptake above blood pool.
RESULTS: Eleven subjects with ATTR and Perugini grade 0 or 1 99mTc-pyrophosphate cardiac scans had cardiac uptake of 124I-evuzamitide, suggesting that 124I-evuzamitide PET/CT imaging may detect ATTR amyloid deposits when 99mTc-pyrophosphate cardiac scintigraphy does not. 124I-evuzamitide showed myocardial uptake in all 5 subjects with variant ATTR with biopsy-proven disease and in 2 subjects with wild-type ATTR and negative (grade 0) results on 99mTc-pyrophosphate scans but extracardiac biopsies showing ATTR. Myocardial amyloid load was moderately to strongly correlated with disease stage and with echocardiographic and quality-of-life measures.
CONCLUSIONS: 124I-evuzamitide PET/CT imaging can identify myocardial amyloid in variant transthyretin allele carriers and wild-type subjects when 99mTc-pyrophosphate does not. (Evuzamitide in PET/CT to Measure Potential Therapeutic Response in ATTR; NCT05635045).