Nuclear imaging in transthyretin amyloid cardiomyopathy
Nuclear imaging in transthyretin amyloid cardiomyopathy
This thesis of Hendrea Tingen investigates how nuclear imaging can improve the diagnosis, monitoring of disease progression, and evaluation of treatment response in patients with a cardiac protein misfolding disease called transthyretin amyloid cardiomyopathy (ATTR-CM).
The first part focuses on bone scintigraphy, a well-established, non-invasive diagnostic tool for ATTR-CM, and explores how additional clinical value can be extracted from this technique. The thesis shows that using a cardiac blood biomarker can help identify which patients truly need a bone scan, reducing unnecessary imaging without loss of diagnostic accuracy. It also demonstrates that bone scintigraphy contains more information than is currently used in routine practice: while clinical interpretation mainly focuses on cardiac uptake, extracardiac tracer uptake is also prognostically relevant and associated with patient outcomes. Furthermore, the thesis shows that in specific patient groups bone scintigraphy can allow an earlier diagnosis than is currently achieved and may also be useful for monitoring treatment response and disease progression.
The second part of the thesis examines the role of positron emission tomography (PET) imaging in ATTR-CM. Although PET is not yet routinely used in clinical practice for this disease, several PET tracers show promise in distinguishing ATTR-CM from other forms of cardiomyopathy and amyloidosis. The thesis demonstrates that PET can be particularly valuable in selected patient groups in whom bone scintigraphy is less sensitive, thereby serving as a meaningful addition to current diagnostic strategies. Finally, the thesis describes an ongoing international multicenter study aimed at validating PET for both diagnosis and longitudinal disease monitoring in patients with ATTR-CM.