Prognostic Value of Left Ventricular 18F-Florbetapir Uptake in Systemic Light-Chain Amyloidosis

被引:12
|
作者
Clerc, Olivier F. [1 ,2 ]
Datar, Yesh [1 ,2 ]
Cuddy, Sarah A. M. [2 ,3 ,4 ]
Bianchi, Giada [2 ,5 ]
Taylor, Alexandra [1 ,2 ]
Benz, Dominik C. [1 ,2 ]
Robertson, Matthew [3 ,4 ]
Kijewski, Marie Foley [1 ]
Jerosch-Herold, Michael [3 ,4 ]
Kwong, Raymond Y. [3 ,4 ]
Ruberg, Frederick L. [6 ,7 ]
Liao, Ronglih [8 ]
Carli, Marcelo F. Di [1 ,3 ,4 ]
Falk, Rodney H. [2 ]
Dorbala, Sharmila [1 ,2 ]
机构
[1] Brigham & Womens Hosp, Dept Radiol, Div Nucl Med, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Dept Med, Div Cardiol, Cardiac Amyloidosis Program, Boston, MA USA
[3] Brigham & Womens Hosp, CV Imaging Program, Cardiovasc Div, Boston, MA USA
[4] Brigham & Womens Hosp, Dept Radiol, Boston, MA USA
[5] Brigham & Womens Hosp, Dept Med, Div Hematol, Boston, MA 02115 USA
[6] Boston Univ, Chobanian & Avedisian Sch Med, Amyloidosis Ctr, Boston, MA USA
[7] Boston Univ, Chobanian & Avedisian Sch Med, Boston Med Ctr, Dept Med,Sect Cardiovasc Med, Boston, MA 02215 USA
[8] Stanford Univ, Amyloidosis Program, Stanford, CA USA
关键词
light-chain (AL) amyloidosis; cardiomyopathy; F-18-florbetapir; adverse outcomes; positron emission tomography (PET); mediation analysis; POSITRON-EMISSION-TOMOGRAPHY; CARDIAC AMYLOIDOSIS; QUANTIFICATION; DYSFUNCTION; PET;
D O I
10.1016/j.jcmg.2024.05.002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Positron emission tomography/computed tomography (PET/CT) with F-18-florbetapir, a novel amyloid-targeting radiotracer, can quantify left ventricular (LV) amyloid burden in systemic light-chain (AL) amyloidosis. However, its prognostic value is not known. OBJECTIVES The authors' aim was to evaluate the prognostic value of LV amyloid burden quantified by F-18-florbetapir PET/CT, and to identify mechanistic pathways mediating its association with outcomes. METHODS A total of 81 participants with newly diagnosed AL amyloidosis underwent F-18-florbetapir PET/CT imaging. Amyloid burden was quantified using F-18-florbetapir LV uptake as percent injected dose. The Mayo stage for AL amyloidosis was determined using troponin T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and free light chain levels. Major adverse cardiac events (MACE) were defined as all-cause death, heart failure hospitalization, or cardiac transplantation within 12 months. RESULTS Among participants (median age, 61 years; 57% males), 36% experienced MACE, increasing from 7% to 63% across tertiles of LV amyloid burden (P < 0.001). LV amyloid burden was associated with MACE (HR: 1.46; 95% CI: 1.16-1.83; P = 0.001). However, this association became nonsignificant when adjusted for Mayo stage. In mediation analysis, the association between LV amyloid burden and MACE was mediated by NT-proBNP (P < 0.001), a marker of cardiomyocyte stretch and heart failure, and a component of Mayo stage. CONCLUSIONS In this first study to link cardiac F-18-florbetapir uptake to subsequent outcomes, LV amyloid burden estimated by percent injected dose predicted MACE in AL amyloidosis. This effect was not independent of Mayo stage and was mediated primarily through NT-proBNP. These findings provide novel insights into the mechanism linking myocardial amyloid deposits to MACE. (c) 2024 by the American College of Cardiology Foundation.
引用
收藏
页码:911 / 922
页数:12
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