Tools to Diagnose | Nuclear Scintigraphy | Diagnostic Algorithm
DISCOVER THE TOOLS TO DIAGNOSE ATTR-CM See how nuclear scintigraphy, endomyocardial biopsy (EMB), and genetic testing can be used to reach an ATTR-CM diagnosis. *Should be combined with blood and urine testing to rule out AL.1,2 Nuclear Scintigraphy
|
A DIAGNOSTIC ALGORITHM FOR PATIENTS WITH SUSPECTED ATTR-CM1
This proposed algorithm is based on using the visual grading system with nuclear scintigraphy1:

Flow chart for the diagnosis of cardiac amyloidosis. aserum-free light chain assay, serum/urine immunofixation. bPerugini grade 1 or 2 with or w/o positive AL amyloidosis screening, grade 3 with positive AL amyloidosis screening. HFpEF heart failure with preserved ejection fraction, AF atrial fibrillation, SVT supraventricular tachycardia, LVH left ventricular hypertrophy, HCM hypertrophic cardiomyopathy, AS aortic stenosis, ECG electrocardiogram, CMR cardiac magnetic resonance, AL amyloid light chain, ATTR amyloid transthyretin, EMB endomyocardial biopsy, IHC immunohistochemistry, MS mass spectrometry, AA amyloid serum A protein, AApoA1 amyloid apolipoprotein A1, MGUS monoclonal gammopathy of unknown significance, TTR transthyretin
Reproduced from Oerlemans MIFJ, Rutten KHG, Minnema MC, Raymakers RAP, Asselbergs FW, de Jonge N. Cardiac amyloidosis: the need for early diagnosis. Neth Heart J. 2019;27(11):525-536. doi: 10.1007/s12471-019-1299-1, under Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).
PREVIOUS SECTION: SUSPECT ATTR-CM
References:
- Gillmore JD, Maurer MS, Falk RH, et al. Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation. 2016;133(24):2404-2412.
- Brunjes DL, Castano A, Clemons A, Rubin J, Maurer MS. Transthyretin cardiac amyloidosis in older Americans. J Card Fail. 2016;22(12):996-1003.
- Narotsky DL, Castaño A, Weinsaft JW, Bokhari S, Maurer MS. Wild-type transthyretin cardiac amyloidosis: novel insights from advanced imaging. Can J Cardiol. 2016;32(9):1166.e1-1166.e10.
- Maurer MS, Elliott P, Comenzo R, Semigran M, Rapezzi C. Addressing common questions encountered in the diagnosis and management of cardiac amyloidosis. Circulation. 2017;135(14):1357-1377.
- American Society of Nuclear Cardiology (ASNC). ASNC practice points: 99mTechnetium-pyrophosphate imaging for transthyretin cardiac amyloidosis. Available at:
https://www.asnc.org/files/19110 ASNC Amyloid Practice Points WEB(2).pdf. © 2019 American Society of Nuclear Cardiology. - Benson MD, Buxbaum JN, Eisenberg DS, et al. Amyloid nomenclature 2018: recommendations by the International Society of Amyloidosis (ISA) nomenclature committee. Amyloid. 2018;25(4):215-219.
PP-RDP-IRL-0111 Date of Preparation February 2021