@article {Leejnmt.120.261893, author = {Christopher Lee and Chieh-Ju Chao and Pradyumna Agasthi and Amith Seri and Amar Shere and Lanyu Mi and Lisa Brown and Chance Marostica and Timothy Barry and Ming Yang and Julie Rosenthal and Samuel Unzek and Farouk Mookadam and Reza Arsanjani}, title = {Global and Regional Variations in Transthyretin Cardiac Amyloidosis: A Comparison of Longitudinal Strain and 99mTechnetium Pyrophosphate Imaging}, elocation-id = {jnmt.120.261893}, year = {2021}, doi = {10.2967/jnmt.120.261893}, publisher = {Society of Nuclear Medicine}, abstract = {Background: There is limited data on the head-to-head comparison of 99mTc-pyrophosphate (PYP) and echocardiographic strain imaging in the assessment of transthyretin (TTR) cardiac amyloidosis. Methods: At Mayo Clinic Arizona, patients that had undergone both a 99mTc-PYP scan and transthoracic echocardiogram (TTE) within a 90-day period were retrospectively identified for chart review and strain imaging analysis. Patients were divided into two groups according to their 99mTc-PYP results (PYP+ and PYP -) for the comparison. A standard 17-segment model was used for segmental, regional and global longitudinal strain comparison. A p-value of \<0.05 was deemed as significant. Results: A total of 64 patients were included, the mean age was 75.1 {\textpm} 13.0 years and 57(89.1\%) were male. Comparing the PYP+ to the PYP- group, the left ventricular global longitudinal strain was significantly worse (PYP+ vs. PYP-: -10.5 {\textpm} 2.6 vs. -13.1 {\textpm} 4.1, P = 0.003). PYP+ patients also had worse regional basal strain (-4.6 {\textpm} 2.6 vs. -8.8{\textpm}4.0, p\<0.001) and a trend of worse mid-ventricular strain (-9.6 {\textpm} 4.0 vs. -11.7{\textpm} 4.4, P = 0.07), however, no statistical difference in apical region (-17.6 {\textpm} 4.73 vs. -19.0 {\textpm} 6.46, P = 0.35). This is consistent with an apical sparing pattern shown by the relative apical longitudinal strain index (1.3 {\textpm}0.5 vs. 1.0 {\textpm} 0.3, P = 0.008). Segment to segment analysis demonstrated significant difference in strain between PYP+ and PYP- segments in 4 segments: basal inferior (P = 0.006), basal anterolateral (P = 0.01), apical septal (P = 0.002) and apical inferior (P = 0.001). Left ventricular diastolic dysfunction was significantly different with 17 (77.3\%) patients in group PYP+ versus 15 (36.6\%) in PYP- participants (P = 0.002). Conclusion: Our study suggested that PYP uptake is related to overall worse LV segmental, regional and global longitudinal strain function, as well as diastolic function compared to patients without PYP uptake. This provides important data for clinicians to know the echocardiographic function features related to 99mTc-PYP uptake and can serve as a hypothesis-generating study for future investigators.}, issn = {0091-4916}, URL = {https://tech.snmjournals.org/content/early/2021/12/20/jnmt.120.261893}, eprint = {https://tech.snmjournals.org/content/early/2021/12/20/jnmt.120.261893.full.pdf}, journal = {Journal of Nuclear Medicine Technology} }