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Histological analysis of endomyocardial tissue is still the gold standard for the diagnosis of cardiac amyloidosis but has its limitations. Accordingly, there is a need for noninvasive techniques to cardiac amyloidosis diagnostics. Echocardiography and magnetic resonance imaging can show characteristics which may not be very specific for cardiac amyloid. Recently, new opportunities of nuclear imaging in risk stratification and assessment of prognosis for patients with cardiac amyloidosis have appeared. During the last two decades different classes of radiopharmaceuticals have been developed based on compounds tropic to the components of amyloid infiltrates. In this paper we describe the current possibilities and perspectives of nuclear medicine techniques in patients with cardiac amyloidosis, including osteotropic and neurotropic scintigraphy, single-photon and positron emission tomography

About the Authors

V. B. Sergienko
National Medical Research Center of Cardiology
Russian Federation

Vladimir B. Sergienko – MD, PhD, Professor, Head of Nuclear Medicine Department, A.L. Myasnikov Research Institute of Cardiology 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 

S. N. Tereshchenko
National Medical Research Center of Cardiology
Russian Federation

Sergey N. Tereshchenko – MD, PhD, Professor, Head of Department of Myocardial Diseases and Heart Failure, A.L. Myasnikov Research Institute of Cardiology, Deputy General Director 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 

A. A. Ansheles
National Medical Research Center of Cardiology
Russian Federation

Alexey A. Ansheles – MD, PhD, Senior Researcher, Nuclear Medicine Department, A.L. Myasnikov Research Institute of Cardiology 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 

I. V. Zhirov
National Medical Research Center of Cardiology
Russian Federation

Igor V. Zhirov – MD, PhD, Leading Researcher, Department of Myocardial Diseases and Heart Failure, A.L. Myasnikov Research Institute of Cardiology 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 

A. A. Safiullina
National Medical Research Center of Cardiology
Russian Federation

Alfiya A. Safiullina – MD, PhD, Senior Researcher, Department of Myocardial Diseases and Heart Failure, A.L. Myasnikov Research Institute of Cardiology 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 


1. Lachman H., Booth D., Booth S., et al . Misdiagnosis of hereditary amyloidosis as AL (primary) amyloidosis. N Engl J Med. 2002;346:1786-91. doi: 10.1001/archinte.166.17.1805.

2. Shah K.B., Inoue Y., Mehra M.R. Amyloidosis and the heart: a comprehensive review. Arch Intern Med. 2006;166(17):1805-13. doi: 10.1001/archinte.166.17.1805.

3. Chapter 65. The Dilated, Restrictive, and Infiltrative Cardiomyopathies. In: Mann D., Zipes D., Libby P., Bonow R. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Saunders; 2015.

4. Blagova O.V., Nedostup A.V., Sedov V.P.,et al. Clinical masks of amyloidosis with the heart involment: modern diagnostic issues. Russian Journal of Cardiology. 2017;2(142):68-79. (In Russ.) [Благова О.В, Недоступ А.В., Седов В.П., и др. Клинические маски амилоидоза с поражением сердца: особенности диагностики на современном этапе. Российский Кардиологический Журнал. 2017;2(142):68-79]. doi: 10.15829/1560-4071-2017-2-68-79.

5. Zdanova E.A., Rameev V.V., Moiseev S.V., et al. Cardiac amyloidosis. Klinicheskaja Farmakologija i Terapija. 2011;20(5);44-50 (In Russ.) [Жданова Е.А., Рамеев В.В., Моисеев С.В., Козловская Л.В., и др. Амилоидоз сердца. Клиническая Фармакология и Терапия. 2011;20(5);44-50].

6. Vrana J.A., Gamez J.D., Madden B.J., et all. Classification of amyloidosis by laser microdissection and mass spectrometry-based proteomic analysis in clinical biopsy specimens. Blood. 2009;114(24):4957-9. doi: 10.1182/blood-2009-07-230722.

7. Zhao L., Tian Z., Fang Q. Diagnostic accuracy of cardiovascular magnetic resonance for patients with suspected cardiac amyloidosis: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2016;16:129. doi: 10.1186/s12872-016-0311-6.

8. Hazenberg B.P., van Rijswijk M.H., Piers D.A., et al. Diagnostic performance of 123I-labeled serum amyloid P component scintigraphy in patients with amyloidosis. Am J Med. 2006;119(4):e315-24. doi: 10.1016/j.amjmed.2005.08.043.

9. Perugini E., Guidalotti P.L., Salvi F., et al. Noninvasive etiologic diagnosis of cardiac amyloidosis using 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy. J Am Coll Cardiol. 2005;46(6):1076-84. doi: 10.1016/j.jacc.2005.05.073.

10. Rapezzi C., Quarta C.C., Guidalotti P.L., et al. Usefulness and limitations of 99mTc-3,3-diphosphono1,2-propanodicarboxylic acid scintigraphy in the aetiological diagnosis of amyloidotic cardiomyopathy. Eur J Nucl Med Mol Imaging. 2011;38(3):470-8. doi: 10.1007/s00259-010-1642-7.

11. Longhi S., Guidalotti P.L., Quarta C.C., et al. Identification of TTR-related subclinical amyloidosis with 99mTc-DPD scintigraphy. JACC Cardiovasc Imaging. 2014;7(5):531-2. doi: 10.1016/j.jcmg.2014.03.004.

12. Rapezzi C., Quarta C.C., Guidalotti P.L.,et al. Role of (99m)Tc-DPD scintigraphy in diagnosis and prognosis of hereditary transthyretin-related cardiac amyloidosis. JACC Cardiovasc Imaging. 2011;4(6):659-70. doi: 10.1016/j.jcmg.2011.03.016.

13. Hutt D.F., Quigley A.M., Page J., et al. Utility and limitations of 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy in systemic amyloidosis. European Heart Journal Cardiovascular Imaging. 2014;15(11):1289-98. doi: 10.1093/ehjci/jeu107.

14. Glaudemans A.W.J.M., van Rheenen R.W.J., van den Berg M.P., et al. Bone scintigraphy with 99mtechnetiumhydroxymethylene diphosphonate allows early diagnosis of cardiac involvement in patients with transthyretin-derived systemic amyloidosis. Amyloid. 2014;21(1):35-44. doi: 10.3109/13506129.2013.871250.

15. Janssen S., Piers D.A., van Rijswijk M.H., et al. Soft-tissue uptake of 99mTc-diphosphonate and 99mTcpyrophosphate in amyloidosis. Eur J Nucl Med. 1990. 16(8-10): 663-670. doi: 10.1007/bf00998166.

16. Yamamoto Y., Onoguchi M., Haramoto M.,et al. Novel method for quantitative evaluation of cardiac amyloidosis using 201TlCl and 99mTc-PYP SPECT. Ann Nucl Med. 2012;26(8):634-43. doi: 10.1007/s12149-012-0627-y.

17. Bokhari S., Castano A., Pozniakoff T., et al. 99mTc-Pyrophosphate Scintigraphy for Differentiating Light-Chain Cardiac Amyloidosis From the Transthyretin-Related Familial and Senile Cardiac Amyloidoses. Circulation: Cardiovascular Imaging. 2013;6(2):195-201. doi: 10.1161/circimaging. 112.000132.

18. Glaudemans A.W.J.M., Slart R.H.J.A., Noordzij W., et al. Utility of 18F-FDG PET(/CT) in patients with systemic and localized amyloidosis. Eur J Nucl Med Mol Imaging. 2013;40(7):1095-101. doi: 10.1007/s00259-013-2375-1.

19. Antoni G., Lubberink M., Estrada S.,et al. In vivo visualization of amyloid deposits in the heart with 11C-PIB and PET. J Nucl Med. 2013;54(2):213-20. doi: 10.2967/jnumed.111.102053.

20. Dorbala S., Vangala D., Semer J., et al. Imaging cardiac amyloidosis: a pilot study using 18F-florbetapir positron emission tomography. Eur J Nucl Med Mol Imaging. 2014;41(9):1652-62.

21. Furukawa K., Ikeda S.i., Okamura N., et al. Cardiac Positron-Emission Tomography Images With an Amyloid-Specific Tracer in Familial Transthyretin-Related Systemic Amyloidosis. Circulation. 2012;125(3):556-7. doi: 10.1007/s00259-014-2787-6.

22. Falk R.H., Rubinow A., Cohen A.S. Cardiac arrhythmias in systemic amyloidosis: correlation with echocardiographic abnormalities. J Am Coll Cardiol. 1984;3(1):107-13. doi: 10.1016/s07351097(84)80436-2.

23. Sergienko V. B., Ansheles A. A. Radionuclide diagnosis neurotropic radiopharmaceuticals. Moscow: Infra-M; 2014. (In Russ.) [Сергиенко В.Б., Аншелес А.А. Радионуклидная диагностика с нейротропными радиофармпрепаратами. М.: Инфра-М; 2014]. 10.12737/1402.

24. Shvalev V. N., Reutov V. P., Sergienko V. B., et al. Mechanisms of development of cardiavascular diseases in age-related diorders of the nervous system. Kazanskij Medicinskij Zhurnal. 2016;97(4):598606. (In Russ.) [Швалев В.Н., Реутов В.П., Сергиенко В.Б., и др. Механизмы развития кардиологических заболеваний при возрастных нарушениях состояния нервной системы. Казанский Медицинский Журнал. 2016;97(4):598-606].

25. Lishmanov Yu.V., Yefimova, I.Yu., Chernov V.I., et al. Scintigraphy as a tool of diagnosis, prevention and monitoring of cardiac disease treatment. Sibirskij Medicinskij Zhurnal. 2007;22(3):74-7. (In Russ.) [Лишманов Ю.Б., Ефимова И.Ю., Чернов В.И., и др. Сцинтиграфия как инструмент диагностики, прогнозирования и мониторинга лечения болезней сердца. Сибирский Медицинский Журнал. 2007;22(3):74-7].

26. Ansheles A. A., Shigoleva Ya. V., Sergienko I. V., Tereshchenko S. N. SPECT myocardial perfusion and sympathetic innervation in patients with hypertrophic cardiomyopathy. Kardiologicheskij Vestnik. 2016;XI(1):24-33. (In Russ.) [Аншелес А.А., Щиголева Я.В., Сергиенко И.В., Терещенко С.Н. Особенности перфузии и симпатической иннервации миокарда по данным однофотонной эмиссионной компьютерной томографии у пациентов с гипертрофической кардиомиопатией. Кардиологический Вестник. 2016;XI(1):24-33].

27. Ansheles A. A., Sergienko V.B. Standardization of 123I-meta-iodobenzyl guanidine cardiac neurotropic scintigraphy and single-photon emission tomography. Vestnik Rentgenologii i Radiologii. 2016;97(3):173-80. (In Russ.) [Аншелес А.А., Сергиенко В.Б. Вопросы стандартизации метода нейротропной сцинтиграфии и однофотонной эмиссионной томографии миокарда с 123I-мета-йод-бензил-гуанидином. Вестник Рентгенологии и Радиологии. 2016;97(3): 173-80].

28. Jacobson A.F., Lombard J., Banerjee G., Camici P.G. 123I-MIBG Scintigraphy to predict risk for adverse cardiac outcomes in heart failure patients: Design of two prospective multicenter international trials. Journal of Nuclear Cardiology. 2009;16(1):113-21. doi: 10.1007/s12350-008-9008-2.

29. Sergienko V.B., Ansheles A.A. Radionuclide diagnosis in cardiology. In: Chazov E.I., ed. Manual of cardiology. Volume 1. Moscow: Praktika; 2014: 571-612. (In Russ.) [Сергиенко В.Б., Аншелес А.А. Радионуклидная диагностика в кардиологии. В: Чазов Е.И., ред. Руководство по кардиологии. Том 1. Москва: Практика; 2014: 571-612].

30. Ansheles A.A. Specific features of interpretation of myocardial perfusion single-photon emission computed tomography with computed tomographic absorption correction. Vestnik Rentgenologii i Radiologii. 2014;(2):5-20.(In Russ.) [Аншелес А.А. Особенности интерпретации перфузионной однофотонной эмиссионной компьютерной томографии миокарда с компьютерно-томографической коррекцией поглощения. Вестник Рентгенологии и Радиологии. 2014;(2):5-20].

31. Sasano T., Abraham M.R., Chang K.C.,et al. Abnormal sympathetic innervation of viable myocardium and the substrate of ventricular tachycardia after myocardial infarction. J Am Coll Cardiol. 2008;51(23):2266-75. doi: 10.1016/j.jacc.2008.02.062.

32. Sergienko V.B., Ansheles A.A. Tomographic methods in the assessment of myocardial perfusion. Vestnik Rentgenologii i Radiologii. 2010;(3):10-4. (In Russ.) [Сергиенко В.Б., Аншелес А.А. Томографические методы в оценке перфузии миокарда. Вестник Рентгенологии и Радиологии. 2010;(3):10-4].

33. Ansheles A.A., Sergienko V.B. Tomographic Modalities in Myocardial Perfusion Assessment in Ischemic Heart Disease Patients. Radiacionnaja Onkologija i Jadernaja Medicina. 2011;(2):77-83. (In Russ.) [Аншелес А.А., Сергиенко В.Б. Томографические методы оценки перфузии миокарда у больных с ишемической болезнью сердца. Радиационная Онкология и Ядерная Медицина. 2011;(2):77-83].__

34. Ansheles A.A., Martirosyan L.A., Sergienko I.V., Sergienko V.B. New approaches to quantifying early disorders and perfusion inhomogeneity of the myocardium according to the data of single-photon emission computed tomography. Vestnik Rentgenologii i Radiologii. 2015;(5):17-26. (In Russ.) [Аншелес А.А., Мартиросян Л.А., Сергиенко И.В., Сергиенко В.Б. Новые подходы к количественной оценке начальных нарушений и неоднородности перфузии миокарда по данным однофотонной эмиссионной компьютерной томографии. Вестник Рентгенологии и Радиологии. 2015;(5):17-26].

35. Ansheles A.A., Khalikova E.I., Ryzhikova O.A. New method of quantifying myocardial perfusion impairments assessed with single-photon emission computed tomography. Medical Physics. 2016;69(1):46-53. (In Russ.) [Аншелес А.А., Халикова Э.И., Рыжикова О.А. Способ количественной оценки нарушений перфузии миокарда по данным однофотонной эмиссионной компьютерной томографии. Медицинская Физика. 2016;69(1):46-53].

36. Dorbala S., Vangala D., Bruyere J., et al. Coronary Microvascular Dysfunction Is Related to Abnormalities in Myocardial Structure and Function in Cardiac Amyloidosis. JACC: Heart Failure. 2014;2(4):358-67. doi: 10.1016/j.jchf.2014.03.009.

37. Delahaye N., Dinanian S., Slama M.S., et al. Cardiac sympathetic denervation in familial amyloid polyneuropathy assessed by iodine-123 meta-iodobenzyl guanidine scintigraphy and heart rate variability. Eur J Nucl Med Mol Imaging. 1999;26(4):416-24. doi: 10.1007/s002590050406.

38. Delahaye N., Rouzet F., Sarda L., et al. Impact of Liver Transplantation on Cardiac Autonomic Denervation in Familial Amyloid Polyneuropathy. Medicine (Baltimore). 2006;85(4):229-38. doi: 10.1097/

39. Haagsma E.B., Van Gameren I.I., Bijzet J., et al. Familial amyloidotic polyneuropathy: long-term followup of abdominal fat tissue aspirate in patients with and without liver transplantation. Amyloid. 2007;14(3):221-6. doi: 10.1080/13506120701461368.

40. Coutinho M.C.A., Cortez-Dias N., Cantinho G., et al. Reduced Myocardial 123-Iodine Meta-iodobenzyl guanidine Uptake: A Prognostic Marker in Familial Amyloid Polyneuropathy. Circulation: Cardiovascular Imaging. 2013;6(5):627-36. doi: 10.1161/circimaging.112.000367.

41. Hongo M., Urushibata K., Kai R., et al. Iodine-123 meta-iodobenzyl guanidine scintigraphic analysis of myocardial sympathetic innervation in patients with AL (primary) amyloidosis. Am Heart J. 2002;144(1):122-9.

42. Pankova A.N., Zavadovsky K.V.Estimation of Dysfunction of the Hearts's Right Ventricle at Patients with Pulmonary Embolizim by Scintigraphy. Medical Visualization. 2009;(3):24-30. (In Russ.) [Завадовский К.В., Панькова А.Н. Сцинтиграфическая оценка дисфункции правого желудочка сердца у пациентов с тромбоэмболией легочной артерии. Медицинская Визуализация. 2009;(3):24-30].

43. Karamitsos T.D., Piechnik S.K., Banypersad S.M., et al. Noncontrast T1 Mapping for the Diagnosis of Cardiac Amyloidosis. JACC: Cardiovascular Imaging. 2013;6(4):488-97. doi: 10.1016/ j.jcmg.2012.11.013.

44. Di Silvestre D., Brambilla F., Mauri P.L. Multidimensional Protein Identification Technology for DirectTissue Proteomics of Heart. Methods Mol Biol. 2013;1005:25-38. doi: 10.1007/978-1-62703386-2_3.


For citations:

Sergienko V.B., Tereshchenko S.N., Ansheles A.A., Zhirov I.V., Safiullina A.A. NUCLEAR IMAGING IN THE DIAGNOSIS OF CARDIAC AMYLOIDOSIS. Rational Pharmacotherapy in Cardiology. 2018;14(1):94-100. (In Russ.)

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