{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T03:23:28Z","timestamp":1777087408520,"version":"3.51.4"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"NIH NCATS","award":["KL2TR002552"],"award-info":[{"award-number":["KL2TR002552"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Cardiovasc Imaging"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Transthyretin (ATTR) amyloidosis is a debilitating systemic disease often associated with symptomatic cardiac involvement. Diagnosis has dramatically changed with the advent of Technetium-99\u00a0m pyrophosphate (Tc-PYP) single-photon emission computed tomography (SPECT). With the ability to diagnose ATTR amyloidosis noninvasively and offer newer therapies, it is increasingly important to identify which patients should be referred for this testing. Relative apical sparing of longitudinal strain on echocardiogram can be potentially used to screen such patients. We sought to describe electrocardiogram (ECG) and echocardiogram (TTE) findings, including relative apical sparing of longitudinal strain, in ATTR amyloidosis patients diagnosed non-invasively with <jats:sup>99m<\/jats:sup>Tc-PYP imaging. This was a single-center, retrospective study with 64 patients who underwent <jats:sup>99m<\/jats:sup>Tc-PYP imaging between June 2016 and February 2019. Relative apical longitudinal strain was calculated from left ventricular longitudinal strain (LV LS) values. No ECG parameters were meaningfully associated with of <jats:sup>99\u00a0m<\/jats:sup> Tc-PYP positive patients. LV mass index (p\u2009=\u20090.001), IVSd (p\u2009&lt;\u20090.001), and LVPWd (&lt;\u20090.001) demonstrated a highly significant difference between positive and negative <jats:sup>99m<\/jats:sup>Tc-PYP groups. <jats:sup>99m<\/jats:sup>Tc-PYP positive patients had a higher relative apical sparing of LV LS (p\u2009&lt;\u20090.001), and notably, no <jats:sup>99m<\/jats:sup>Tc-PYP negative patient had a ratio\u2009&gt;\u20091.0. The finding of relative apical sparing of longitudinal strain can reliably guide clinicians in triaging which patients to consider ordering <jats:sup>99m<\/jats:sup>Tc-PYP imaging for the noninvasive diagnosis of wild type cardiac amyloidosis. A patient with clinically suggestive features and an LV LS relative apical sparing ratio\u2009&gt;\u20090.8 can be considered for <jats:sup>99m<\/jats:sup>Tc-PYP imaging to evaluate for ATTR cardiac amyloidosis.<\/jats:p>","DOI":"10.1007\/s10554-022-02692-y","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T10:04:04Z","timestamp":1657879444000},"page":"201-208","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Wild type cardiac amyloidosis: is it time to order a nuclear technetium pyrophosphate SPECT imaging study?"],"prefix":"10.1007","volume":"39","author":[{"given":"Christine P.","family":"Shen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher T.","family":"Vanichsarn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amitabh C.","family":"Pandey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Billick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S.","family":"Rubenson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev C.","family":"Mohan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James Thomas","family":"Heywood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay V.","family":"Srivastava","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"2692_CR1","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1161\/CIRCULATIONAHA.111.078915","volume":"126","author":"FL Ruberg","year":"2012","unstructured":"Ruberg FL, Berk JL (2012) Transthyretin (TTR) cardiac amyloidosis. Circulation 126:1286\u20131300. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.111.078915","journal-title":"Circulation"},{"key":"2692_CR2","doi-asserted-by":"publisher","first-page":"1840","DOI":"10.1161\/CIRCULATIONAHA.113.006242","volume":"129","author":"CC Quarta","year":"2014","unstructured":"Quarta CC, Solomon SD, Uraizee I et al (2014) Left ventricular structure and function in transthyretin-related versus light-chain cardiac amyloidosis. Circulation 129:1840\u20131849. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.113.006242","journal-title":"Circulation"},{"key":"2692_CR3","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1056\/NEJMoa1805689","volume":"379","author":"MS Maurer","year":"2018","unstructured":"Maurer MS, Schwartz JH, Gundapaneni B et al (2018) Tafamidis treatment for patients with transthyretin amyloid cardiomyopathy. N Engl J Med 379:1007\u20131016. https:\/\/doi.org\/10.1056\/NEJMoa1805689","journal-title":"N Engl J Med"},{"key":"2692_CR4","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1161\/CIRCULATIONAHA.115.018852","volume":"133","author":"LH Connors","year":"2016","unstructured":"Connors LH, Sam F, Skinner M et al (2016) Heart failure resulting from age-related cardiac amyloid disease associated with wild-type transthyretin: a prospective, observational cohort study. Circulation 133:282\u2013290. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.115.018852","journal-title":"Circulation"},{"key":"2692_CR5","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000098","volume":"2","author":"JH Pinney","year":"2013","unstructured":"Pinney JH, Whelan CJ, Petrie A et al (2013) Senile systemic amyloidosis: clinical features at presentation and outcome. J Am Heart Assoc 2:e000098. https:\/\/doi.org\/10.1161\/JAHA.113.000098","journal-title":"J Am Heart Assoc"},{"key":"2692_CR6","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/s40119-019-0142-5","volume":"8","author":"I Winburn","year":"2019","unstructured":"Winburn I, Ishii T, Sumikawa T et al (2019) Estimating the prevalence of transthyretin amyloid cardiomyopathy in a large in-hospital database in Japan. Cardiol Ther 8:297\u2013316. https:\/\/doi.org\/10.1007\/s40119-019-0142-5","journal-title":"Cardiol Ther"},{"key":"2692_CR7","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1080\/07853890701842988","volume":"40","author":"M Tanskanen","year":"2008","unstructured":"Tanskanen M, Peuralinna T, Polvikoski T et al (2008) Senile systemic amyloidosis affects 25% of the very aged and associates with genetic variation in alpha2-macroglobulin and tau: a population-based autopsy study. Ann Med 40:232\u2013239. https:\/\/doi.org\/10.1080\/07853890701842988","journal-title":"Ann Med"},{"key":"2692_CR8","doi-asserted-by":"publisher","first-page":"2404","DOI":"10.1161\/CIRCULATIONAHA.116.021612","volume":"133","author":"JD Gillmore","year":"2016","unstructured":"Gillmore JD, Maurer MS, Falk RH et al (2016) Nonbiopsy diagnosis of cardiac transthyretin amyloidosis. Circulation 133:2404\u20132412. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.116.021612","journal-title":"Circulation"},{"key":"2692_CR9","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1016\/j.acvd.2013.06.051","volume":"106","author":"D Mohty","year":"2013","unstructured":"Mohty D, Damy T, Cosnay P et al (2013) Cardiac amyloidosis: updates in diagnosis and management. Arch Cardiovasc Dis 106:528\u2013540. https:\/\/doi.org\/10.1016\/j.acvd.2013.06.051","journal-title":"Arch Cardiovasc Dis"},{"issue":"Suppl 1","key":"2692_CR10","first-page":"42","volume":"18","author":"V Papantoniou","year":"2015","unstructured":"Papantoniou V, Valsamaki P, Kastritis S et al (2015) Imaging of cardiac amyloidosis by (99m)Tc-PYP scintigraphy. Hell J Nucl Med 18(Suppl 1):42\u201350","journal-title":"Hell J Nucl Med"},{"key":"2692_CR11","doi-asserted-by":"publisher","first-page":"2851","DOI":"10.1016\/j.jacc.2020.04.022","volume":"75","author":"M Hanna","year":"2020","unstructured":"Hanna M, Ruberg FL, Maurer MS et al (2020) Cardiac scintigraphy with technetium-99m-labeled bone-seeking tracers for suspected amyloidosis: JACC review topic of the week. J Am Coll Cardiol 75:2851\u20132862. https:\/\/doi.org\/10.1016\/j.jacc.2020.04.022","journal-title":"J Am Coll Cardiol"},{"key":"2692_CR12","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1080\/13506129.2019.1583192","volume":"26","author":"N Ruiz-Negr\u00f3n","year":"2019","unstructured":"Ruiz-Negr\u00f3n N, Nativi-Nicolau J, Maurer MS et al (2019) Cost-effectiveness of technetium pyrophosphate scintigraphy versus heart biopsy for the diagnosis of transthyretin amyloidosis. Amyloid 26:71\u201372. https:\/\/doi.org\/10.1080\/13506129.2019.1583192","journal-title":"Amyloid"},{"key":"2692_CR13","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.119.006075","author":"MS Maurer","year":"2019","unstructured":"Maurer MS, Sabahat B, Thibaud D et al (2019) Expert consensus recommendations for the suspicion and diagnosis of transthyretin cardiac amyloidosis. Circ Heart Fail. https:\/\/doi.org\/10.1161\/CIRCHEARTFAILURE.119.006075","journal-title":"Circ Heart Fail"},{"key":"2692_CR14","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.jchf.2019.04.010","volume":"7","author":"RM Witteles","year":"2019","unstructured":"Witteles RM, Bokhari S, Damy T et al (2019) Screening for transthyretin amyloid cardiomyopathy in everyday practice. J Am Coll Cardiol HF 7:709\u2013716. https:\/\/doi.org\/10.1016\/j.jchf.2019.04.010","journal-title":"J Am Coll Cardiol HF"},{"key":"2692_CR15","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1136\/heartjnl-2012-302353","volume":"98","author":"D Phelan","year":"2012","unstructured":"Phelan D, Collier P, Thavendiranathan P et al (2012) Relative apical sparing of longitudinal strain using two-dimensional speckle-tracking echocardiography is both sensitive and specific for the diagnosis of cardiac amyloidosis. Heart 98:1442\u20131448. https:\/\/doi.org\/10.1136\/heartjnl-2012-302353","journal-title":"Heart"},{"key":"2692_CR16","doi-asserted-by":"publisher","first-page":"2065","DOI":"10.1007\/s12350-019-01760-6","volume":"26","author":"S Dorbala","year":"2019","unstructured":"Dorbala S, Ando Y, Bokhari S et al (2019) ASNC\/AHA\/ASE\/EANM\/HFSA\/ISA\/SCMR\/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: Part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol 26:2065\u20132123. https:\/\/doi.org\/10.1007\/s12350-019-01760-6","journal-title":"J Nucl Cardiol"},{"key":"2692_CR17","unstructured":"ASNC Practice Points. https:\/\/www.asnc.org\/content.asp?contentid=182. Accessed 23 Jan 2021"},{"key":"2692_CR18","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.1093\/eurheartj\/ehv338","volume":"36","author":"E Gonz\u00e1lez-L\u00f3pez","year":"2015","unstructured":"Gonz\u00e1lez-L\u00f3pez E, Gallego-Delgado M, Guzzo-Merello G et al (2015) Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J 36:2585\u20132594. https:\/\/doi.org\/10.1093\/eurheartj\/ehv338","journal-title":"Eur Heart J"},{"key":"2692_CR19","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1016\/j.jjcc.2015.11.004","volume":"68","author":"L Zhao","year":"2016","unstructured":"Zhao L, Li J, Tian Z, Fang Q (2016) Clinical correlates and prognostic values of pseudoinfarction in cardiac light-chain amyloidosis. J Cardiol 68:426\u2013430. https:\/\/doi.org\/10.1016\/j.jjcc.2015.11.004","journal-title":"J Cardiol"},{"key":"2692_CR20","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2015-000289","volume":"3","author":"T Damy","year":"2016","unstructured":"Damy T, Maurer MS, Rapezzi C et al (2016) Clinical, ECG and echocardiographic clues to the diagnosis of TTR-related cardiomyopathy. Open Heart 3:e000289. https:\/\/doi.org\/10.1136\/openhrt-2015-000289","journal-title":"Open Heart"},{"key":"2692_CR21","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1136\/heartjnl-2015-308657","volume":"102","author":"A Senapati","year":"2016","unstructured":"Senapati A, Sperry BW, Grodin JL et al (2016) Prognostic implication of relative regional strain ratio in cardiac amyloidosis. Heart (British Cardiac Society) 102:748\u2013754. https:\/\/doi.org\/10.1136\/heartjnl-2015-308657","journal-title":"Heart (British Cardiac Society)"},{"key":"2692_CR22","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1161\/CIRCULATIONAHA.104.489187","volume":"112","author":"RH Falk","year":"2005","unstructured":"Falk RH (2005) Diagnosis and management of the cardiac amyloidoses. Circulation 112:2047\u20132060. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.104.489187","journal-title":"Circulation"},{"key":"2692_CR23","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1056\/NEJMoa052256","volume":"355","author":"TE Owan","year":"2006","unstructured":"Owan TE, Hodge DO, Herges RM et al (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355:251\u2013259. https:\/\/doi.org\/10.1056\/NEJMoa052256","journal-title":"N Engl J Med"},{"key":"2692_CR24","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1161\/CIRCIMAGING.113.001396","volume":"7","author":"RH Falk","year":"2014","unstructured":"Falk RH, Quarta CC, Dorbala S (2014) How to image cardiac amyloidosis. Circ Cardiovasc Imaging 7:552\u2013562. https:\/\/doi.org\/10.1161\/CIRCIMAGING.113.001396","journal-title":"Circ Cardiovasc Imaging"},{"key":"2692_CR25","doi-asserted-by":"publisher","first-page":"825","DOI":"10.2214\/ajr.179.4.1790825","volume":"179","author":"CR Herman","year":"2002","unstructured":"Herman CR, Gill HK, Eng J, Fajardo LL (2002) Screening for preclinical disease: test and disease characteristics. Am J Roentgenol 179:825\u2013831. https:\/\/doi.org\/10.2214\/ajr.179.4.1790825","journal-title":"Am J Roentgenol"}],"container-title":["The International Journal of Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-022-02692-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10554-022-02692-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-022-02692-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,8]],"date-time":"2023-01-08T05:05:57Z","timestamp":1673154357000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10554-022-02692-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,15]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["2692"],"URL":"https:\/\/doi.org\/10.1007\/s10554-022-02692-y","relation":{},"ISSN":["1875-8312"],"issn-type":[{"value":"1875-8312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,15]]},"assertion":[{"value":"9 May 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This is an observational study. The Institutional Review Board confirmed that no ethical approval is required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}