{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T03:18:33Z","timestamp":1788578313624,"version":"build-2803163510"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","license":[{"start":{"date-parts":[[2024,4,9]],"date-time":"2024-04-09T00:00:00Z","timestamp":1712620800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,4,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The extent of myocardial bone tracer uptake with technetium pyrophosphate, hydroxymethylene diphosphonate, and 3,3-diphosphono-1,2-propanodicarboxylate in transthyretin amyloid cardiomyopathy (ATTR-CM) might reflect cardiac amyloid burden and be associated with outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Consecutive patients with ATTR-CM who underwent diagnostic bone tracer scintigraphy with acquisition of whole-body planar and cardiac single-photon emission computed tomography (SPECT) images from the National Amyloidosis Centre and 4 Italian centers were included. Cardiac uptake was defined according to the Perugini classification: 0=absent cardiac uptake; 1=mild uptake less than bone; 2=moderate uptake equal to bone; and 3=high uptake greater than bone. Extent of right ventricular (RV) uptake was defined as focal (basal segment of the RV free wall only) or diffuse (extending beyond basal segment) on the basis of SPECT imaging. The primary outcome was all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1422 patients with ATTR-CM, RV uptake accompanying left ventricular uptake was identified by SPECT imaging in 100% of cases at diagnosis. Median follow-up in the whole cohort was 34 months (interquartile range, 21 to 50 months), and 494 patients died. By Kaplan-Meier analysis, diffuse RV uptake on SPECT imaging (n=936) was associated with higher all-cause mortality compared with focal (n=486) RV uptake (77.9% versus 22.1%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), whereas Perugini grade was not associated with survival (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.27 in grade 2 versus grade 3). On multivariable analysis, after adjustment for age at diagnosis (hazard ratio [HR], 1.03 [95% CI, 1.02\u20131.04];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), presence of the p.(V142I)\n                      <jats:italic toggle=\"yes\">TTR<\/jats:italic>\n                      variant (HR, 1.42 [95% CI, 1.20\u20131.81];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004), National Amyloidosis Centre stage (each category,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), stroke volume index (HR, 0.99 [95% CI, 0.97\u20130.99];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.043), E\/e\u2019 (HR, 1.02 [95% CI, 1.007\u20131.03];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004), right atrial area index (HR, 1.05 [95% CI, 1.02\u20131.08];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001), and left ventricular global longitudinal strain (HR, 1.06 [95% CI, 1.03\u20131.09];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), diffuse RV uptake on SPECT imaging (HR, 1.60 [95% CI, 1.26\u20132.04];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) remained an independent predictor of all-cause mortality. The prognostic value of diffuse RV uptake was maintained across each National Amyloidosis Centre stage and in both wild-type and hereditary ATTR-CM (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Diffuse RV uptake of bone tracer on SPECT imaging is associated with poor outcomes in patients with ATTR-CM and is an independent prognostic marker at diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.123.066524","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T05:00:31Z","timestamp":1707368431000},"page":"1157-1168","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Clinical and Prognostic Implications of Right Ventricular Uptake on Bone Scintigraphy in Transthyretin Amyloid Cardiomyopathy"],"prefix":"10.1161","volume":"149","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3307-0825","authenticated-orcid":true,"given":"Aldostefano","family":"Porcari","sequence":"first","affiliation":[{"name":"National Amyloidosis Centre, Division of Medicine, University College London, UK (A.P., M.F., D.R., J.G., D.F.H., P.N.H., J.D.G.)."},{"name":"Centre for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina and University of Trieste, Italy (A.P., L.P., M.M., 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