PT - JOURNAL ARTICLE AU - Christian Nitsche AU - Katharina Mascherbauer AU - Raffaella Calabretta AU - Matthias Koschutnik AU - Carolina Dona AU - Varius Dannenberg AU - Felix Hofer AU - Kseniya Halavina AU - Andreas A. Kammerlander AU - Tatjana Traub-Weidinger AU - Georg Goliasch AU - Christian Hengstenberg AU - Marcus Hacker AU - Julia Mascherbauer TI - Prevalence and Outcomes of Cardiac Amyloidosis in All-Comer Referrals for Bone Scintigraphy AID - 10.2967/jnumed.122.264041 DP - 2022 Dec 01 TA - Journal of Nuclear Medicine PG - 1906--1911 VI - 63 IP - 12 4099 - http://jnm.snmjournals.org/content/63/12/1906.short 4100 - http://jnm.snmjournals.org/content/63/12/1906.full SO - J Nucl Med2022 Dec 01; 63 AB - The prevalence of cardiac amyloidosis (CA) in the general population and associated prognostic implications remain poorly understood. We aimed to identify CA prevalence and outcomes in bone scintigraphy referrals. Methods: Consecutive all-comers undergoing 99mTc-3,3-diphosphono-1,2-propanodicarboxylic-acid (99mTc-DPD) bone scintigraphy between 2010 and 2020 were included. Perugini grade 1 was defined as low-grade uptake and grade 2 or 3 as confirmed CA. All-cause mortality, cardiovascular death, and heart failure hospitalization (HHF) served as endpoints. Results: In total, 17,387 scans from 11,527 subjects (age, 61 ± 16 y; 63.0% women, 73.6% cancer) were analyzed. Prevalence of 99mTc-DPD positivity was 3.3% (n = 376/11,527; grade 1: 1.8%, grade 2 or 3: 1.5%), and was higher among cardiac than noncardiac referrals (18.2% vs. 1.7%). In individuals with more than 1 scan, progression from grade 1 to grade 2 or 3 was observed. Among patients with biopsy-proven CA, the portion of light-chain (AL)-CA was significantly higher in grade 1 than grade 2 or 3 (73.3% vs. 15.4%). After a median of 6 y, clinical event rates were: 29.4% mortality, 2.6% cardiovascular death, and 1.5% HHF, all independently predicted by positive 99mTc-DPD. Overall, adverse outcomes were driven by confirmed CA (vs. grade 0, mortality: adjusted hazard ratio [AHR] 1.46 [95% CI 1.12–1.90]; cardiovascular death: AHR 2.34 [95% CI 1.49–3.68]; HHF: AHR 2.25 [95% CI 1.51–3.37]). One-year mortality was substantially higher in cancer than noncancer patients. Among noncancer patients, also grade 1 had worse outcomes than grade 0 (HHF/death: AHR 1.45 [95% CI 1.01–2.09]), presumably because of longer observation and higher prognostic impact of early infiltration. Conclusion: Positive 99mTc-DPD was identified in a substantial number of consecutive 99mTc-DPD referrals and associated with adverse outcomes.