Correlation Between Cardiac Images, Biomarkers, and Amyloid Load in Wild‐Type Transthyretin Amyloid Cardiomyopathy

BACKGROUND: Several imaging parameters and biomarkers provide diagnostic and prognostic information for wild‐type transthyretin amyloid cardiomyopathy. However, the relevance of these parameters and their association with cardiac amyloid load requires further substantiation. We aimed to elucidate the association of imaging parameters obtained using (99m)Tc‐labeled pyrophosphate scintigraphy, cardiovascular magnetic resonance imaging, global longitudinal strain (GLS), and cardiac biomarkers with cardiac amyloid load in patients with wild‐type transthyretin amyloid cardiomyopathy. METHODS AND RESULTS: Eighty‐eight patients with wild‐type transthyretin amyloid cardiomyopathy who underwent (99m)Tc‐labeled pyrophosphate scintigraphy and cardiovascular magnetic resonance were retrospectively evaluated. Quantitative cardiac amyloid load was obtained from 61 patients after myocardial biopsy. Correlations were assessed using Pearson’s correlation coefficient applied to medical record data. The mean heart to contralateral ratio, native T1, extracellular volume, and GLS were 1.91±0.36, 1419.4±56.4 ms, 56.5±13.6%, and −9.4±2.5%, respectively. Median high‐sensitivity cardiac troponin T (hs‐cTnT) and BNP (B‐type natriuretic peptide) levels were 0.0478 (0.0334‐0.0691) ng/mL and 213.8 (125.8–392.7) pg/mL, respectively. The mean cardiac amyloid load was 22.9±15.0%. The heart to contralateral ratio correlated significantly with native T1 (r=0.397), extracellular volume (r=0.477), GLS (r=0.363), cardiac amyloid load (r=0.379), and Ln (hs‐cTnT) (r=0.247). Further, cardiac amyloid load correlated significantly with native T1 (r=0.509), extracellular volume (r=0.310), GLS (r=0.446), and Ln (hs‐cTnT) (r=0.354). Compared with BNP, hs‐cTnT levels better correlated with several imaging parameters and cardiac amyloid load. CONCLUSIONS: Increased cardiac amyloid load correlated with increased (99m)Tc‐labeled pyrophosphate positivity, native T1, extracellular volume, and hs‐cTnT levels, and an impaired GLS, suggesting that imaging parameters and cardiac biomarkers may reflect histological and functional changes attributable to amyloid deposition in the myocardium.