Abstract 14585: Diagnostic Sensitivity of Tissue Biopsy in ATTR Cardiac Amyloidosis Diagnosed by Non-Invasive Diagnostic Criteria

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A14585-A14585
• Main Authors: Nishi, Masato, Kyohei, Marume, Hirakawa, Kyoko, Yamamoto, Masahiro, Hanatani, Shinsuke, Takashio, Seiji, Oda, Seitaro, Utsunomiya, Daisuke, Shiraishi, Shinya, Ueda, Mitsuharu, Yamashita, Taro, Izumiya, Yasuhiro, Yamashita, Yasuyuki, Ando, Yukio, Tsujita, Kenichi
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

BackgroundDiagnostic utility of Tc-pyrophosphate (Tc-PYP) scintigraphy in transthyretin (ATTR) cardiac amyloidosis (CA) has been recently established. However, pathological evaluation is still the basis to confirm diagnosis. Precise diagnosis of cardiac amyloidosis requires endomyocardial biopsy to demonstrate amyloid deposition, but this procedure is relatively invasive and cannot be performed routinely. Subcutaneous tissue and gastrointestinal tract biopsy are useful examinations alternative to endomyocardial biopsy. However, the positive ratio of amyloid deposition in these organs is not fully evaluated based on recent non-invasive diagnostic criteria. This study investigated the diagnostic sensitivity of tissue biopsy in ATTR CA patients diagnosed by Tc-PYP scintigraphy.MethodsWe retrospectively evaluated 89 consecutive ATTR CA patients [wild-type (ATTRwt)63, hereditary (hATTR)26] who were diagnosed by positive findings of Tc-PYP scintigraphy (visual score 2 or 3).ResultsA total of 81 patients underwent tissue biopsy at least one organ. Amyloid was detected on Congo red staining of subcutaneous tissue (33/7047%), gastrointestinal tract (35/5167%) and heart (36/36100%), respectively. Among 46 patients who underwent both subcutaneous tissue and gastrointestinal tract biopsy, amyloid was detected at least one specimen in 40/46 (87%). Compared to hATTR CA patients, ATTRwt CA patients had lower positive ratio of subcutaneous tissue (83% vs. 28%) and gastrointestinal tract (80% vs. 61%) biopsy. The diagnostic sensitivity of subcutaneous tissue and gastrointestinal tract biopsy was lower in ATTRwt CA compared to hATTR CA (ATTRwt66%, hATTR89%).ConclusionsNon-invasive diagnostic criteria of ATTR CA had excellent sensitivity of amyloid deposition in heart. The combination of subcutaneous tissue and gastrointestinal tract biopsy improve diagnostic sensitivity. This strategy help to confirm histological diagnosis of cardiac amyloidosis without endomyocardial biopsy.