Abstract Background Transthyretin cardiac amyloidosis (ATTR) has been increasingly recognized in patients with degenerative aortic stenosis (AS). In some reports, the uptake of Tc-99m labeled bone radiotracers in cardiac amyloidosis has been documented. Tc-99m pyrophosphate (PYP) scintigraphy in the absence of evidence of a monoclonal gammopathy was diagnostic for transthyretin cardiac amyloidosis, providing a cost-effective and non-invasive technique with a specificity and positive predictive value of nearly 100%. We sought to determine the prevalence of ATTR as detected by the bone scan tracer among the patients with severe AS requiring surgical valve replacement. Methods We retrospectively analyzed clinical and echocardiographical data for 44 patients with severe AS requiring surgical valve replacement between Jan. 2009 and Dec. 2016. All eligible patients were offered Tc-99m PYP scintigraphy. Retention of Tc-99m PYP in the heart was assessed using both a semiquantitative visual score (range, 0 [no uptake] to 3 [uptake greater than bone]). Positive uptake was defined score 2 and 3. Results Myocardial deposition of Tc-99m PYP (Score 2–3) was identified in 4 of 44 patients (9%), all >70 years and 75% male. Patients with myocardial deposition of the tracer were older (78±8 years vs. 70±12 years), and had more mean interventricular septum thickness (18±3 mm vs. 14±5 mm). Both groups had at least ejection fraction and abnormal global longitudinal strain with no significant difference between groups. Pre-operative serum median NT-pro BNP level was similar between two groups, but post-operative improvement of NT-pro BNP was larger in non-deposition of the tracer group. During the post operative follow-up, survival was significantly worse if patients had amyloid deposition compared with no deposition subjects (25% vs. 7.5%). Conclusion Incidental transthyretin cardiac amyroidosis had a prevelance of 9% among patients undergoing surgical aortic valve replacement and was associated with a poor outcome. Funding Acknowledgement Type of funding source: None
Abstract Introduction; Infective endocarditis (IE) is a rare but serious disease with a wide range of phenotypes and clinical courses. The diagnosis of IE is often difficult and must be comprehensively judged. Case Presentation; We report the case of a 78-year-old woman with back pain and fever of unknown origin, who was transferred to our hospital due to acute radial artery occlusion. We diagnosed purulent spondylitis and IE. The mobile vegetation remained in the anterior mitral valve leaflet after embolism, and the embolism to the central nervous system was relatively mild, so we decided to perform early surgery. Mitral valve replacement was performed because of embolic symptoms without further complications. Conclusions; Early evaluation by echocardiography is required for the prompt diagnosis of IE and its associated high-risk features may benefit from surgical intervention. Early diagnosis of infective endocarditis and surgical intervention are associated with better outcome in patients with large vegetations, recurrent embolisms, and heart failure. While purulent spondylitis is not commonly associated with infective endocarditis, it is important to actively suspect the existence of IE in patients who complain of back pain along with fever. Both physicians and orthopedic surgeons need to recognize IE as a common disease, especially in the elderly society.
The electrocardiogram (ECG) of a 73-year-old, asymptomatic woman showed deep T-wave inversion. The complete workup was negative. Ten years later, she developed takotsubo cardiomyopathy with abnormal ECG again. Isolated deep T-wave inversion might be an aftereffect of takotsubo cardiomyopathy that does not warrant an invasive workup.
