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Eur J Heart Fail ; 23(6): 895-905, 2021 06.
Article in English | MEDLINE | ID: covidwho-1206759


Transthyretin amyloid cardiomyopathy (ATTR-CM) is a life-threatening condition with a heterogeneous clinical presentation. The recent availability of treatment for ATTR-CM has stimulated increased awareness of the disease and patient identification. Stratification of patients with ATTR-CM is critical for optimal management and treatment; however, monitoring disease progression is challenging and currently lacks best-practice guidance. In this report, experts with experience in treating amyloidosis and ATTR-CM developed consensus recommendations for monitoring the course of patients with ATTR-CM and proposed meaningful thresholds and frequency for specific parameters. A set of 11 measurable features across three separate domains were evaluated: (i) clinical and functional endpoints, (ii) biomarkers and laboratory markers, and (iii) imaging and electrocardiographic parameters. Experts recommended that one marker from each of the three domains provides the minimum requirements for assessing disease progression. Assessment of cardiac disease status should be part of a multiparametric evaluation in which progression, stability or improvement of other involved systems in transthyretin amyloidosis should also be considered. Additional data from placebo arms of clinical trials and future studies assessing ATTR-CM will help to elucidate, refine and define these and other measurements.

Amyloid Neuropathies, Familial , Cardiomyopathies , Heart Failure , Amyloid Neuropathies, Familial/diagnosis , Cardiomyopathies/diagnosis , Consensus , Humans , Prealbumin/genetics
J Nucl Med ; 61(5): 632-636, 2020 05.
Article in English | MEDLINE | ID: covidwho-27152


Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may remain asymptomatic, leading to under-recognition of the related disease, coronavirus disease, 2019 (COVID-19), and to incidental findings in nuclear imaging procedures performed for standard clinical indications. Here, we report about our local experience in a region with high COVID-19 prevalence and dynamically increasing infection rates. Methods: Within the 8-d period of March 16-24, 2020, hybrid imaging studies of asymptomatic patients who underwent 18F-FDG PET/CT or 131I SPECT/CT for standard oncologic indications at our institution in Brescia, Italy, were analyzed for findings suggestive of COVID-19. The presence, radiologic features, and metabolic activity of interstitial pneumonia were identified, correlated with the subsequent short-term clinical course, and described in a case series. Results: Six of 65 patients (9%) who underwent PET/CT for various malignancies showed unexpected signs of interstitial pneumonia on CT and elevated regional 18F-FDG avidity. Additionally, 1 of 12 patients who received radioiodine for differentiated thyroid carcinoma also showed interstitial pneumonia on SPECT/CT. Five of 7 patients had subsequent proof of COVID-19 by reverse-transcriptase polymerase chain reaction. The remaining 2 patients were not tested immediately but underwent quarantine and careful monitoring. Conclusion: Incidental findings suggestive of COVID-19 may not be infrequent in hybrid imaging of asymptomatic patients in regions with an expansive spread of SARS-CoV-2. Nuclear medicine services should prepare accordingly.

Coronavirus Infections/diagnosis , Incidental Findings , Lung Diseases, Interstitial , Pneumonia, Viral/diagnosis , Positron Emission Tomography Computed Tomography , Aged , Asymptomatic Diseases , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Female , Fluorodeoxyglucose F18 , Humans , Infection Control , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/etiology , Male , Membrane Glycoproteins , Middle Aged , Neoplasms/diagnostic imaging , Nuclear Medicine/trends , Pandemics , Pneumonia, Viral/complications , Prevalence , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed