Cardiac amyloid imaging with 18F-florbetaben positron emission tomography: a pilot study.

Aim: Determine the feasibility of 18F-florbetaben positron emission tomography (PET) in diagnosing cardiac amyloidosis. Methods: 18F-florbetaben PET was performed in 14 subjects: 5 light chain (AL) amyloid, 5 transthyretin (ATTR) amyloid, and 4 control subjects with hypertensive heart disease. Qualitative and quantitative assessments of 18F-florbetaben activity were performed using mean standardized uptake value (SUV) of the left ventricular (LV) myocardium and blood pool, and calculation of target-to-background SUV ratio. Percentage myocardial 18F-forbetaben retention was also calculated as the percentage mean myocardial SUV change between 0−5mins and 15−20mins after radiotracer injection. Global LV longitudinal and right ventricular (RV) free wall longitudinal strain were calculated using 2D speckle tracking echocardiography. Results: Target-to-background SUV ratio and percentage myocardial 18Fforbetaben retention were higher in amyloid patients compared to hypertensive control subjects. A cut-off value of 40% was able to differentiate between cardiac amyloid patients and hypertensive control subjects. Percentage myocardial 18F-forbetaben retention was an independent determinant of both global LV longitudinal and RV free wall longitudinal strain via an inverse curve relationship. Conclusions: 18F-florbetaben PET imaging can accurately identify and differentiate between cardiac amyloidosis and hypertensive heart disease. Percentage myocardial 18F-florbetaben retention was an independent determinant of myocardial dysfunction in cardiac amyloidosis.