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Delbarre MA, Girardon F, Roquette L, Blanc-Durand P, Hubaut MA, Hachulla É, Semah F, Huglo D, Garcelon N, Marchal E, El Esper I, Tribouilloy C, Lamblin N, Duhaut P, Schmidt J, Itti E, Damy T. Deep Learning on Bone Scintigraphy to Detect Abnormal Cardiac Uptake at Risk of Cardiac Amyloidosis. JACC Cardiovasc Imaging 2023; 16:1085-1095. [PMID: 37227330 DOI: 10.1016/j.jcmg.2023.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 12/09/2022] [Accepted: 01/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cardiac uptake on technetium-99m whole-body scintigraphy (WBS) is almost pathognomonic of transthyretin cardiac amyloidosis. The rare false positives are often related to light-chain cardiac amyloidosis. However, this scintigraphic feature remains largely unknown, leading to misdiagnosis despite characteristic images. A retrospective review of all WBSs in a hospital database to detect those with cardiac uptake may allow the identification of undiagnosed patients. OBJECTIVES The authors sought to develop and validate a deep learning-based model that automatically detects significant cardiac uptake (Perugini grade ≥2) on WBS from large hospital databases in order to retrieve patients at risk of cardiac amyloidosis. METHODS The model is based on a convolutional neural network with image-level labels. The performance evaluation was performed with C-statistics using a 5-fold cross-validation scheme stratified so that the proportion of positive and negative WBSs remained constant across folds and using an external validation data set. RESULTS The training data set consisted of 3,048 images: 281 positives (Perugini grade ≥2) and 2,767 negatives. The external validation data set consisted of 1,633 images: 102 positives and 1,531 negatives. The performance of the 5-fold cross-validation and external validation was as follows: 98.9% (± 1.0) and 96.1% for sensitivity, 99.5% (± 0.4) and 99.5% for specificity, and 0.999 (SD = 0.000) and 0.999 for the area under the curve of the receiver-operating characteristic curves. Sex, age <90 years, body mass index, injection-acquisition delay, radionuclides, and the indication of WBS only slightly affected performances. CONCLUSIONS The authors' detection model is effective at identifying patients with cardiac uptake Perugini grade ≥2 on WBS and may help in the diagnosis of patients with cardiac amyloidosis.
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Affiliation(s)
- Marc-Antoine Delbarre
- Department of Internal Medicine, Amiens University Hospital, Amiens, France; Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France. https://twitter.com/ma_delbarre
| | | | - Lucien Roquette
- Department of Research and Development, Codoc SAS, Paris, France
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, Henri Mondor University Hospital, Assistance-Publique Hôpitaux de Paris (APHP), Créteil, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de la Recherche Biomédicale (IMRB), Team 8, Université Paris Est Créteil (UPEC), Créteil, France; Institut National de Recherhe en Informatique et en automatique, Epione Team, Sophia Antipolis Epione Team, Sophia Antipolis, France
| | - Marc-Antoine Hubaut
- Department of Nuclear Medicine, Roger Salengro Hospital, Lille University Hospital, Lille, France
| | - Éric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for Rare Systemic Autoimmune Diseases North and North-West of France, Centre Hospitalier et Universitaire (University Hospital Center) Lille, Lille, France; University of Lille, Inserm, U1286 Institute for Translational Research in Inflammation, Lille, France
| | - Franck Semah
- Department of Nuclear Medicine, Roger Salengro Hospital, Lille University Hospital, Lille, France
| | - Damien Huglo
- Department of Nuclear Medicine, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Nicolas Garcelon
- Department of Research and Development, Codoc SAS, Paris, France
| | - Etienne Marchal
- Nuclear Medicine Department, Amiens University Hospital, Amiens, France
| | - Isabelle El Esper
- Nuclear Medicine Department, Amiens University Hospital, Amiens, France
| | - Christophe Tribouilloy
- Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France; Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Nicolas Lamblin
- Department of Cardiology, Cœur-Poumons Institut, Lille University Hospital, Lille, France; Inserm UMR1167, Institut Pasteur of Lille, Lille, France
| | - Pierre Duhaut
- Department of Internal Medicine, Amiens University Hospital, Amiens, France; Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France
| | - Jean Schmidt
- Department of Internal Medicine, Amiens University Hospital, Amiens, France; Research Unit 7517, Mécanisme physiopathologiques et conséquences des calcifications cardiovasculaires (MP3CV), Jules Verne Picardie University, Amiens, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor University Hospital, Assistance-Publique Hôpitaux de Paris (APHP), Créteil, France
| | - Thibaud Damy
- Department of Cardiology, French Referral Center for Cardiac Amyloidosis, Henri Mondor University Hospital, Assistance-Publique Hôpitaux de Paris (APHP), Créteil, France; InsermUnit U955, Clinical Epidemiology and Ageing, Paris-Est Créteil University, Val-de-Marne, Créteil, France. https://twitter.com/ThibaudDamy
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Belfeki N, Ghriss N, Monchi M, Moini C. State of the Art of Cardiac Amyloidosis. Biomedicines 2023; 11:biomedicines11041045. [PMID: 37189662 DOI: 10.3390/biomedicines11041045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Cardiac amyloidosis is defined by extracellular deposition of misfolded proteins in the heart. The most frequent cases of cardiac amyloidosis are caused by transthyretin and light chain amyloidosis. This condition is underdiagnosed, and its incidence has been continuously rising in recent studies because of the aging of the population and the development of noninvasive multimodal diagnostic tools. Amyloid infiltration affects all cardiac tunics and causes heart failure with preserved ejection fraction, aortic stenosis, arrythmia, and conductive disorder. Innovative, specific therapeutic approaches have demonstrated an improvement in affected organs and the global survival of patients. This condition is no longer considered rare and incurable. Thus, better knowledge of the disease is mandatory. This review will provide a digest of the clinical signs and symptoms of cardiac amyloidosis, the diagnostic tools used to confirm the diagnosis, and current symptomatic and etiopathogenic management considerations according to guidelines and recommendations.
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Oghina S, Delbarre MA, Poullot E, Belhadj K, Fanen P, Damy T. [Cardiac amyloidosis: State of art in 2022]. Rev Med Interne 2022; 43:537-544. [PMID: 35870985 DOI: 10.1016/j.revmed.2022.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/17/2022] [Accepted: 04/30/2022] [Indexed: 10/17/2022]
Abstract
The 3 main types of cardiac amyloidosis are linked to two protein precursors: AL amyloidosis secondary to free light chain deposits in the context of monoclonal gammopathy (mainly of undetermined significance or myeloma) and transthyretin amyloidosis (ATTR), comprising wild-type transthyretin amyloidosis (ATTRwt for wild type) and hereditary transthyretin amyloidosis (ATTRv for variant). These diseases are underdiagnosed and highly prevalent in common cardiac phenotypes in recent studies (heart failure with preserved ejection fraction, severe aortic stenosis, hypertrophic cardiomyopathy). Myocardial amyloid infiltration affects all cardiac structures and clinically promotes predominantly heart failure, conductive disorders and cardioembolic events. The search for extracardiac signs makes it possible to arouse diagnostic suspicion. Electrocardiogram, echocardiography and cardiac MRI can suspect cardiac amyloidosis. The diagnostic confirmation follows a simple algorithm including a systematic search for monoclonal gammapathy and a disphosphonate scintigraphy. Histological proof is necessary in case of AL or ATTR amyloidosis with concomitant monoclonal gammopathy in order to initiate specific treatment. Due to the late disease onset in ATTRv, genetic testing must be routine in all cases of ATTR. These diseases are no longer perceived as incurable since recent therapeutic innovations. A better knowledge of the disease is more than ever necessary.
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Affiliation(s)
- S Oghina
- Service de cardiologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France.
| | - M A Delbarre
- Service de cardiologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - E Poullot
- Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Service d'anatomo-pathologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - K Belhadj
- Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Service d'hématologie lymphoïde, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - P Fanen
- Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Service de génétique, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), FHU SENEC, 1, rue Gustave-Eiffel, 94010 Créteil, France
| | - T Damy
- Service de cardiologie, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre de référence national des amyloses cardiaques et réseau amylose Mondor, Filière Cardiogen, Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), 1, rue Gustave-Eiffel, 94010 Créteil, France; Centre Hospitalier Universitaire Henri-Mondor, AP-HP (Assistance Publique-Hôpitaux de Paris), FHU SENEC, 1, rue Gustave-Eiffel, 94010 Créteil, France
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