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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2004.09.048 Byline: Alberto Conti (a), Lucia Sammicheli (a), Chiara Gallini (b), Egidio Natalino Costanzo (b), David Antoniucci (c), Giuseppe Barletta (d) Abstract: The aim of the study was to compare head-to-head the performance of exercise tolerance test-stress echocardiography (ex-Echo) and exercise stress-perfusion nuclear imaging (exercise-single-photon emission computed tomography [ex-SPECT]) for the diagnosis of coronary artery disease (CAD) in patients evaluated at the chest pain unit with delay from chest pain (CP) onset. Author Affiliation: (a) Emergency Medicine Department and Chest Pain Unit, Careggi Hospital, Florence, Italy (b) Nuclear Medicine, Department of Images, Careggi Hospital, Florence, Italy (c) Invasive Cardiology I, Department of Heart and Vessels, Careggi Hospital, Florence, Italy (d) Noninvasive Cardiology, Department of Heart and Vessels, Careggi Hospital, Florence, Italy Article History: Received 9 October 2003; Accepted 20 September 2004

Background Full body scintigraphy using bone tracers plays an important role in defining the type of amyloidosis and in diagnosing the heart involvement (cardiac amyloidosis, CA). No study has been conducted to explore lung retention (LR) in CA and its correlation to heart retention (HR).We evaluated LR in patients undergoing 99mTc-HMDP scintigraphy during evaluation for suspected CA. Methods and results We enrolled 93 suspected CA patients. Patients underwent a complete diagnostic work up. After diagnostic process 82 patients resulted affected by certain CA (20 AL and 62 TTR), while 11 subjects showed left ventricular hypertrophy (LVH) not caused by CA. 99mTc-HMDP cardiac uptake was evaluated using the Perugini visual score while the modified Janssen score was used for LR estimation (grade 0 no uptake, grade 1 less than ribs, grade 2 more than ribs). Results 99mTc-HMDP LR was observed in 1/20 AL patient (5%), while 36/62 (58%) TTR patients showed LR with 29 grade 1 (47%) and 7 grade 2 (11%). No LR was observed in patients with LVH and no CA. LR was not evident in patients without HR, present in 1/3 (33%) of the patients with Perugini 1 HR and 11/24 (46%) and 26/36 (72%) of the patients showing respectively a Perugini 2 and a Perugini 3. Conclusion 99mTc-HMDP scintigraphy shows LR in about 60% of TTR subjects, related to the grade of HR. In AL amyloidosis LR is less frequent than in TTR amyloidosis suggesting an aetiological tropism that seems comparable to the already known TTR related cardiac tropism. [ABSTRACT FROM AUTHOR]